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Suh CH, Yoo DH, Berrocal Kasay A, Chalouhi El-Khouri E, Cons Molina FF, Shesternya P, Miranda P, Medina-Rodriguez FG, Wiland P, Jeka S, Chavez-Corrales J, Linde T, Hrycaj P, Abello-Banfi M, Hospodarskyy I, Jaworski J, Piotrowski M, Brzosko M, Krogulec M, Shevchuk S, Calvo A, Andersone D, Park W, Shim SC, Lee SJ, Lee SY. Long-Term Efficacy and Safety of Biosimilar CT-P10 Versus Innovator Rituximab in Rheumatoid Arthritis: 48-Week Results from a Randomized Phase III Trial. BioDrugs 2019; 33:79-91. [PMID: 30719632 PMCID: PMC6373391 DOI: 10.1007/s40259-018-00331-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of this study was to investigate long-term clinical outcomes of extended treatment with CT-P10, a rituximab biosimilar, compared with rituximab reference products sourced from the USA and the EU (US-RTX and EU-RTX) in rheumatoid arthritis (RA) for up to 48 weeks. METHODS In this multinational, randomized, double-blind trial, adults with active RA received up to two courses of CT-P10, US-RTX, or EU-RTX alongside methotrexate. Efficacy endpoints included Disease Activity Score 28-joint count (DAS28) and American College of Rheumatology (ACR) response rates. Pharmacokinetics, pharmacodynamics, immunogenicity, and safety were also assessed. RESULTS Of 372 patients randomized to the study drug, 330 (88.7%) completed the second treatment course. Mean change from baseline to week 48 in DAS28-C-reactive protein was comparable in the CT-P10 and combined rituximab (US-RTX and EU-RTX) groups (- 2.7 and - 2.6, respectively). ACR20, ACR50, and ACR70 response rates at week 48 indicated no differences between groups (80.6%, 55.4%, and 31.7% vs. 79.8%, 53.9%, and 33.7% in the CT-P10 and combined rituximab groups, respectively). Similar improvements in the Health Assessment Questionnaire Disability Index and all medical outcomes in the Short Form 36-Item Health Survey, including physical and mental health, were seen in all groups. At week 48, antidrug antibodies were detected in 4.9%, 9.4%, and 8.6% of patients in the CT-P10, US-RTX, and EU-RTX groups, respectively. CT-P10 and rituximab displayed similar pharmacokinetic, pharmacodynamic, and safety profiles. CONCLUSION CT-P10 was similar to EU-RTX and US-RTX in terms of efficacy, pharmacokinetics, pharmacodynamics, immunogenicity, and safety up to week 48. CLINICALTRIALS. GOV IDENTIFIER NCT02149121.
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Affiliation(s)
- Chang-Hee Suh
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Dae Hyun Yoo
- Division of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, Republic of Korea.
| | | | | | | | | | | | | | | | - Slawomir Jeka
- Department of Rheumatology and Connective Tissue Diseases, University Hospital No. 2, Collegium Medicum UMK, Bydgoszcz, Poland
| | | | - Thomas Linde
- MVZ für Rheumatologie und Autoimmundiagnostik, Halle (Salle), Germany
| | - Pawel Hrycaj
- Department of Rheumatology, Koscian Municipal Hospital, Koscian, Poland
| | | | | | | | - Mariusz Piotrowski
- Department of Rheumatology, Medical University of Lublin, Lublin, Poland
| | - Marek Brzosko
- Department of Rheumatology, Internal Diseases and Geriatrics, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | | | - Sergii Shevchuk
- National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Armando Calvo
- Centro de Investigación Clínica Inunoreumatología, Clínica San Felipe, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Won Park
- School of Medicine, Medicine/Rheumatology, IN-HA University, Incheon, Republic of Korea
| | - Seung Cheol Shim
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
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2
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Sha C, Barrans S, Cucco F, Bentley MA, Care MA, Cummin T, Kennedy H, Thompson JS, Uddin R, Worrillow L, Chalkley R, van Hoppe M, Ahmed S, Maishman T, Caddy J, Schuh A, Mamot C, Burton C, Tooze R, Davies A, Du MQ, Johnson PW, Westhead DR. Molecular High-Grade B-Cell Lymphoma: Defining a Poor-Risk Group That Requires Different Approaches to Therapy. J Clin Oncol 2019; 37:202-212. [PMID: 30523719 PMCID: PMC6338391 DOI: 10.1200/jco.18.01314] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Biologic heterogeneity is a feature of diffuse large B-cell lymphoma (DLBCL), and the existence of a subgroup with poor prognosis and phenotypic proximity to Burkitt lymphoma is well known. Conventional cytogenetics identifies some patients with rearrangements of MYC and BCL2 and/or BCL6 (double-hit lymphomas) who are increasingly treated with more intensive chemotherapy, but a more biologically coherent and clinically useful definition of this group is required. PATIENTS AND METHODS We defined a molecular high-grade (MHG) group by applying a gene expression-based classifier to 928 patients with DLBCL from a clinical trial that investigated the addition of bortezomib to standard rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy. The prognostic significance of MHG was compared with existing biomarkers. We performed targeted sequencing of 70 genes in 400 patients and explored molecular pathology using gene expression signature databases. Findings were validated in an independent data set. RESULTS The MHG group comprised 83 patients (9%), with 75 in the cell-of-origin germinal center B-cell-like group. MYC rearranged and double-hit groups were strongly over-represented in MHG but comprised only one half of the total. Gene expression analysis revealed a proliferative phenotype with a relationship to centroblasts. Progression-free survival rate at 36 months after R-CHOP in the MHG group was 37% (95% CI, 24% to 55%) compared with 72% (95% CI, 68% to 77%) for others, and an analysis of treatment effects suggested a possible positive effect of bortezomib. Double-hit lymphomas lacking the MHG signature showed no evidence of worse outcome than other germinal center B-cell-like cases. CONCLUSION MHG defines a biologically coherent high-grade B-cell lymphoma group with distinct molecular features and clinical outcomes that effectively doubles the size of the poor-prognosis, double-hit group. Patients with MHG may benefit from intensified chemotherapy or novel targeted therapies.
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MESH Headings
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Bortezomib/administration & dosage
- Cyclophosphamide/administration & dosage
- Databases, Genetic
- Doxorubicin/administration & dosage
- Female
- Humans
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Neoplasm Grading
- Prednisone/administration & dosage
- Proportional Hazards Models
- Randomized Controlled Trials as Topic
- Retrospective Studies
- Rituximab/administration & dosage
- Transcriptome
- Vincristine/administration & dosage
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Affiliation(s)
- Chulin Sha
- University of Leeds, Leeds, United Kingdom
| | | | | | | | | | - Thomas Cummin
- Cancer Research UK Centre and Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | | | | | | | | | | | | | | | - Tom Maishman
- Cancer Research UK Centre and Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Josh Caddy
- Cancer Research UK Centre and Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Anna Schuh
- University of Oxford, Oxford, United Kingdom
| | - Christoph Mamot
- Cantonal Hospital Aarau, Aarau/Swiss Group for Clinical Cancer Research, Switzerland
| | | | | | - Andrew Davies
- Cancer Research UK Centre and Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Ming-Qing Du
- University of Cambridge, Cambridge, United Kingdom
| | - Peter W.M. Johnson
- Cancer Research UK Centre and Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
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3
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Abstract
Objective Although R-CHOP (rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisone) is a standard therapy for diffuse large B-cell lymphoma (DLBCL), the optimal dose for elderly patients remains unclear. Methods and Patients We retrospectively verified our R-CHOP dose-attenuation system implemented from 2005 for DLBCL patients. Among the 115 DLBCL patients treated during 2001-2010, 33 patients treated during 2001-2005 received R-CHOP doses adjusted according to physicians' decisions (PHY group). Eighty-two patients treated after 2005 received adjusted R-CHOP doses according to a unified dose-attenuation system (UNI group). Patients aged <60, 60-69, 70-79, and ≥80 years received the standard R-CHOP, 100% R-CHO+P (50 mg/m2), 100% R+75% CHO+P (40 mg/m2), and 100% R+50% CHO+P (30 mg/m2), respectively. We compared the responses, survival, and treatment cessation between the PHY and UNI groups. Results The patients' characteristics between both groups were closely comparable. All PHY patients received randomly adjusted R-CHOP doses; 94% of UNI patients received scheduled doses. The complete response rates differed significantly between the UNI (77%) and PHY patients (50%) (p=0.011). The two-year event-free survival rates were 50% and 32% in the UNI and PHY groups, respectively (p=0.0083). The two-year OS rates were 77% and 72% in the UNI and PHY group (p=0.16). Among the patients aged >70 years (n=59) overall survival was shorter in the PHY group (62%) than in the UNI group (72%; p=0.02). The UNI group received higher anti-tumor agent doses than the PHY group. The therapy discontinuation rates were 5% in the UNI group and 24% in the PHY group. Conclusion Carrying out unified dose reduction may improve the efficacy and prognosis among elderly DLBCL patients.
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Affiliation(s)
- Akira Tanimura
- Department of Hematology, Tokyo-Kita Medical Center, Japan
| | - Risen Hirai
- Department of Hematology, Tokyo-Kita Medical Center, Japan
| | - Miki Nakamura
- Division of Hematology, National Center for Global Health and Medicine, Japan
| | | | - Shotaro Hagiwara
- Division of Hematology, National Center for Global Health and Medicine, Japan
- Division of Hematology, Tokyo Women' s Medical University, Japan
| | - Akiyoshi Miwa
- Department of Hematology, Tokyo-Kita Medical Center, Japan
- Division of Hematology, National Center for Global Health and Medicine, Japan
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4
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Murer P, Kiefer JD, Plüss L, Matasci M, Blümich SL, Stringhini M, Neri D. Targeted Delivery of TNF Potentiates the Antibody-Dependent Cell-Mediated Cytotoxicity of an Anti-Melanoma Immunoglobulin. J Invest Dermatol 2018; 139:1339-1348. [PMID: 30543899 DOI: 10.1016/j.jid.2018.11.028] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/01/2018] [Accepted: 11/13/2018] [Indexed: 12/27/2022]
Abstract
The recombinant murine IgG2a antibody TA99, directed against a melanoma antigen, was used to study combination modalities that potentiate antibody-dependent cell cytotoxicity. As previously reported, IgG2a(TA99) was extremely efficacious in preventing the growth of B16 lung metastases. However, the same antibody mediated only minimal tumor growth retardation when used to treat established neoplastic masses. The therapeutic activity of IgG2a(TA99) could be substantially enhanced by co-administration with an antibody-cytokine fusion (TA99-murine tumor necrosis factor [mTNF]), consisting of the TA99 antibody in single-chain variable fragment format fused to murine TNF. This fusion protein efficiently killed endothelial cells in vitro and displayed only minimal activity against B16 melanoma cells. In vivo, TA99-mTNF boosted the influx of natural killer cells and macrophages into B16 melanoma lesions. Therapy studies with two different administration schedules showed that the combination of TA99-mTNF and IgG2a(TA99) was superior to the individual products used as single agents. The combination treatment converted most of the tumor mass into a necrotic lesion, but a vital tumor rim eventually regrew, even when dacarbazine was included in the therapeutic regimen. The treatment modality described in this article may be applicable to the treatment of melanoma patients, given the specificity of the gp75 antigen and its conservation across species.
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MESH Headings
- Animals
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/genetics
- Antibodies, Monoclonal, Murine-Derived/isolation & purification
- Antigens, Neoplasm/immunology
- CHO Cells
- Cell Line, Tumor/transplantation
- Cricetulus
- Drug Administration Schedule
- Drug Screening Assays, Antitumor
- Female
- Humans
- Immunoconjugates/administration & dosage
- Immunoconjugates/genetics
- Immunoconjugates/isolation & purification
- Immunoglobulin G/immunology
- Melanoma, Experimental/drug therapy
- Melanoma, Experimental/immunology
- Melanoma, Experimental/pathology
- Membrane Glycoproteins/immunology
- Mice
- Oxidoreductases/immunology
- Recombinant Fusion Proteins/administration & dosage
- Recombinant Fusion Proteins/genetics
- Recombinant Fusion Proteins/isolation & purification
- Skin Neoplasms/drug therapy
- Skin Neoplasms/immunology
- Skin Neoplasms/pathology
- Tumor Necrosis Factor-alpha/administration & dosage
- Tumor Necrosis Factor-alpha/genetics
- Tumor Necrosis Factor-alpha/isolation & purification
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Affiliation(s)
- Patrizia Murer
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Jonathan D Kiefer
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Louis Plüss
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology, Zurich, Switzerland
| | | | - Sandra L Blümich
- Laboratory for Animal Model Pathology, Institute of Veterinary Pathology, University of Zurich, Zurich, Switzerland
| | - Marco Stringhini
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Dario Neri
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology, Zurich, Switzerland.
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5
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Josephs DH, Nakamura M, Bax HJ, Dodev TS, Muirhead G, Saul L, Karagiannis P, Ilieva KM, Crescioli S, Gazinska P, Woodman N, Lombardelli C, Kareemaghay S, Selkirk C, Lentfer H, Barton C, Canevari S, Figini M, Downes N, Dombrowicz D, Corrigan CJ, Nestle FO, Jones PS, Gould HJ, Blower PJ, Tsoka S, Spicer JF, Karagiannis SN. An immunologically relevant rodent model demonstrates safety of therapy using a tumour-specific IgE. Allergy 2018; 73:2328-2341. [PMID: 29654623 PMCID: PMC6492130 DOI: 10.1111/all.13455] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Designing biologically informative models for assessing the safety of novel agents, especially for cancer immunotherapy, carries substantial challenges. The choice of an in vivo system for studies on IgE antibodies represents a major impediment to their clinical translation, especially with respect to class-specific immunological functions and safety. Fcε receptor expression and structure are different in humans and mice, so that the murine system is not informative when studying human IgE biology. By contrast, FcεRI expression and cellular distribution in rats mirror that of humans. METHODS We are developing MOv18 IgE, a human chimeric antibody recognizing the tumour-associated antigen folate receptor alpha. We created an immunologically congruent surrogate rat model likely to recapitulate human IgE-FcεR interactions and engineered a surrogate rat IgE equivalent to MOv18. Employing this model, we examined in vivo safety and efficacy of antitumour IgE antibodies. RESULTS In immunocompetent rats, rodent IgE restricted growth of syngeneic tumours in the absence of clinical, histopathological or metabolic signs associated with obvious toxicity. No physiological or immunological evidence of a "cytokine storm" or allergic response was seen, even at 50 mg/kg weekly doses. IgE treatment was associated with elevated serum concentrations of TNFα, a mediator previously linked with IgE-mediated antitumour and antiparasitic functions, alongside evidence of substantially elevated tumoural immune cell infiltration and immunological pathway activation in tumour-bearing lungs. CONCLUSION Our findings indicate safety of MOv18 IgE, in conjunction with efficacy and immune activation, supporting the translation of this therapeutic approach to the clinical arena.
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MESH Headings
- Animals
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antibodies, Monoclonal, Murine-Derived/metabolism
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Cell Line, Tumor
- Folate Receptor 1/immunology
- Humans
- Immunoglobulin E/administration & dosage
- Immunoglobulin E/adverse effects
- Immunoglobulin E/immunology
- Immunoglobulin E/therapeutic use
- Immunoglobulin G/immunology
- Immunoglobulin G/metabolism
- Immunotherapy/methods
- Mice
- Models, Animal
- Neoplasms/pathology
- Neoplasms/therapy
- Protein Binding
- Rats
- Receptors, IgE/metabolism
- Statistics, Nonparametric
- Treatment Outcome
- Tumor Necrosis Factor-alpha/blood
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Affiliation(s)
- D. H. Josephs
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesKing's College LondonLondonUK
- School of Cancer & Pharmaceutical SciencesGuy's HospitalKing's College LondonLondonUK
| | - M. Nakamura
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesKing's College LondonLondonUK
| | - H. J. Bax
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesKing's College LondonLondonUK
- School of Cancer & Pharmaceutical SciencesGuy's HospitalKing's College LondonLondonUK
| | - T. S. Dodev
- Randall Centre for Cell and Molecular BiophysicsKing's College LondonLondonUK
| | - G. Muirhead
- Department of InformaticsFaculty of Natural and Mathematical SciencesKing's College LondonLondonUK
| | - L. Saul
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesKing's College LondonLondonUK
- School of Cancer & Pharmaceutical SciencesGuy's HospitalKing's College LondonLondonUK
| | - P. Karagiannis
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesKing's College LondonLondonUK
- School of Cancer & Pharmaceutical SciencesGuy's HospitalKing's College LondonLondonUK
| | - K. M. Ilieva
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesKing's College LondonLondonUK
- Breast Cancer Now Research UnitSchool of Cancer & Pharmaceutical SciencesGuy's Cancer CentreKing's College LondonLondonUK
| | - S. Crescioli
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesKing's College LondonLondonUK
| | - P. Gazinska
- Breast Cancer Now Research UnitSchool of Cancer & Pharmaceutical SciencesGuy's Cancer CentreKing's College LondonLondonUK
- King's Health Partners Cancer BiobankSchool of Cancer & Pharmaceutical SciencesKing's College LondonLondonUK
| | - N. Woodman
- King's Health Partners Cancer BiobankSchool of Cancer & Pharmaceutical SciencesKing's College LondonLondonUK
| | - C. Lombardelli
- King's Health Partners Cancer BiobankSchool of Cancer & Pharmaceutical SciencesKing's College LondonLondonUK
| | - S. Kareemaghay
- King's Health Partners Cancer BiobankSchool of Cancer & Pharmaceutical SciencesKing's College LondonLondonUK
| | - C. Selkirk
- Biotherapeutics Development UnitCancer Research UKSouth MimmsUK
| | - H. Lentfer
- Biotherapeutics Development UnitCancer Research UKSouth MimmsUK
| | - C. Barton
- Centre for Drug DevelopmentCancer Research UKLondonUK
| | - S. Canevari
- Department of Applied Research and Technology DevelopmentFondazione IRCCS Istituto Nazionale dei TumouriMilanItaly
| | - M. Figini
- Department of Applied Research and Technology DevelopmentFondazione IRCCS Istituto Nazionale dei TumouriMilanItaly
| | | | - D. Dombrowicz
- CHU LilleInstitut Pasteur de LilleInsermUniv. LilleLilleFrance
| | - C. J. Corrigan
- Medical Research Council & Asthma UK Centre in Allergic Mechanisms of AsthmaKing's College LondonLondonUK
| | - F. O. Nestle
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesKing's College LondonLondonUK
- Immunology and Inflammation Therapeutic Research AreaSanofi USCambridgeMAUSA
| | - P. S. Jones
- Centre for Drug DevelopmentCancer Research UKLondonUK
| | - H. J. Gould
- Randall Centre for Cell and Molecular BiophysicsKing's College LondonLondonUK
| | - P. J. Blower
- Imaging Chemistry & BiologyDivision of Imaging Sciences and Biomedical EngineeringSt. Thomas's HospitalKing's College LondonLondonUK
| | - S. Tsoka
- Department of InformaticsFaculty of Natural and Mathematical SciencesKing's College LondonLondonUK
| | - J. F. Spicer
- School of Cancer & Pharmaceutical SciencesGuy's HospitalKing's College LondonLondonUK
| | - S. N. Karagiannis
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesKing's College LondonLondonUK
- Breast Cancer Now Research UnitSchool of Cancer & Pharmaceutical SciencesGuy's Cancer CentreKing's College LondonLondonUK
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6
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Cho MC, Chung Y, Jang S, Park CJ, Chi HS, Huh J, Suh C, Shim H. Prognostic impact of germinal center B-cell-like and non-germinal center B-cell-like subtypes of bone marrow involvement in patients with diffuse large B-cell lymphoma treated with R-CHOP. Medicine (Baltimore) 2018; 97:e13046. [PMID: 30407302 PMCID: PMC6250444 DOI: 10.1097/md.0000000000013046] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The prognostic significances of the germinal center B-cell-like (GCB) and non-germinal center B-cell-like (non-GCB) types of diffuse large B-cell lymphoma (DLBCL) have been reported to be different. We analyzed the effect of the cell of origin (COO) of bone marrow (BM) involvement in patients with DLBCL who were treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in a single institute.The subtype of BM involvement was evaluated in 633 patients who were diagnosed with primary DLBCL and had been treated with R-CHOP. BM trephine biopsies were analyzed, and immunohistochemical staining of CD20, CD79a, and CD3 was performed. Additional staining of CD10, Bcl-6, and MUM1 was performed to determine the COO based on a previously reported algorithm.BM involvement was present in 81 patients (12.8%). Among them, 30 patients (37.0%) had GCB-type BM involvement and 51 (63.0%) showed non-GCB-type involvement. Kaplan-Meier survival analysis showed that the non-GCB type had the worst progression-free survival (PFS) and overall survival (OS) (P <.001). In multivariate analysis controlled for the International Prognostic Index (IPI) score, non-GCB type was an independent predictor of PFS (P <.004) and OS (P =.042), whereas GCB type was not a prognostic factor independent of the IPI score.Further prognostication based on the COO of BM involvement is a useful indicator of PFS, independent of IPI score. Accurate staging based on the COO should be included in the examination of BM in DLBCL.
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Affiliation(s)
- Min-Chul Cho
- Department of Laboratory Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital
- Institute of Health Sciences, Gyeonsang National University, Jinju
| | - Yousun Chung
- Department of Laboratory Medicine, Hallym University, College of Medicine, Seoul
| | | | | | | | | | - Cheolwon Suh
- Department of Oncology, University of Ulsan College of Medicine and Asan Medical Center, Seoul
| | - Hyoeun Shim
- Department of Laboratory Medicine, National Cancer Center, Goyang, Republic of Korea
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7
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Castrillo A, Cerdan D, Eguizabal J, Mendoza-Rodriguez A, Rodriguez MF, Zamora T, Sonlleva A, Duarte J. [New case of intradural extramedullary capillary haemangioma]. Rev Neurol 2018; 67:155-156. [PMID: 30039843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
MESH Headings
- Adult
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Arteriovenous Malformations/diagnosis
- Cyclophosphamide/administration & dosage
- Diagnosis, Differential
- Doxorubicin/administration & dosage
- Hemangioma, Capillary/diagnosis
- Hemangioma, Capillary/surgery
- Hemangioma, Cavernous, Central Nervous System/diagnosis
- Humans
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Magnetic Resonance Imaging
- Male
- Neoplasm Recurrence, Local/diagnosis
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/surgery
- Prednisone/administration & dosage
- Remission Induction
- Rituximab
- Spinal Cord Neoplasms/diagnosis
- Spinal Cord Neoplasms/surgery
- Thoracic Vertebrae
- Vincristine/administration & dosage
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Affiliation(s)
- A Castrillo
- Complejo Asistencial de Segovia, Segovia, Espana
| | - D Cerdan
- Complejo Asistencial de Segovia, Segovia, Espana
| | - J Eguizabal
- Complejo Asistencial de Segovia, Segovia, Espana
| | | | | | - T Zamora
- Hospital Rio Hortega de Valladolid, Valladolid, Espana
| | - A Sonlleva
- Centro medico Los Tilos, Segovia, Espana
| | - J Duarte
- Complejo Asistencial de Segovia, Segovia, Espana
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8
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Kamal WSA, Affandi AM, Bhullar A, Kamal WSZ. Relapsed lymphoma mimicking venous ulcer: A case report. Med J Malaysia 2018; 73:253-254. [PMID: 30121690] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Lymphoma presenting with ulceration is not typical. We report a case of relapsed DLBCL in a 73-year-old man presenting with a chronic non-healing leg ulcer. He has underlying varicose veins with recurrent venous ulcers. This patient was diagnosed to have DLBCL six years earlier when he presented with recurrent epistaxis originating from a left nasal cavity nodule. Complete resolution was achieved after eight cycles of R-CHOP and intrathecal methotrexate. For this current problem, this patient was treated with rituximab combined with chemotherapy which resulted in healing of the ulcer.
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Affiliation(s)
- W S A Kamal
- Universiti Teknologi MARA, Faculty of Medicine, Department of Dermatology, Selangor, Malaysia.
| | - A M Affandi
- Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - A Bhullar
- Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - W S Z Kamal
- Hospital Tuanku Fauziah, Pusat Bandar Kangar, Perlis, Malaysia
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9
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Konishi H, Taguchi Y, Yamamoto M, Nukui T, Dougu N, Nakatsuji Y. [A case of neurolymphomatosis presented as cauda equine syndrome accompanied with M-proteinemia]. Rinsho Shinkeigaku 2018; 58:223-228. [PMID: 29607914 DOI: 10.5692/clinicalneurol.cn-001079] [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] [Indexed: 06/08/2023]
Abstract
A 63-year-old man developed a syndrome of cauda equine, with the numbness which is a left lower extremity from the left buttocks, weakness of left leg, and a dysfunction of bladder and bowel. Enhanced MRI revealed the enhancement of lower cauda equine, and a nerve conduction test revealed decreased F-wave persistency in the tibial nerve and increased F-wave latency in the peroneal nerve on the both sides. M-proteinemia was admitted and myeloma was suspected. By a biopsy of a vertebral arch, we diagnosed with diffuse large B-cell lymphoma. We treated with dexamethasone and R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone (prednisolone)), then the symptom was improved. In case of caude equine syndrome with M-proteinemia, a possibility of the malignant lymphoma should also be considered.
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MESH Headings
- Animals
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/administration & dosage
- Doxorubicin/administration & dosage
- Humans
- Immunoglobulin M/blood
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Magnetic Resonance Imaging
- Male
- Marek Disease/complications
- Marek Disease/diagnosis
- Marek Disease/drug therapy
- Marek Disease/pathology
- Middle Aged
- Paraproteinemias/blood
- Paraproteinemias/etiology
- Polyradiculopathy/diagnostic imaging
- Polyradiculopathy/etiology
- Polyradiculopathy/pathology
- Positron-Emission Tomography
- Prednisone/administration & dosage
- Rituximab
- Treatment Outcome
- Vincristine/administration & dosage
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10
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Vari F, Arpon D, Keane C, Hertzberg MS, Talaulikar D, Jain S, Cui Q, Han E, Tobin J, Bird R, Cross D, Hernandez A, Gould C, Birch S, Gandhi MK. Immune evasion via PD-1/PD-L1 on NK cells and monocyte/macrophages is more prominent in Hodgkin lymphoma than DLBCL. Blood 2018; 131:1809-1819. [PMID: 29449276 PMCID: PMC5922274 DOI: 10.1182/blood-2017-07-796342] [Citation(s) in RCA: 211] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 02/09/2018] [Indexed: 12/21/2022] Open
Abstract
Much focus has been on the interaction of programmed cell death ligand 1 (PD-L1) on malignant B cells with programmed cell death 1 (PD-1) on effector T cells in inhibiting antilymphoma immunity. We sought to establish the contribution of natural killer (NK) cells and inhibitory CD163+ monocytes/macrophages in Hodgkin lymphoma (cHL) and diffuse large B-cell lymphoma (DLBCL). Levels of PD-1 on NK cells were elevated in cHL relative to DLBCL. Notably, CD3-CD56hiCD16-ve NK cells had substantially higher PD-1 expression relative to CD3-CD56dimCD16+ cells and were expanded in blood and tissue, more marked in patients with cHL than patients with DLBCL. There was also a raised population of PD-L1-expressing CD163+ monocytes that was more marked in patients with cHL compared with patients with DLBCL. The phenotype of NK cells and monocytes reverted back to normal once therapy (ABVD [doxorubicin 25 mg/m2, bleomycin 10 000 IU/m2, vinblastine 6 mg/m2, dacarbazine 375 mg/m2, all given days 1 and 15, repeated every 28 days] or R-CHOP [rituximab 375 mg/m2, cyclophosphamide 750 mg/m2 IV, doxorubicin 50 mg/m2 IV, vincristine 1.4 mg/m2 (2 mg maximum) IV, prednisone 100 mg/day by mouth days 1-5, pegfilgrastim 6 mg subcutaneously day 4, on a 14-day cycle]) had commenced. Tumor-associated macrophages (TAMs) expressed high levels of PD-L1/PD-L2 within diseased lymph nodes. Consistent with this, CD163/PD-L1/PD-L2 gene expression was also elevated in cHL relative to DLBCL tissues. An in vitro functional model of TAM-like monocytes suppressed activation of PD-1hi NK cells, which was reversed by PD-1 blockade. In line with these findings, depletion of circulating monocytes from the blood of pretherapy patients with cHL and patients with DLBCL enhanced CD3-CD56hiCD16-ve NK-cell activation. We describe a hitherto unrecognized immune evasion strategy mediated via skewing toward an exhausted PD-1-enriched CD3-CD56hiCD16-ve NK-cell phenotype. In addition to direct inhibition of NK cells by the malignant B cell, suppression of NK cells can occur indirectly by PD-L1/PD-L2-expressing TAMs. The mechanism is more prominent in cHL than DLBCL, which may contribute to the clinical sensitivity of cHL to PD-1 blockade.
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MESH Headings
- Adult
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- B7-H1 Antigen/immunology
- Bleomycin/administration & dosage
- Cyclophosphamide/administration & dosage
- Dacarbazine/administration & dosage
- Doxorubicin/administration & dosage
- Female
- Hodgkin Disease/drug therapy
- Hodgkin Disease/immunology
- Hodgkin Disease/pathology
- Humans
- Killer Cells, Natural/immunology
- Killer Cells, Natural/pathology
- Lymph Nodes/immunology
- Lymph Nodes/pathology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Macrophages/immunology
- Macrophages/pathology
- Male
- Models, Immunological
- Monocytes/immunology
- Monocytes/pathology
- Neoplasm Proteins/immunology
- Prednisone/administration & dosage
- Programmed Cell Death 1 Receptor/immunology
- Rituximab
- Tumor Escape
- Vinblastine/administration & dosage
- Vincristine/administration & dosage
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Affiliation(s)
- Frank Vari
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD, Australia
| | - David Arpon
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD, Australia
| | - Colm Keane
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD, Australia
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | | | - Dipti Talaulikar
- Canberra Hospital, Canberra, ACT, Australia
- Australian National University Medical School, Acton, ACT, Australia; and
| | | | - Qingyan Cui
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD, Australia
| | - Erica Han
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD, Australia
| | - Josh Tobin
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD, Australia
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Robert Bird
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Donna Cross
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Annette Hernandez
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Clare Gould
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD, Australia
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Simone Birch
- Department of Pathology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Maher K Gandhi
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD, Australia
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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11
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Pedersen MØ, Gang AO, Brown P, Pedersen M, Knudsen H, Nielsen SL, Poulsen T, Wirenfeldt Klausen T, Høgdall E, Nørgaard P. Real world data on young patients with high-risk diffuse large B-cell lymphoma treated with R-CHOP or R-CHOEP - MYC, BCL2 and BCL6 as prognostic biomarkers. PLoS One 2017; 12:e0186983. [PMID: 29088292 PMCID: PMC5663399 DOI: 10.1371/journal.pone.0186983] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 10/11/2017] [Indexed: 01/01/2023] Open
Abstract
Background Double expression of MYC and BCL2 proteins (DE) and double-hit MYC+BCL2/BCL6 translocations (DH) were established as important biomarkers in patients with diffuse large B-cell lymphoma (DLBCL) by the 2016 revision of the World Health Organization classification of lymphoid neoplasms. Whether this applies to the subgroup of young patients with high risk DLBCL is not known. We previously found that in a uniform retrospective population-based cohort of patients aged 18–60 years with high-risk DLBCL, the addition of etoposide to R-CHOP chemotherapy (R-CHOEP) resulted in improved survival mainly in patients with germinal center B-cell like (GCB) immunophenotype. The aim of this study was to investigate the prognostic and predictive value of DE and DH in this patient cohort. Methods Data on all young Danish patients diagnosed with de novo high-risk DLBCL 2004–2008 and treated with R-CHOP or R-CHOEP were obtained from the Danish Lymphoma database (n = 159). Tumor samples were available from 103 patients. MYC and BCL2 proteins were analyzed with quantitative immunohistochemistry (IHC) using different cut off values. MYC-, BCL2- and BCL6-translocations were examined with fluorescent in situ hybridization (FISH). Results DE with MYC>75% and BCL2>85% was an independent negative prognostic marker of progression free survival (PFS) in patients treated with R-CHOP but not R-CHOEP (p<0.001), also after exclusion of patients with DH. A predictive effect of DE for response (PFS) to R-CHOEP vs. R-CHOP was almost significant (p = 0.07). DH was not prognostic in this patient cohort. Conclusion In young patients with high-risk DLBCL, treatment with R-CHOEP may overcome the negative prognostic impact of DE observed in patients treated with R-CHOP.
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MESH Headings
- Adolescent
- Adult
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Cyclophosphamide/administration & dosage
- Doxorubicin/administration & dosage
- Etoposide/administration & dosage
- Female
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Kaplan-Meier Estimate
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Male
- Middle Aged
- Prednisone/administration & dosage
- Prognosis
- Proto-Oncogene Proteins c-bcl-2/genetics
- Proto-Oncogene Proteins c-bcl-2/metabolism
- Proto-Oncogene Proteins c-bcl-6/genetics
- Proto-Oncogene Proteins c-bcl-6/metabolism
- Proto-Oncogene Proteins c-myc/genetics
- Proto-Oncogene Proteins c-myc/metabolism
- Retrospective Studies
- Risk Factors
- Vincristine/administration & dosage
- Young Adult
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Affiliation(s)
| | - Anne Ortved Gang
- Dept. of Hematology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Peter Brown
- Dept. of Hematology, Rigshospitalet, Copenhagen, Denmark
| | | | - Helle Knudsen
- Dept. of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
| | | | - Tim Poulsen
- Dept. of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
| | | | - Estrid Høgdall
- Dept. of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Peter Nørgaard
- Dept. of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
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12
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Kusano Y, Yokoyama M, Terui Y, Inoue N, Takahashi A, Yamauchi H, Tsuyama N, Nishimura N, Mishima Y, Takeuchi K, Hatake K. High pretreatment level of soluble interleukin-2 receptor is a robust prognostic factor in patients with follicular lymphoma treated with R-CHOP-like therapy. Blood Cancer J 2017; 7:e614. [PMID: 28960192 PMCID: PMC5709758 DOI: 10.1038/bcj.2017.96] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Y Kusano
- Department of Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - M Yokoyama
- Department of Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Y Terui
- Department of Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - N Inoue
- Department of Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - A Takahashi
- Department of Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - H Yamauchi
- Department of Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - N Tsuyama
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - N Nishimura
- Department of Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Y Mishima
- Department of Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - K Takeuchi
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
- Pathological Project for Molecular Target, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - K Hatake
- Department of Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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13
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Lee H, Kim YR, Kim SJ, Park Y, Eom HS, Oh SY, Kim HJ, Kang HJ, Lee WS, Moon JH, Won YW, Kim TS, Kim JS. Clinical outcomes in patients with diffuse large B cell lymphoma with a partial response to first-line R-CHOP chemotherapy: prognostic value of secondary International Prognostic Index scores and Deauville scores. Ann Hematol 2017; 96:1873-1881. [PMID: 28831584 DOI: 10.1007/s00277-017-3107-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 05/07/2017] [Accepted: 08/16/2017] [Indexed: 12/21/2022]
Abstract
After introducing a rituximab-containing chemoimmunotherapy (R-CHOP) for diffuse large B cell lymphoma (DLBCL), a partial response (PR) which is regarded as treatment failure is still observed. To investigate the prognostic factors for the DLBCL patients with a PR to R-CHOP, we retrospectively evaluated 758 newly diagnosed DLBCL patients. After R-CHOP, 88 (11.6%) achieved a PR. Three-year progression-free and overall survival rates measured from the date of PR achievement (PFS2 and OS2) were 57.4 and 67.8%, respectively. The secondary International Prognostic Index (IPI2) scores after R-CHOP were low (0-1) in 68.2% and high (2-3) in 31.8% of the patients. The Deauville scores from 18-fluorodeoxyglucose positron emission tomography after R-CHOP showed low (2-3) in 58.0% and high (4) in 42.0% of the patients. High IPI2 and high Deauville scores were associated with worse PFS2 (P < 0.001 and P = 0.009) and OS2 (P = 0.013 and P = 0.067). The high-risk group defined by the IPI2 and Deauville scores, whose scores were both high, showed significantly lower 3-year PFS2 (P < 0.001) and OS2 (P = 0.006) rates compared with those of the other groups. In multivariate analyses, the IPI score of ≥ 3 at diagnosis and bone marrow involvement at diagnosis were independent prognostic factors. In addition, high IPI2-Deauville score after R-CHOP was significantly associated with poor PFS2 (P = 0.009) and demonstrated a trend toward inferior OS2. In conclusion, DLBCL patients who partially responded to R-CHOP are still a heterogeneous group, for which IPI2 and Deauville scores should be evaluated for prediction of prognosis.
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Affiliation(s)
- Hyewon Lee
- Center for Hematologic Malignancy, National Cancer Center, Goyang, South Korea
| | - Yu Ri Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, South Korea
| | - Soo-Jeong Kim
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Yong Park
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Hyeon-Seok Eom
- Center for Hematologic Malignancy, National Cancer Center, Goyang, South Korea
| | - Sung Yong Oh
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea
| | - Hyo Jung Kim
- Division of Hematology-Oncology, Department of Internal Medicine, College of Medicine, Hallym University, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Hye Jin Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Won-Sik Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Joon Ho Moon
- Department of Hematology and Medical Oncology, Kyungpook National University Hospital, Daegu, South Korea
| | - Young-Woong Won
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Tae-Sung Kim
- Department of Nuclear Medicine, National Cancer Center, Goyang, South Korea
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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14
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Kimura Y, Takeuchi M, Matsue K. Tubulointerstitial capillaries limited intravascular lymphoma of the kidney. Int J Hematol 2017; 106:589-590. [PMID: 28755205 DOI: 10.1007/s12185-017-2304-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/08/2017] [Accepted: 07/14/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Yuya Kimura
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan.
| | - Masami Takeuchi
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan
| | - Kosei Matsue
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan
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15
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Kühnl A, Cunningham D, Counsell N, Hawkes EA, Qian W, Smith P, Chadwick N, Lawrie A, Mouncey P, Jack A, Pocock C, Ardeshna KM, Radford J, McMillan A, Davies J, Turner D, Kruger A, Johnson PW, Gambell J, Rosenwald A, Ott G, Horn H, Ziepert M, Pfreundschuh M, Linch D. Outcome of elderly patients with diffuse large B-cell lymphoma treated with R-CHOP: results from the UK NCRI R-CHOP14v21 trial with combined analysis of molecular characteristics with the DSHNHL RICOVER-60 trial. Ann Oncol 2017; 28:1540-1546. [PMID: 28398499 PMCID: PMC5815562 DOI: 10.1093/annonc/mdx128] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is an on-going debate whether 2- or 3-weekly administration of R-CHOP is the preferred first-line treatment for elderly patients with diffuse large B-cell lymphoma (DLBCL). The UK NCRI R-CHOP14v21 randomized phase 3 trial did not demonstrate a difference in outcomes between R-CHOP-14 and R-CHOP-21 in newly diagnosed DLBCL patients aged 19-88 years, but data on elderly patients have not been reported in detail so far. Here, we provide a subgroup analysis of patients ≥60 years treated on the R-CHOP14v21 trial with extended follow-up. PATIENTS AND METHODS Six hundred and four R-CHOP14v21 patients ≥60 years were included in this subgroup analysis, with a median follow-up of 77.7 months. To assess the impact of MYC rearrangements (MYC-R) and double-hit-lymphoma (DHL) on outcome in elderly patients, we performed a joint analysis of cases with available molecular data from the R-CHOP14v21 (N = 217) and RICOVER-60 (N = 204) trials. RESULTS Elderly DLBCL patients received high dose intensities with median total doses of ≥98% for all agents. Toxicities were similar in both arms with the exception of more grade ≥3 neutropenia (P < 0.0001) and fewer grade ≥3 thrombocytopenia (P = 0.05) in R-CHOP-21 versus R-CHOP-14. The elderly patient population had a favorable 5-year overall survival (OS) of 69% (95% CI: 65-73). We did not identify any subgroup of patients that showed differential response to either regimen. In multivariable analysis including individual factors of the IPI, gender, bulk, B2M and albumin levels, only age and B2M were of independent prognostic significance for OS. Molecular analyses demonstrated a significant impact of MYC-R (HR = 1.96; 95% CI: 1.22-3.16; P = 0.01) and DHL (HR = 2.21; 95% CI: 1.18-4.11; P = 0.01) on OS in the combined trial cohorts, independent of other prognostic factors. CONCLUSIONS Our data support equivalence of both R-CHOP application forms in elderly DLBCL patients. Elderly MYC-R and DHL patients have inferior prognosis and should be considered for alternative treatment approaches. TRIAL NUMBERS ISCRTN 16017947 (R-CHOP14v21); NCT00052936 (RICOVER-60).
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MESH Headings
- Age Factors
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Biomarkers, Tumor/genetics
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/adverse effects
- Doxorubicin/administration & dosage
- Doxorubicin/adverse effects
- Drug Administration Schedule
- Female
- Gene Rearrangement
- Humans
- Kaplan-Meier Estimate
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Multivariate Analysis
- Patient Selection
- Precision Medicine
- Prednisone/administration & dosage
- Prednisone/adverse effects
- Proto-Oncogene Proteins c-bcl-2/genetics
- Proto-Oncogene Proteins c-bcl-6/genetics
- Proto-Oncogene Proteins c-myc/genetics
- Risk Factors
- Rituximab
- Time Factors
- Treatment Outcome
- United Kingdom
- Vincristine/administration & dosage
- Vincristine/adverse effects
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Affiliation(s)
- A. Kühnl
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - D. Cunningham
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - N. Counsell
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - E. A. Hawkes
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
- Olivia-Newton John Cancer Research & Wellness Centre, Melbourne, Australia
| | - W. Qian
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - P. Smith
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - N. Chadwick
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - A. Lawrie
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - P. Mouncey
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - A. Jack
- HMDS, St James’s Institute of Oncology, Leeds
| | | | - K. M. Ardeshna
- Department of Hematology, University College London, London
- Mount Vernon Cancer Centre, Northwood
| | - J. Radford
- Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester
| | - A. McMillan
- Department of Hematology, Nottingham City Hospital, Nottingham
| | | | - D. Turner
- Department of Hematology, Torbay Hospital, Torquay
| | | | - P. W. Johnson
- Cancer Research UK Center, University of Southampton, Southampton, UK
| | - J. Gambell
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - A. Rosenwald
- Institute of Pathology, Würzburg University, Würzburg
| | - G. Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart
| | - H. Horn
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tübingen, Stuttgart
| | - M. Ziepert
- Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig
| | - M. Pfreundschuh
- Department of Medicine, Saarland University Medical School, Homburg/Saar, Germany
| | - D. Linch
- Department of Hematology, University College London, London
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16
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Kusano Y, Yokoyama M, Terui Y, Nishimura N, Mishima Y, Ueda K, Tsuyama N, Hirofumi Y, Takahashi A, Inoue N, Takeuchi K, Hatake K. Low absolute peripheral blood CD4+ T-cell count predicts poor prognosis in R-CHOP-treated patients with diffuse large B-cell lymphoma. Blood Cancer J 2017; 7:e558. [PMID: 28430176 PMCID: PMC5436080 DOI: 10.1038/bcj.2017.37] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/25/2017] [Accepted: 03/29/2017] [Indexed: 12/20/2022] Open
Abstract
The absolute peripheral blood lymphocyte count at diagnosis is known to be a strong prognostic factor in patients with diffuse large B-cell lymphoma (DLBCL) treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP), but it remains unclear as to which peripheral blood lymphocyte population is reflective of DLBCL prognosis. In this cohort, 355 patients with DLBCL treated with R-CHOP from 2006 to 2013 were analyzed. The low absolute CD4+ T-cell count (ACD4C) at diagnosis negatively correlated with the overall response rate and the complete response rate significantly (P<0.00001). An ACD4C<343 × 106/l had a significant negative impact on the 5-year progression-free survival and the overall survival as compared with an ACD4C⩾343 × 106/l (73.7% (95% confidence interval (CI)=66.7-79.5) versus 50.3% (95% CI=39.0-60.6), P<0.00001 and 83.3% (95% CI=77.1-88.0) versus 59.0% (95% CI=47.9-68.5), P<0.00000001, respectively). Multivariate analysis revealed that the ACD4C was an independent prognostic marker (hazard ratio=2.2 (95% CI=1.3-3.7), P<0.01). In conclusion, a low ACD4C at diagnosis served as an independent poor prognostic marker in patients with DLBCL.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- CD4 Lymphocyte Count
- CD4-Positive T-Lymphocytes/drug effects
- CD4-Positive T-Lymphocytes/pathology
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/adverse effects
- Disease-Free Survival
- Doxorubicin/administration & dosage
- Doxorubicin/adverse effects
- Female
- Humans
- Lymphoma, Large B-Cell, Diffuse/blood
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Prednisone/administration & dosage
- Prednisone/adverse effects
- Prognosis
- Rituximab
- Treatment Outcome
- Vincristine/administration & dosage
- Vincristine/adverse effects
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Affiliation(s)
- Y Kusano
- Department of Hematology Oncology, Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - M Yokoyama
- Department of Hematology Oncology, Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Y Terui
- Department of Hematology Oncology, Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - N Nishimura
- Department of Hematology Oncology, Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Y Mishima
- Department of Hematology Oncology, Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - K Ueda
- Department of Hematology Oncology, Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - N Tsuyama
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Y Hirofumi
- Department of Hematology Oncology, Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - A Takahashi
- Department of Hematology Oncology, Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - N Inoue
- Department of Hematology Oncology, Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - K Takeuchi
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
- Pathology Project for Molecular Targets, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - K Hatake
- Department of Hematology Oncology, Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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17
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Miura K, Konishi J, Miyake T, Makita M, Hojo A, Masaki Y, Uno M, Ozaki J, Yoshida C, Niiya D, Kitazume K, Maeda Y, Takizawa J, Sakai R, Yano T, Yamamoto K, Sunami K, Hiramatsu Y, Aoyama K, Tsujimura H, Murakami J, Hatta Y, Kanno M. A Host-Dependent Prognostic Model for Elderly Patients with Diffuse Large B-Cell Lymphoma. Oncologist 2017; 22:554-560. [PMID: 28408622 DOI: 10.1634/theoncologist.2016-0260] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 07/01/2016] [Accepted: 11/29/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Decision-making models for elderly patients with diffuse large B-cell lymphoma (DLBCL) treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) are in great demand. PATIENTS AND METHODS The Society of Lymphoma Treatment in Japan (SoLT-J), in collaboration with the West-Japan Hematology and Oncology Group (West-JHOG), collected and retrospectively analyzed the clinical records of ≥65-year-old patients with DLBCL treated with R-CHOP from 19 sites across Japan to build an algorithm that can stratify adherence to R-CHOP. RESULTS A total of 836 patients with a median age of 74 years (range, 65-96 years) were analyzed. In the SoLT-J cohort (n = 555), age >75 years, serum albumin level <3.7 g/dL, and Charlson Comorbidity Index score ≥3 were independent adverse risk factors and were defined as the Age, Comorbidities, and Albumin (ACA) index. Based on their ACA index score, patients were categorized into "excellent" (0 points), "good" (1 point), "moderate" (2 points), and "poor" (3 points) groups. This grouping effectively discriminated the 3-year overall survival rates, mean relative total doses (or relative dose intensity) of anthracycline and cyclophosphamide, unanticipated R-CHOP discontinuance rates, febrile neutropenia rates, and treatment-related death rates. Additionally, the ACA index showed comparable results for these clinical parameters when it was applied to the West-JHOG cohort (n = 281). CONCLUSION The ACA index has the ability to stratify the prognosis, tolerability to cytotoxic drugs, and adherence to treatment of elderly patients with DLBCL treated with R-CHOP. The Oncologist 2017;22:554-560 IMPLICATIONS FOR PRACTICE: Currently, little is known regarding how to identify elderly patients with diffuse large B-cell lymphoma who may tolerate a full dose of chemotherapy or to what extent cytotoxic drugs should be reduced in some specific conditions. The Society of Lymphoma Treatment in Japan developed a host-dependent prognostic model consisting of higher age (>75 years), hypoalbuminemia (<3.7 g/dL), and higher Charlson Comorbidity Index score (≥3) for such elderly patients. This model can stratify the prognosis, tolerability to cytotoxic drugs, and adherence to treatment of these patients and thus help clinicians in formulating personalized treatment strategies for this growing patient population.
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Affiliation(s)
- Katsuhiro Miura
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Jun Konishi
- Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Takaaki Miyake
- Department of Oncology/Hematology, Shimane University Hospital, Shimane, Japan
| | - Masanori Makita
- Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Atsuko Hojo
- Division of Hematology and Oncology, Kasukabe Medical Center, Saitama, Japan
| | - Yasufumi Masaki
- Department of Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
| | - Masatoshi Uno
- Division of Internal Medicine, Kaneda Hospital, Okayama, Japan
| | - Jun Ozaki
- Department of Hematology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Chikamasa Yoshida
- Department of Hematology, National Hospital Organization Minami-Okayama Medical Center, Okayama, Japan
| | - Daigo Niiya
- Department of Hematology, Okayama Rosai Hospital, Okayama, Japan
| | - Koichi Kitazume
- Department of Hematology, Showa General Hospital, Tokyo, Japan
| | - Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Jun Takizawa
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan
| | - Rika Sakai
- Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Tomofumi Yano
- Department of Hematology, Okayama Rosai Hospital, Okayama, Japan
| | | | - Kazutaka Sunami
- Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Yasushi Hiramatsu
- Department of Hematology and Oncology, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan
| | - Kazutoshi Aoyama
- Department of Hematology, Chugoku Central Hospital, Hiroshima, Japan
| | - Hideki Tsujimura
- Division of Hematology-Oncology, Chiba Cancer Center, Chiba, Japan
| | - Jun Murakami
- The Third Department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yoshihiro Hatta
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Masatoshi Kanno
- Oncology Center, Nara Medical University Hospital, Nara, Japan
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18
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Xu PP, Qian Y, Chen QS, Li LQ, Zhang L, Zhao WL. [Prognostic Significance of Follicular Lymphoma International Prognostic Index 2 (FLIPI2) in Follicular Lymphoma Patients Treated with Rituximab Maintenance]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2017; 25:426-430. [PMID: 28446287 DOI: 10.7534/j.issn.1009-2137.2017.02.021] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the prognostic significance of Follicular Lymphoma International Prognostic Index 2 (FLIPI2) in FL patients treated with rituximab maintenance. METHODS A tatol of 140 newly diagnosed FL patients who received Rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) chemotherapy in our department were retrospectively analyzed from December 2002 to December 2014. Among 140 patients with FL 122 patients achieved response, from them 56 patients received R maintenance (RM) every 2 months for median 8 times (RM group) while the rest 66 patients did not receive further anti-lymphoma treatment (non-RM group). RESULTS There was no statistical difference in age, sex, pathologic grading, staging, FLIPI or FLIPI2 between RM and non-RM groups. The 2-year progression-free survival (PFS) of RM and non-RM groups were 89.7% and 77.6% (P=0.043) while the 2-year overall survival were 100% and 98.6% (P=0.131). FLIPI2 is a significant prognostic model either in the total cohort, RM or non-RM groups (P<0.001 all). In subgroup analysis, RM was able to decrease disease progression in low and intermediate-risk group of FLIPI2, while the 2-year PFS of RM and non-RM groups in high-risk group were similar (55.6% vs 46.9%)(P=0.920). CONCLUSION FLIPI2 presents robust prognostic significance either in RM or OBS patients, the patients in FLIPI2 low and intermediate-risk group may benefite from RM, but the role of RM in high-risk patients should be further to investigate.
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Affiliation(s)
- Peng-Peng Xu
- Department of Hematology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Ying Qian
- Department of Hematology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Qiu-Sheng Chen
- Department of Hematology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Liang-Qun Li
- Department of Hematology, Shanghai Beizhan Hospital, Shanghai 200070, China
| | - Li Zhang
- Department of Hematology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China. E-mail:
| | - Wei-Li Zhao
- Department of Hematology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
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19
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El-Galaly TC, Villa D, Michaelsen TY, Hutchings M, Mikhaeel NG, Savage KJ, Sehn LH, Barrington S, Hansen JW, Smith D, Rady K, Mylam KJ, Larsen TS, Holmberg S, Juul MB, Cordua S, Clausen MR, Jensen KB, Johnsen HE, Seymour JF, Connors JM, de Nully Brown P, Bøgsted M, Cheah CY. The number of extranodal sites assessed by PET/CT scan is a powerful predictor of CNS relapse for patients with diffuse large B-cell lymphoma: An international multicenter study of 1532 patients treated with chemoimmunotherapy. Eur J Cancer 2017; 75:195-203. [PMID: 28237865 DOI: 10.1016/j.ejca.2016.12.029] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [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: 11/30/2016] [Accepted: 12/07/2016] [Indexed: 01/26/2023]
Abstract
PURPOSE Development of secondary central nervous system involvement (SCNS) in patients with diffuse large B-cell lymphoma is associated with poor outcomes. The CNS International Prognostic Index (CNS-IPI) has been proposed for identifying patients at greatest risk, but the optimal model is unknown. METHODS We retrospectively analysed patients with diffuse large B-cell lymphoma diagnosed between 2001 and 2013, staged with PET/CT and treated with R-CHOP(-like) regimens. Baseline clinicopathologic characteristics, treatments, and outcome data were collected from clinical databases and medical files. We evaluated the association between candidate prognostic factors and modelled different risk models for predicting SCNS. RESULTS Of 1532 patients, 62 (4%) subsequently developed SCNS. By multivariate analysis, disease stage III/IV, elevated serum LDH, kidney/adrenal and uterine/testicular involvement were independently associated with SCNS. There was a strong correlation between absolute number of extranodal sites and risk of SCNS; the 144 patients (9%) with >2 extranodal sites had a 3-year cumulative incidence of SCNS of 15.2% (95% confidence interval [CI] 9.2-21.2%) compared with 2.6% (95% CI 1.7-3.5) among those with ≤2 sites (P < 0.001). The 3-year cumulative risks of SCNS for CNS-IPI defined risk groups were 11.2%, 3.1% and 0.4% for high-, intermediate- and low-risk patients, respectively. All risk models analysed had high negative predictive values, but only modest positive predictive values. CONCLUSIONS Patients with >2 extranodal sites or high-risk disease according to the CNS-IPI should be considered for baseline CNS staging. Clinical risk prediction models suffer from limited positive predictive ability, highlighting the need for more sensitive biomarkers to identify patients at highest risk of this devastating complication.
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Affiliation(s)
- Tarec Christoffer El-Galaly
- Department of Hematology, Aalborg University Hospital, Mølleparkvej 4, DK-9100 Aalborg, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Sdr. Skovvej 15, 9100 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, DK-9000 Aalborg, Denmark.
| | - Diego Villa
- Division of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia, 150-686 W. Broadway, Vancouver, BC, Canada
| | | | - Martin Hutchings
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9 DK-2100 Copenhagen, Denmark
| | - Nabegh George Mikhaeel
- Department of Clinical Oncology, Guy's and St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Kerry J Savage
- Division of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia, 150-686 W. Broadway, Vancouver, BC, Canada
| | - Laurie H Sehn
- Division of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia, 150-686 W. Broadway, Vancouver, BC, Canada
| | - Sally Barrington
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Jakob W Hansen
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9 DK-2100 Copenhagen, Denmark
| | - Daniel Smith
- Department of Clinical Oncology, Guy's and St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Kirsty Rady
- Department of Haematology, Peter MacCallum Cancer Centre and University of Melbourne, 305 Grattan Street, Melbourne VIC 3000, Australia
| | - Karen J Mylam
- Department of Hematology, Odense University Hospital, Søndre Boulevard 29, DK-5000 Odense, Denmark
| | - Thomas S Larsen
- Department of Hematology, Odense University Hospital, Søndre Boulevard 29, DK-5000 Odense, Denmark
| | - Staffan Holmberg
- Department of Hematology, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - Maja B Juul
- Department of Hematology, Vejle Hospital, Kabbeltoft 25, DK-7100 Vejle, Denmark
| | - Sabrina Cordua
- Department of Hematology, Roskilde Hospital, Zealand University Hospital, Sygehusvej 10, DK-4000 Roskilde, Denmark
| | - Michael R Clausen
- Department of Hematology, Aarhus University Hospital, Tage-Hansens Gade 2, DK-8000 Aarhus, Denmark
| | - Kristina B Jensen
- Department of Hematology, Holstebro Hospital, Lægårdvej, DK-7500 Holstebro, Denmark
| | - Hans E Johnsen
- Department of Hematology, Aalborg University Hospital, Mølleparkvej 4, DK-9100 Aalborg, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Sdr. Skovvej 15, 9100 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, DK-9000 Aalborg, Denmark
| | - John F Seymour
- Department of Haematology, Peter MacCallum Cancer Centre and University of Melbourne, 305 Grattan Street, Melbourne VIC 3000, Australia
| | - Joseph M Connors
- Division of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer and the University of British Columbia, 150-686 W. Broadway, Vancouver, BC, Canada
| | - Peter de Nully Brown
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9 DK-2100 Copenhagen, Denmark
| | - Martin Bøgsted
- Department of Hematology, Aalborg University Hospital, Mølleparkvej 4, DK-9100 Aalborg, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Sdr. Skovvej 15, 9100 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, DK-9000 Aalborg, Denmark
| | - Chan Y Cheah
- Department of Haematology, Peter MacCallum Cancer Centre and University of Melbourne, 305 Grattan Street, Melbourne VIC 3000, Australia; Department of Hematology, Sir Charles Gairdner Hospital and Pathwest Laboratory Medicine, Hospital Ave, Nedlands WA 6009, Australia; University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia
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20
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Keane C, Gould C, Jones K, Hamm D, Talaulikar D, Ellis J, Vari F, Birch S, Han E, Wood P, Le-Cao KA, Green MR, Crooks P, Jain S, Tobin J, Steptoe RJ, Gandhi MK. The T-cell Receptor Repertoire Influences the Tumor Microenvironment and Is Associated with Survival in Aggressive B-cell Lymphoma. Clin Cancer Res 2017; 23:1820-1828. [PMID: 27649554 DOI: 10.1158/1078-0432.ccr-16-1576] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/31/2016] [Accepted: 09/02/2016] [Indexed: 11/16/2022]
Abstract
Purpose: To investigate the relationship between the intra-tumoral T-cell receptor (TCR) repertoire and the tumor microenvironment (TME) in de novo diffuse large B-cell lymphoma (DLBCL) and the impact of TCR on survival.Experimental Design: We performed high-throughput unbiased TCRβ sequencing on a population-based cohort of 92 patients with DLBCL treated with conventional (i.e., non-checkpoint blockade) frontline "R-CHOP" therapy. Key immune checkpoint genes within the TME were digitally quantified by nanoString. The primary endpoints were 4-year overall survival (OS) and progression-free survival (PFS).Results: The TCR repertoire within DLBCL nodes was abnormally narrow relative to non-diseased nodal tissues (P < 0.0001). In DLBCL, a highly dominant single T-cell clone was associated with inferior 4-year OS rate of 60.0% [95% confidence interval (CI), 31.7%-79.6%], compared with 79.8% in patients with a low dominant clone (95% CI, 66.7%-88.5%; P = 0.005). A highly dominant clone also predicted inferior 4-year PFS rate of 46.6% (95% CI, 22.5%-76.6%) versus 72.6% (95% CI, 58.8%-82.4%, P = 0.008) for a low dominant clone. In keeping, clonal expansions were most pronounced in the EBV+ DLBCL subtype that is known to express immunogenic viral antigens and is associated with particularly poor outcome. Increased T-cell diversity was associated with significantly elevated PD-1, PD-L1, and PD-L2 immune checkpoint molecules.Conclusions: Put together, these findings suggest that the TCR repertoire is a key determinant of the TME. Highly dominant T-cell clonal expansions within the TME are associated with poor outcome in DLBCL treated with conventional frontline therapy. Clin Cancer Res; 23(7); 1820-8. ©2016 AACR.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Cyclophosphamide/administration & dosage
- Disease-Free Survival
- Doxorubicin/administration & dosage
- Female
- High-Throughput Nucleotide Sequencing
- Humans
- Kaplan-Meier Estimate
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Prednisone/administration & dosage
- Prognosis
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Receptors, Antigen, T-Cell, alpha-beta/immunology
- Rituximab/administration & dosage
- Tumor Microenvironment/genetics
- Vincristine/administration & dosage
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Affiliation(s)
- Colm Keane
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia.
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Clare Gould
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Kimberley Jones
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia
| | - David Hamm
- Adaptive Biotechnologies, Seattle, Washington
| | - Dipti Talaulikar
- Canberra Hospital, Canberra, Australian Capital Territory, Australia
- Australian National University Medical School, Australian Capital Territory, Australia
| | - Jonathan Ellis
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia
| | - Frank Vari
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia
| | - Simone Birch
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Pathology Queensland, Brisbane, Queensland, Australia
| | - Erica Han
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia
| | - Peter Wood
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Kim-Anh Le-Cao
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia
| | - Michael R Green
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Pauline Crooks
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia
| | - Sanjiv Jain
- Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Josh Tobin
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Raymond J Steptoe
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia
| | - Maher K Gandhi
- University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Australia.
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
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21
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Park YH, Yi HG, Lee MH, Kim CS, Lim JH. Prognostic Value of the Pretreatment Advanced Lung Cancer Inflammation Index (ALI) in Diffuse Large B Cell Lymphoma Patients Treated with R-CHOP Chemotherapy. Acta Haematol 2017; 137:76-85. [PMID: 28076862 DOI: 10.1159/000452991] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/01/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Advanced Lung Cancer Inflammation Index (ALI, body mass index × albumin/neutrophil-to-lymphocyte ratio) has been demonstrated to be a prognostic factor of survival in some solid cancers. We retrospectively investigated the usefulness of the ALI to predict chemotherapy response and survival in 212 patients with diffuse large B cell lymphoma (DLBCL) treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy. METHODS Patients were allocated to a low ALI group (n = 82, 38.7%) or a high ALI group (n = 130, 61.3%) according to an optimal pretreatment ALI cut-off value of 15.5 as determined by receiver operating curve analysis. RESULTS The low ALI group displayed more adverse clinical characteristics, lower rates of complete remission (54.9 vs. 75.4%, p = 0.008), and poorer 5-year progression-free (PFS, 58.1 vs. 77.3%, p = 0.006) and overall (OS, 64.2 vs. 80.2%, p = 0.008) survival. Multivariate analysis showed that low ALI was found to independently predict shorter PFS and OS. Interestingly, a low ALI reverted to a high ALI during treatment in 58 patients (27.4%), and the 5-year OS of these patients was better than that of patients whose ALI remained low (n = 24, 72.5 vs. 24%, p < 0.001). CONCLUSIONS ALI might be an easily available marker for predicting clinical outcomes in DLBCL patients treated with R-CHOP chemotherapy.
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Affiliation(s)
- Young Hoon Park
- Department of Hematology/Oncology, Hanil General Hospital, Seoul, Republic of Korea
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22
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Stock P, Weber K. Deep Digging: Far Red Imaging for the Monitoring of Transplanted Hepatocytes in Rats. Methods Mol Biol 2017; 1506:215-228. [PMID: 27830556 DOI: 10.1007/978-1-4939-6506-9_15] [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] [Indexed: 06/06/2023]
Abstract
Technologies for in vivo imaging of the distribution and integration of cell transplants gain significance for the use of novel cell therapy approaches in regenerative medicine. Applied to adequate animal models, they provide information on the spatio-temporal engraftment and functional performance of the cells transplanted. This chapter includes a detailed description of the in vivo tracking of transplanted hepatocytes in rat liver including the conjugation of antibodies to fluorochromes for far red imaging using a multispectral optical imager.
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Affiliation(s)
- Peggy Stock
- Clinics and Policlinics of Visceral-, Transplantation-, Thoracic- and Vascular Surgery, Applied Molecular Hepatology, University of Leipzig, Liebigstraße 21, 04103, Leipzig, Germany.
| | - Kristin Weber
- Department of Surgery, University of Leipzig, Leipzig, Germany
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23
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Frölich A, Knoll G, Bähre M, Neumann C. Diagnosis of chronic osteomyelitis by combined 99mTc-bone and 99mTc-anti-granulocyte scintigraphy. Nuklearmedizin 2016; 55:N60-N61. [PMID: 27922152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/29/2016] [Indexed: 06/06/2023]
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24
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Vitolo U, Angrili F, DeCosta L, Wetten S, Federico M. G-CSF use in patients receiving first-line chemotherapy for non-Hodgkin's lymphoma (NHL) and granulocyte-colony stimulating factors (G-CSF) as observed in clinical practice in Italy. Med Oncol 2016; 33:139. [PMID: 27822615 DOI: 10.1007/s12032-016-0850-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 07/27/2016] [Accepted: 10/27/2016] [Indexed: 11/26/2022]
Abstract
Treatment of non-Hodgkin lymphoma (NHL) requires chemotherapy regimens with significant risk of febrile neutropenia (FN). For patients at ≥20% FN risk, guidelines recommend primary prophylaxis (PP) with granulocyte-colony stimulating factor (G-CSF). This study assessed whether G-CSF use in NHL was in line with recommendations in routine practice. This was a retrospective, observational study of adult NHL patients receiving first-line (R)CHOP-like chemotherapy and G-CSF support between June 2010 and 2012, in Italy. The primary outcome was whether G-CSF was provided as PP, which was defined as G-CSF initiation on days 1-3 after chemotherapy, ≥3 days' use for daily G-CSFs and continued prophylaxis from cycle 1 across all cycles. Secondary prophylaxis was defined as continued prophylaxis from cycle 2 or later, and all other use was defined as Suboptimal. The analysis included 199 patients, 61% of whom had diffuse large B cell lymphoma and 21% follicular lymphoma. (R)CHOP-21 was given to 52% of patients and (R)CHOP-14 to 32%. Overall, 29% of patients received PP, while two-thirds received Suboptimal G-CSF. Of patients receiving daily G-CSF, 3% received PP and 94% received Suboptimal use; with pegfilgrastim, 65% received PP and 26% Suboptimal use. FN occurred in 13 patients (7%) and grade 3/4 neutropenia in 43%. Chemotherapy dose delays occurred in 22% and dose reductions in 18% of patients. Delivery of G-CSF, particularly daily G-CSFs, was not in accordance with guideline or product label recommendations in a large proportion of NHL patients receiving chemotherapy in Italy.
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Affiliation(s)
- Umberto Vitolo
- A.O.U Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | - Massimo Federico
- Dipartimento di Medicina Diagnostica, Clinica e di Sanità Pubblica, Università di Modena e Reggio Emilia, Modena, Italy
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25
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Song HN, Kim SJ, Ko YH, Kim WS. Mediastinal Gray Zone Lymphoma with Features Intermediate between Classical Hodgkin Lymphoma and Primary Mediastinal B-Cell Lymphoma. Acta Haematol 2016; 136:186-90. [PMID: 27623181 DOI: 10.1159/000448159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 06/22/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mediastinal gray zone lymphoma (MGZL) shares clinical characteristics with primary mediastinal B-cell lymphoma (PMBCL) and nodular sclerosing Hodgkin lymphoma (NSHL). However, MGZL is extremely rare, and an appropriate treatment for it has not yet been established. METHODS We retrospectively analyzed 8 patients who were treated with systemic chemotherapy for MGZL between 2007 and 2014. RESULTS The patients with MGZL were predominantly young and male (median age 26 years), and 62.5% of patients had bulky disease. The overall response rate (ORR) and complete remission (CR) rate were both 75% (6/8) for all treated patients The median overall survival (OS) and progression-free survival (PFS) was 40.7 and 3.9 months, respectively. Most responders (4/6, 66.7%) were treated with R-CHOP (rituximab + cyclophosphamide, hydroxydaunorubicin, Oncovin and prednisolone) as the frontline therapy. The CR rate of patients who received R-CHOP and those who did not was 100% (4/4) and 50% (2/4), respectively. Particularly striking was the finding that the median PFS of patients who received R-CHOP frontline chemotherapy was 11.4 months, which was superior to the median PFS of patients who did not receive R-CHOP. CONCLUSIONS Of the 8 patients with MGZL who were treated with systemic chemotherapy, superior treatment responses were observed in patients who received R-CHOP as the frontline therapy.
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Affiliation(s)
- Haa-Na Song
- Division of Hemato-Oncology, Department of Internal Medicine, Gyeongsang National University of Medicine and Gyeongsang National University Hospital, Jinju, Korea
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26
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Jurczak W, Bryk AH, Mensah P, Gałązka K, Trofimiuk-Müldner M, Wyrobek Ł, Sawiec A, Skotnicki AB. Single-agent MOR208 salvage and maintenance therapy in a patient with refractory/relapsing diffuse large B-cell lymphoma: a case report. J Med Case Rep 2016; 10:123. [PMID: 27178351 PMCID: PMC4868005 DOI: 10.1186/s13256-016-0875-x] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 03/18/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma is the most common subtype of non-Hodgkin's lymphoma. Standard first-line treatment for this aggressive subtype comprises the anti-CD20 antibody rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone. If patients receiving such treatment have an early relapse, or their disease is initially refractory to such treatment, standard salvage regimens may not be effective. There is therefore a high unmet clinical need for new targeted agents that might improve the outcome for such patients. CD19 is a B-lymphocyte lineage-specific cell surface antigen that is expressed by most B-cell non-Hodgkin's lymphomas. MOR208 is an fragment-crystallizable engineered humanized monoclonal antibody with enhanced antitumor activity that targets CD19 and that may consequently have clinical utility in this setting. CASE PRESENTATION We describe the case of a 33-year-old Caucasian man who presented with a 3-month history of general symptoms and who was admitted to our pulmonology ward with dyspnea due to pneumonia and severe anemia. A histopathological examination of an enlarged right suprasternal lymph node confirmed a diagnosis of T-cell/histiocyte-rich large B-cell lymphoma, an uncommon morphological variant of diffuse large B-cell lymphoma. Our patient had a complete response to first-line rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone, but had an early relapse 5 months after the end of treatment. After intensive salvage therapy consolidated with an autologous stem-cell transplant, our patient again had an early relapse and was subsequently enrolled in a phase IIa trial of single-agent MOR208. Following a scheduled 3 months of weekly treatment, a partial response was confirmed and MOR208 was continued as maintenance therapy, with administration every second week. Positron emission tomography-computed tomography confirmed a complete response 9 months later. This response is ongoing, with a duration of 24 months. MOR208 was well-tolerated by our patient and his quality of life and performance status remain high. No hospitalizations were required and our patient engaged in full-time work and physical activities. CONCLUSION Third-line single-agent therapy with the CD19 antibody MOR208 was highly effective in this patient, despite a history of early relapse after standard first-line and second-line treatment regimens. These data provide support for future randomized studies of MOR208.
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Affiliation(s)
- Wojciech Jurczak
- Department of Hematology, Jagiellonian University, Kopernika 17, Kraków, 31-501, Poland.
| | - Agata Hanna Bryk
- Department of Hematology, Jagiellonian University, Kopernika 17, Kraków, 31-501, Poland
| | - Patrycja Mensah
- Department of Hematology, Jagiellonian University, Kopernika 17, Kraków, 31-501, Poland
| | - Krystyna Gałązka
- Department of Pathology, Jagiellonian University, Kraków, Poland
| | | | | | - Anna Sawiec
- Clinical Research Facility - MCM, Kraków, Poland
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27
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Cho H, Yoon DH, Kim JH, Ko YB, Kwon BS, Song IH, Suh C. Occurrence of sarcoidosis after chemotherapy for non-Hodgkin lymphoma. Korean J Intern Med 2016; 31:605-7. [PMID: 26968186 PMCID: PMC4855092 DOI: 10.3904/kjim.2014.305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/18/2014] [Accepted: 12/26/2014] [Indexed: 11/27/2022] Open
MESH Headings
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biopsy
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/therapeutic use
- Doxorubicin/administration & dosage
- Doxorubicin/therapeutic use
- Female
- Genital Neoplasms, Female/complications
- Genital Neoplasms, Female/diagnosis
- Genital Neoplasms, Female/drug therapy
- Humans
- Lymph Nodes/diagnostic imaging
- Lymph Nodes/pathology
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Middle Aged
- Positron-Emission Tomography
- Prednisone/administration & dosage
- Prednisone/therapeutic use
- Remission Induction
- Rituximab/administration & dosage
- Sarcoidosis/diagnostic imaging
- Sarcoidosis/etiology
- Sarcoidosis/pathology
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
- Vincristine/administration & dosage
- Vincristine/therapeutic use
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Affiliation(s)
- Hyungwoo Cho
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jwa Hoon Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Bo Ko
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byoung Soo Kwon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Hye Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence to Cheolwon Suh, M.D. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3209 Fax: +82-2-3010-6961 E-mail:
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Illidge TM, McKenzie HS, Mayes S, Bates A, Davies AJ, Pettengell R, Stanton L, Cozens K, Hampson G, Dive C, Zivanovic M, Tipping J, Gallop-Evans E, Radford JA, Johnson PWM. Short duration immunochemotherapy followed by radioimmunotherapy consolidation is effective and well tolerated in relapsed follicular lymphoma: 5-year results from a UK National Cancer Research Institute Lymphoma Group study. Br J Haematol 2016; 173:274-82. [PMID: 26849853 DOI: 10.1111/bjh.13954] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 10/20/2015] [Accepted: 11/30/2015] [Indexed: 12/24/2022]
Abstract
UNLABELLED We report a phase II study to evaluate the efficacy and toxicity of abbreviated immunochemotherapy followed by (90) Y Ibritumomab tiuxetan ((90) Y-IT) in patients with recurrent follicular lymphoma. Of the 52 patients enrolled, 50 were treated with three cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) or R-CVP (rituximab, cyclophosphamide, vincristine, prednisolone), followed by (90) Y-IT regimen (15 MBq/kg, maximum 1200 MBq) preceded by two infusions of 250 mg/m(2) rituximab. The overall response rate was 98% with complete response (CR) 30% and partial response (PR) 68%. 18 patients with a PR following chemotherapy improved to a CR following (90) Y-IT: a conversion rate of 40%. Seven patients with PR following (90) Y-IT subsequently improved to a CR 12-18 months later, leading to an overall CR rate of 44%. With a median follow-up of 5 years, median progression-free survival was 23·1 months and overall survival was 77·5% at 5 years. High trough serum rituximab levels (median 112 μg/ml; range 52-241) were attained after four doses of rituximab, prior to (90) Y-IT; this was not found to influence response rates. The treatment was well tolerated with few (13·5%) grade 3 or 4 infective episodes and manageable haematological toxicity. Abbreviated immunochemotherapy followed by (90) Y-IT is an effective and well-tolerated treatment in recurrent follicular lymphoma patients previously exposed to rituximab. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT00637832.
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Affiliation(s)
- Tim M Illidge
- Manchester Academic Health Sciences Centre, University of Manchester, Christie NHS Foundation Trust, Manchester, UK
| | - Hayley S McKenzie
- NIHR/Cancer Research UK Experimental Cancer Medicine Centre, Southampton, UK
| | - Sam Mayes
- Manchester Academic Health Sciences Centre, University of Manchester, Christie NHS Foundation Trust, Manchester, UK
| | - Andrew Bates
- NIHR/Cancer Research UK Experimental Cancer Medicine Centre, Southampton, UK
| | - Andrew J Davies
- NIHR/Cancer Research UK Experimental Cancer Medicine Centre, Southampton, UK
| | - Ruth Pettengell
- Department of Haematology, St Georges University of London, London, UK
| | | | - Kelly Cozens
- Southampton Clinical Trials Unit, Southampton, UK
| | - Grace Hampson
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK
| | - Caroline Dive
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK
| | - Maureen Zivanovic
- Manchester Academic Health Sciences Centre, University of Manchester, Christie NHS Foundation Trust, Manchester, UK
| | - Jill Tipping
- Manchester Academic Health Sciences Centre, University of Manchester, Christie NHS Foundation Trust, Manchester, UK
| | | | - John A Radford
- Manchester Academic Health Sciences Centre, University of Manchester, Christie NHS Foundation Trust, Manchester, UK
| | - Peter W M Johnson
- NIHR/Cancer Research UK Experimental Cancer Medicine Centre, Southampton, UK
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29
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González-Barca E, Canales M, Salar A, Ferreiro-Martínez JJ, Ferrer-Bordes S, García-Marco JA, Sánchez-Blanco JJ, García-Frade J, Peñalver J, Bello-López JL, Sancho JM, Caballero D. Central nervous system prophylaxis with intrathecal liposomal cytarabine in a subset of high-risk patients with diffuse large B-cell lymphoma receiving first line systemic therapy in a prospective trial. Ann Hematol 2016; 95:893-9. [PMID: 27025508 PMCID: PMC4853453 DOI: 10.1007/s00277-016-2648-4] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 03/17/2016] [Indexed: 10/26/2022]
Abstract
The dissemination in the central nervous system (CNS) is an uncommon but fatal complication occurring in patients with diffuse large B-cell lymphoma (DLBCL). Standard prophylaxis has been demonstrated to reduce CNS relapse and improve survival rates. Intrathecal (IT) liposomal cytarabine allows maintaining elevated drug levels in the cerebrospinal fluid for an extended period of time. Data on the efficacy and safety of liposomal cytarabine as CNS prophylaxis in patients with DLBCL are still insufficient. The objective of the present study was to evaluate the effectiveness and safety of the prophylaxis with IT liposomal cytarabine in prevention of CNS relapse in high-risk patients with DLBCL who were included in a trial of first line systemic therapy with 6 cycles of dose-dense R-CHOP every 14 days. Twenty-four (18.6 %) out of 129 patients were identified to have risk factors for CNS involvement, defined as follows: >30 % bone marrow infiltration, testes infiltration, retroperitoneal mass ≥10 cm, Waldeyer ring, or bulky cervical nodes involvement. Liposomal cytarabine (50 mg) was administered by lumbar puncture the first day of the 1st, 2nd, and 6th cycle of R-CHOP14 scheme. Among 70 IT infusions, grade 3-4 adverse events reported were headache (one patient) and nausea/vomiting (one patient). With a median follow-up of 40.1 months, no CNS involvement by DLBCL was observed in any patient. In conclusion, IT liposomal cytarabine is safe, feasible, and effective for CNS prophylaxis, causing few associated risks and little discomfort to patients with DLBCL.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antimetabolites, Antineoplastic/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Cyclophosphamide/administration & dosage
- Cytarabine/administration & dosage
- Doxorubicin/administration & dosage
- Female
- Follow-Up Studies
- Humans
- Injections, Spinal
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Male
- Middle Aged
- Post-Exposure Prophylaxis/methods
- Prednisone/administration & dosage
- Prospective Studies
- Risk Factors
- Rituximab
- Survival Rate
- Vincristine/administration & dosage
- Young Adult
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Affiliation(s)
- E González-Barca
- Institut Català d'Oncologia. IDIBELL., Hospital Duran i Reynals, Av. Gran Vía 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - M Canales
- Hospital Universitario La Paz, Madrid, Spain
| | - A Salar
- Hospital del Mar, Barcelona, Spain
| | | | | | | | | | | | - J Peñalver
- Fundación Hospital de Alcorcón, Madrid, Spain
| | - J L Bello-López
- Complexo Hospitalario de Santiago, Santiago de Compostela, Spain
| | - J M Sancho
- Institut Català d'Oncologia - Hospital Germans Trias i Pujol, Badalona, Spain
| | - D Caballero
- Hospital Clínico Universitario de Salamanca, Salamanca, Spain
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31
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Gadaev IY, Ershov VI, Bochkarnikova OV, Sokolova IY, Budanova DA, Kotova ES, Lishuta AS. [LISHUTA EXTRANODAL INVOLVEMENT OF THE HEART IN LYMPHOMAS: A CLINICAL CASE OF LARGE B-CELL LYMPHOMA AND LITERATURE REVIEW]. Klin Med (Mosk) 2016; 94:780-784. [PMID: 30299043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The authors report a case of rare cardiac involvement in lymphoma, one of the manifestations of which was rhythm and conduction disorders with their resolution after chemotherapy. Also presented are clinical manifestations of heart lesions in lymphoma and modern methods of their diagnostics and treatment.
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32
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Fukuba N, Moriyama I, Ishihara S, Sonoyama H, Yamashita N, Tada Y, Oka A, Oshima N, Yuki T, Kawashima K, Kinoshita Y. Primary Pancreatic Malignant Lymphoma Diagnosed from Endoscopic Ultrasound-guided Fine-needle Aspiration Findings. Intern Med 2016; 55:31-5. [PMID: 26726082 DOI: 10.2169/internalmedicine.55.5749] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 60-year-old woman was admitted to our hospital with upper abdominal pain and jaundice. Computed tomography showed a 9-cm mass that was penetrated by the common hepatic artery in the pancreatic head area. Endoscopic retrograde pancreatography revealed no stenosis or obstruction of the main pancreatic duct, and a cytologic examination of the patient's pancreatic juice was negative. Next, endoscopic ultrasound-guided fine needle aspiration was performed. The immunohistological findings of the specimen revealed a diffuse large B-cell lymphoma. The size of the tumor was significantly reduced after 8 cycles of R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone).
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MESH Headings
- Abdominal Pain/diagnostic imaging
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Cyclophosphamide/administration & dosage
- Doxorubicin/administration & dosage
- Endoscopic Ultrasound-Guided Fine Needle Aspiration
- Female
- Humans
- Jaundice/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Middle Aged
- Pancreatic Ducts/pathology
- Pancreatic Neoplasms/diagnosis
- Pancreatic Neoplasms/drug therapy
- Pancreatic Neoplasms/pathology
- Prednisone/administration & dosage
- Radiography, Abdominal
- Rituximab
- Tomography, X-Ray Computed
- Treatment Outcome
- Vincristine/administration & dosage
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Affiliation(s)
- Nobuhiko Fukuba
- Department of Internal Medicine II, Shimane University School of Medicine, Japan
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33
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Ruan J, Martin P, Shah B, Schuster SJ, Smith SM, Furman RR, Christos P, Rodriguez A, Svoboda J, Lewis J, Katz O, Coleman M, Leonard JP. Lenalidomide plus Rituximab as Initial Treatment for Mantle-Cell Lymphoma. N Engl J Med 2015; 373:1835-44. [PMID: 26535512 PMCID: PMC4710541 DOI: 10.1056/nejmoa1505237] [Citation(s) in RCA: 176] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Mantle-cell lymphoma is generally incurable. Initial treatment is not standardized but usually includes cytotoxic chemotherapy. Lenalidomide, an immunomodulatory compound, and rituximab, an anti-CD20 antibody, are active in patients with recurrent mantle-cell lymphoma. We evaluated lenalidomide plus rituximab as a first-line therapy. METHODS We conducted a single-group, multicenter, phase 2 study with induction and maintenance phases. During the induction phase, lenalidomide was administered at a dose of 20 mg daily on days 1 through 21 of every 28-day cycle for 12 cycles; the dose was escalated to 25 mg daily after the first cycle if no dose-limiting adverse events occurred during the first cycle and was reduced to 15 mg daily during the maintenance phase. Rituximab was administered once weekly for the first 4 weeks and then once every other cycle until disease progression. The primary end point was the overall response rate. Secondary end points included outcomes related to safety, survival, and quality of life. RESULTS A total of 38 participants were enrolled at four centers from July 2011 through April 2014. The median age was 65 years. On the basis of the Mantle Cell Lymphoma International Prognostic Index scores, the proportions of participants with low-risk, intermediate-risk, and high-risk disease at baseline were similar (34%, 34%, and 32%, respectively). The most common grade 3 or 4 adverse events were neutropenia (in 50% of the patients), rash (in 29%), thrombocytopenia (in 13%), an inflammatory syndrome ("tumor flare") (in 11%), anemia (in 11%), serum sickness (in 8%), and fatigue (in 8%). At the median follow-up of 30 months (through February 2015), the overall response rate among the participants who could be evaluated was 92% (95% confidence interval [CI], 78 to 98), and the complete response rate was 64% (95% CI, 46 to 79); median progression-free survival had not been reached. The 2-year progression-free survival was estimated to be 85% (95% CI, 67 to 94), and the 2-year overall survival 97% (95% CI, 79 to 99). A response to treatment was associated with improvement in quality of life. CONCLUSIONS Combination biologic therapy consisting of lenalidomide plus rituximab was active as initial therapy for mantle-cell lymphoma. (Funded by Celgene and Weill Cornell Medical College; ClinicalTrials.gov number, NCT01472562.).
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Affiliation(s)
- Jia Ruan
- From the Meyer Cancer Center, Division of Hematology and Medical Oncology (J.R., P.M., R.R.F., A.R., J.L., O.K., M.C., J.P.L.), and Division of Biostatistics and Epidemiology (P.C.), Weill Cornell Medical College and New York-Presbyterian Hospital, New York; Moffitt Cancer Center, Tampa, FL (B.S.); University of Pennsylvania Abramson Cancer Center, Philadelphia (S.J.S., J.S.); and the University of Chicago Medical Center, Chicago (S.M.S.)
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34
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Gillispie MC, Thomas RD, Hennon TR. Successful treatment of IgG-4 related sclerosing disease with rituximab: a novel case report. Clin Exp Rheumatol 2015; 33:549-550. [PMID: 25897489] [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] [Received: 09/23/2014] [Accepted: 01/19/2015] [Indexed: 06/04/2023]
Abstract
IgG4-related sclerosing disease (IgG4-RSD) is a rare inflammatory disease that can affect multi organs. We describe a paediatric patient with ocular, nerve, and renal involvement successfully treated twice with corticosteroids and rituximab.
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Affiliation(s)
- Miriah C Gillispie
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Florida, USA
| | | | - Theresa R Hennon
- The Women and Children's Hospital of Buffalo; and Department of Pediatrics, University at Buffalo, NY, USA
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35
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Barone M, Notarnicola A, Lopalco G, Viggiani MT, Sebastiani F, Covelli M, Iannone F, Avolio AW, Di Leo A, Cantarini L, Lapadula G. Safety of long-term biologic therapy in rheumatologic patients with a previously resolved hepatitis B viral infection. Hepatology 2015; 62:40-6. [PMID: 25613809 DOI: 10.1002/hep.27716] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 01/18/2015] [Indexed: 02/05/2023]
Abstract
UNLABELLED European and Asian studies report conflicting data on the risk of hepatitis B virus (HBV) reactivation in rheumatologic patients with a previously resolved HBV (prHBV) infection undergoing long-term biologic therapies. In this patient category, the safety of different immunosuppressive biologic therapies, including rituximab, was assessed. A total of 1218 Caucasian rheumatologic patients, admitted consecutively as outpatients between 2001 and 2012 and taking biologic therapies, underwent evaluation of anti-HCV and HBV markers as well as liver amino transferases every 3 months. Starting from January 2009, HBV DNA monitoring was performed in patients with a prHBV infection who had started immunosuppressive biologic therapy both before and after 2009. Patients were considered to have elevated aminotransferase levels if values were >1× upper normal limit at least once during follow-up. We found 179 patients with a prHBV infection (14 treated with rituximab, 146 with anti-tumor necrosis factor-alpha, and 19 with other biologic therapies) and 959 patients without a prHBV infection or other liver disease (controls). The mean age in the former group was significantly higher than the controls. Patients with a prHBV infection never showed detectable HBV DNA serum levels or antibody to hepatitis B surface antigen/hepatitis B surface antigen seroreversion. However, when the prevalence of elevated amino transferases in patients with prHBV infection was compared to controls, it was significantly higher in the former group only for aminotransferase levels >1× upper normal limit but not when aminotransferase levels >2× upper normal limit were considered. CONCLUSION Among patients with a prHBV infection and rheumatologic indications for long-term biologic therapies, HBV reactivation was not seen; this suggests that universal prophylaxis is not justified and is not cost-effective in this clinical setting.
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Affiliation(s)
- Michele Barone
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Giuseppe Lopalco
- Rheumatology Unit, Medical School, University of Bari, Bari, Italy
| | - Maria Teresa Viggiani
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Francesco Sebastiani
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Michele Covelli
- Rheumatology Unit, Medical School, University of Bari, Bari, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Medical School, University of Bari, Bari, Italy
| | - Alfonso W Avolio
- Department of Surgery-Transplantation Service, Catholic University of Rome, Rome, Italy
| | - Alfredo Di Leo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Luca Cantarini
- Rheumatology Unit, Department Research Center of Systemic Autoimmune and Autoinflammatory Diseases, University of Siena, Siena, Italy
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Fraticelli P, De Vita S, Franzolini N, Svegliati S, Scott CA, Tonnini C, Spadoni T, Gabrielli B, Pomponio G, Moroncini G, Gabrielli A. Reduced type I collagen gene expression by skin fibroblasts of patients with systemic sclerosis after one treatment course with rituximab. Clin Exp Rheumatol 2015; 33:S160-S167. [PMID: 26339895] [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] [Received: 06/09/2015] [Accepted: 07/01/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES There is evidence that B lymphocytes play a role in the pathogenesis of systemic sclerosis (scleroderma). Stimulatory autoantibodies targeting and activating normal human fibroblasts in vitro have been demonstrated in sera from scleroderma patients. Rituximab is a monoclonal antibody which selectively targets and depletes CD20+ B lymphocytes. We investigated the biological effects of rituximab in six patients affected by scleroderma with severe skin involvement. METHODS Six patients with severe skin fibrosis, unresponsive to immunosuppressive treatment, were treated with 375 mg/m2 per week of intravenous rituximab for a total of four doses. Serum stimulatory autoantibodies to the PDGF receptor were detected. Fibroblast activation was evaluated in fibroblasts grown from skin biopsies performed at baseline and at months 3 and 6 post-treatment. The modified Rodnan's skin score, health assessment questionnaire (HAQ) and visual analogic scale (VAS) for global wellness and B lymphocyte count were performed monthly. RESULTS A significant reduction of anti-PDGF receptor autoantibodies was observed in the serum of all patients 3 months after treatment. Fibroblasts showed a significant downregulation of type I collagen gene expression and of the intracellular signalling triggered by anti-PDGFR autoantibodies. A decrease of the skin score and an improvement of disability indexes matched with the in vitro results. A single course of rituximab reduced scleroderma fibroblast activation in vitro and the serum levels of anti-PDGFR stimulatory autoantibodies. CONCLUSIONS These data provide further evidence of B-cell involvement in the pathogenesis of scleroderma. Targeting B cells may be a promising treatment for scleroderma patients, and controlled clinical trials are warranted.
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MESH Headings
- Aged
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Autoantibodies/blood
- B-Lymphocytes/drug effects
- B-Lymphocytes/immunology
- B-Lymphocytes/metabolism
- Cells, Cultured
- Collagen Type I/genetics
- Collagen Type I/metabolism
- Down-Regulation
- Drug Administration Schedule
- Female
- Fibroblasts/drug effects
- Fibroblasts/immunology
- Fibroblasts/metabolism
- Fibroblasts/pathology
- Fibrosis
- Hospitals, University
- Humans
- Immunologic Factors/administration & dosage
- Infusions, Intravenous
- Italy
- Male
- Middle Aged
- Receptors, Platelet-Derived Growth Factor/immunology
- Rituximab
- Scleroderma, Systemic/blood
- Scleroderma, Systemic/diagnosis
- Scleroderma, Systemic/drug therapy
- Scleroderma, Systemic/genetics
- Scleroderma, Systemic/immunology
- Severity of Illness Index
- Skin/drug effects
- Skin/immunology
- Skin/metabolism
- Skin/pathology
- Time Factors
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Paolo Fraticelli
- Clinica Medica, Dipartimento di Medicina Interna, Ospedali Riuniti, Ancona, Italy
| | - Salvatore De Vita
- Clinica di Reumatologia, Dipartimento di Patologia e Medicina Sperimentale e Clinica, Università di Udine, Udine, Italy
| | - Nicoletta Franzolini
- Clinica di Reumatologia, Dipartimento di Patologia e Medicina Sperimentale e Clinica, Università di Udine, Udine, Italy
| | - Silvia Svegliati
- Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Caterina A Scott
- Istituto di Anatomia Patologica, Dipartimento di Ricerche Mediche e Morfologiche Università di Udine, Udine, Italy
| | - Cecilia Tonnini
- Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Tatiana Spadoni
- Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Barbara Gabrielli
- Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Giovanni Pomponio
- Clinica Medica, Dipartimento di Medicina Interna, Ospedali Riuniti, Ancona, Italy
| | - Gianluca Moroncini
- Clinica Medica, Dipartimento di Medicina Interna, Ospedali Riuniti, Ancona; and Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Armando Gabrielli
- Clinica Medica, Dipartimento di Medicina Interna, Ospedali Riuniti, Ancona; and Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy.
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Iaccarino L, Bartoloni E, Carli L, Ceccarelli F, Conti F, De Vita S, Ferraccioli G, Galeazzi M, Gatto M, Gerli R, Govoni M, Gremese E, Iuliano A, Mansutti E, Moroni G, Mosca M, Nalli C, Naretto C, Padovan M, Palma L, Raffiotta F, Roccatello D, Tincani A, Valesini G, Zen M, Doria A. Efficacy and safety of off-label use of rituximab in refractory lupus: data from the Italian Multicentre Registry. Clin Exp Rheumatol 2015; 33:449-456. [PMID: 26053285] [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] [Received: 09/21/2014] [Accepted: 01/08/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To evaluate the efficacy and safety of rituximab (RTX) in patients with systemic lupus erythematosus (SLE) refractory to standard therapy in the clinical practice setting. METHODS 145 SLE patients (ACR criteria) were treated with RTX in 11 Italian Centres: 118 with two infusions (1 g), two weeks apart; 27 with 4 infusions (375 mg/m2), one week apart, followed in 10 cases by two further doses, after 1 and 2 months. Systemic complete response (CR) was defined as European Consensus Lupus Activity Measurement (ECLAM) score ≤1 and partial response (PR) as 1< ECLAM ≤3. Renal CR (RCR) and renal PR (RPR) were defined according to EULAR recommendations for management of lupus nephritis. RESULTS Data from 134 (92.4%) patients were available. The mean±SD follow-up was 27.3±18.5 months. After the first course of RTX, CR or PR were observed in 85.8% and CR in 45.5% of cases; RCR or RPR in 94.1% and RCR in 30.9% of patients after 12-month follow-up. Disease flares occurred in 35.1% and renal flares in 31.2% of patients during observational period. Among patients retreated, CR or PR were observed in 84.4% and CR in 57.8% of cases. Adverse events, infections, and infusion reactions occurred after first RTX course in 23.8%, 16.4%, and 3.8% of patients and after retreatment in 33.3%, 22.2% and 11.1%, respectively. No severe infusion reactions or deaths occurred. CONCLUSIONS Data from Italian multicentre RTX Registry confirmed the efficacy and safety of RTX in SLE patients refractory to standard treatment in clinical practice setting.
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Affiliation(s)
- Luca Iaccarino
- Department of Medicine-DIMED, Division of Rheumatology, University of Padova, Italy
| | - Elena Bartoloni
- Department of Medicine, Rheumatology Unit, University of Perugia, Perugia, Italy
| | - Linda Carli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Fulvia Ceccarelli
- Department of Internal Medicine and Medical Specialities, Rheumatology, La Sapienza University, Roma, Italy
| | - Fabrizio Conti
- Department of Internal Medicine and Medical Specialities, Rheumatology, La Sapienza University, Roma, Italy
| | - Salvatore De Vita
- Department of Medical and Biological Sciences, Rheumatology Clinic, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Gianfranco Ferraccioli
- Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Mauro Galeazzi
- Research Centre of Systemic Autoimmune and Autoinflammatory Diseases, Rheumatology Unit, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Mariele Gatto
- Department of Medicine-DIMED, Division of Rheumatology, University of Padova, Italy
| | - Roberto Gerli
- Department of Medicine, Rheumatology Unit, University of Perugia, Perugia, Italy
| | - Marcello Govoni
- Department of Medical Sciences, University of Ferrara, Italy
| | - Elisa Gremese
- Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Annamaria Iuliano
- Research Centre of Systemic Autoimmune and Autoinflammatory Diseases, Rheumatology Unit, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Elena Mansutti
- Department of Medical and Biological Sciences, Rheumatology Clinic, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Gabriella Moroni
- Division of Nephrology, Fondazione Ca' Granda Ospedale Maggiore IRCCS, Milano, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Cecilia Nalli
- Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, Spedali Civili and University of Brescia, Italy
| | - Carla Naretto
- Department of Rare Disease, Immunology, Haematology and Immunohaematology, Research Centre of Immunopathology of Rare Diseases (CMID), Hospital Torino Nord Emergenza San G. Bosco and University of Torino, Italy
| | - Melissa Padovan
- Department of Medical Sciences, University of Ferrara, Italy
| | - Lavinia Palma
- Department of Medicine-DIMED, Division of Rheumatology, University of Padova, Italy
| | - Francesca Raffiotta
- Division of Nephrology, Fondazione Ca' Granda Ospedale Maggiore IRCCS, Milano, Italy
| | - Dario Roccatello
- Department of Rare Disease, Immunology, Haematology and Immunohaematology, Research Centre of Immunopathology of Rare Diseases (CMID), Hospital Torino Nord Emergenza San G. Bosco and University of Torino, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, Spedali Civili and University of Brescia, Italy
| | - Guido Valesini
- Department of Internal Medicine and Medical Specialities, Rheumatology, La Sapienza University, Roma, Italy
| | - Margherita Zen
- Department of Medicine-DIMED, Division of Rheumatology, University of Padova, Italy
| | - Andrea Doria
- Department of Medicine-DIMED, Division of Rheumatology, University of Padova, Italy
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Rituximab (MABTHERA) and severe polyangiitis. An option for patients informed of the uncertainties. Prescrire Int 2015; 24:145-8. [PMID: 26436161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Granulomatosis with polyangiitis (Wegener's granulomatosis) and microscopic polyangiitis are two types of rapidly fatal necrotizing vasculitis. The standard induction therapy consists of cyclophosphamide (an immunosuppressant) plus a corticosteroid. This treatment significantly prolongs survival but has burdensome adverse effects. After an induction phase lasting 3 to 6 months, cyclophosphamide is replaced by another immunosuppressant such as azathioprine for 2 to 5 years in order to prevent relapse. There is no consensus on an alternative treatment for patients who cannot receive cyclophosphamide. Rituximab, a monoclonal antibody already approved in oncology and rheumatology, is now authorised in the European Union for induction therapy in adult patients with granulomatosis with polyangiitis and microscopic polyangiitis. A randomised, double-blind, non-inferiority trial in 197 patients compared intravenous rituximab infusion once a week for 4 weeks, versus oral cyclophosphamide given for 3 to 6 months, followed by azathioprine for 12 months. During the 18-month follow-up period, 2% of patients in each group died. Rituximab was at least as effective as cyclophosphamide in terms of complete remission rate by 6 months (primary endpoint), which was respectively 64% and 55%. At 18 months, about one-third of patients in both arms were still in remission, despite the absence of maintenance therapy in the rituximab arm. Uncertainties concerning the use of rituximab in this setting include its longer-term impact on survival, possible advantage in patients who relapse, efficacy in patients with life-threatening disease, and optimal dose. During 18 months of follow-up, about 42% of patients in the rituximab group and 70% of those in the cyclophosphamide and azathioprine group had at least one treatment-related adverse effect. The following adverse effects were more frequent with rituximab than with sequential treatment with cyclophosphamide followed by azathioprine: infections, thrombocytopenia, diarrhoea, peripheral oedema, cough and cardiovascular disorders, while the following effects were more frequent with cyclophosphamide followed by azathioprine: leukopenia, venous thromboembolism, nausea, vomiting, transaminase elevation and hair loss. Rituximab should be avoided during pregnancy because it can cause lymphopenia in the unborn child. Its effects on fertility are poorly documented. In practice, in patients with severe granulomatosis with polyangiitis or microscopic polyangiitis, rituximab is as effective at 18 months as cyclophosphamide followed by azathioprine; in addition, it has different and less frequent adverse effects. Rituximab is therefore an alternative when the standard treatment is likely to be problematic, but patients should be informed that longer-term efficacy is uncertain and that the optimal dose remains to be established.
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39
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Brown JR. Optimal First-Line Therapy for Previously Untreated Chronic Lymphocytic Leukemia: The Case for Chemotherapy. Oncology (Williston Park) 2015; 29:442-444. [PMID: 26091679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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40
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Roll P, Mahmood Z, Muhammad K, Feuchtenberger M, Dörner T, Tony HP. Long-term repopulation of peripheral B-cell subsets after single and repeated rituximab infusions in patients with rheumatoid arthritis. Clin Exp Rheumatol 2015; 33:347-353. [PMID: 25897997] [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] [Received: 08/14/2014] [Accepted: 12/19/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES B-cell depletion using rituximab (RTX) has proven efficacy in patients with RA. Long-term effects on the B-cell system after single and repeated treatments are sparse. Our aim was to study the effect of multiple courses of rituximab to evaluate its impact on repeated B-cell re-population capacity. METHODS Two cohorts, altogether 20 patients with RA were included in an open label extension study with RTX. Cohort 1 received one cycle RTX and was followed for up to 7 years. In cohort 2 patients were studied under up to 5 cycles of RTX. Immunophenotyping was performed before therapy and during follow-up. RESULTS After a single therapy with RTX (cohort 1) the frequency of pre-switch (MZ-like) B cells were significantly reduced during the follow-up of 7 years and absolute numbers slowly repopulated to nearly 50% of baseline value without numerical normalisation. The acquisition of mutations in Ig receptors of pre-switch (MZ-like) memory B cells was also significantly reduced 10 years after one course. In contrast, absolute numbers of (classical) post-switch B cells tended to normalise to baseline values after 7 years. Analysing B-cell repopulation capacities after multiple cycles revealed (cohort 2) a comparable repopulation pattern after each cycle with no substantial further impact on memory B cells. CONCLUSIONS A single therapy with RTX leads to long-term changes in the memory B-cell compartment particularly in pre-switch memory B cells. Multiple cycles of RTX show a comparable repopulation pattern after each cycle with no additional cumulative effect on memory B cells.
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Affiliation(s)
- Petra Roll
- Department of Medicine II, Rheumatology and Clinical Immunology, University of Würzburg, Würzburg, Germany
| | - Zafar Mahmood
- Department of Medicine II, Rheumatology and Clinical Immunology, University of Würzburg, Würzburg, Germany
| | - Khalid Muhammad
- Department of Medicine II, Rheumatology and Clinical Immunology, University of Würzburg, Würzburg, Germany
| | - Martin Feuchtenberger
- Department of Medicine II, Rheumatology and Clinical Immunology, University of Würzburg, Würzburg, Germany
| | - Thomas Dörner
- Charité, Universitätsmedizin Berlin and DRFZ Berlin, Germany
| | - Hans-Peter Tony
- Department of Medicine II, Rheumatology and Clinical Immunology, University of Würzburg, Würzburg, Germany
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Meiners PM, Arends S, Meijer JM, Moerman RV, Spijkervet FKL, Vissink A, Bootsma H. Efficacy of retreatment with rituximab in patients with primary Sjögren's syndrome. Clin Exp Rheumatol 2015; 33:443-444. [PMID: 25897541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/19/2015] [Indexed: 06/04/2023]
Affiliation(s)
- Petra M Meiners
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Suzanne Arends
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Jiska M Meijer
- Department of General Practice, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Rada V Moerman
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Fred K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, The Netherlands
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Usami M, Kuroda H, Shimoyama S, Yoshida M, Yamada M, Abe T, Sakurai T, Fujii S, Maeda M, Wakabayashi Y, Tsukamoto K, Fujita M, Kanari Y, Takada K, Kato J. [A case of primary testicular diffuse large B-cell lymphoma with a p53 gene point mutation]. Gan To Kagaku Ryoho 2015; 42:613-616. [PMID: 25981657] [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: 06/04/2023]
Abstract
A 52-year-old man with bilateral swelling in the scrotum was referred to the department of urology in our hospital in January 2013. Pathological examination of the scrotum revealed diffuse large B-cell lymphoma(DLBCL). Immunohistochemical staining revealed p53 overexpression, and polymerase chain reaction-single strand conformation polymorphism(PCRSSCP) revealed a point mutation in exon 7 of the p53 gene. Rituximab plus cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisolone(R-CHOP)therapy and intrathecal prophylaxis were initiated. After three courses of R-CHOP therapy, high-dose cytarabine was administered, followed by peripheral blood stem cell harvesting. Busulfan, etoposide, and Ara-C(BEA)therapy was then administered, followed by autologous peripheral blood stem cell transplantation(auto- PBSCT). Primary testicular lymphoma(PTL)is a rare, clinically aggressive form of extranodal lymphoma, and there is a high incidence rate of relapse in the central nervous system(CNS). The vast majority of cases are histologically DLBCL. The p53 mutation is an independent marker of poor prognosis in patients with DLBCL treated with R-CHOP therapy. Our patient has been disease free for 17 months after auto-PBSCT with high-dose chemotherapy, which results in a greater level of penetration into the CNS.
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Affiliation(s)
- Makoto Usami
- Dept. of Gastroenterology and Hematology/Clinical Oncology, Internal Medicine, Steel Memorial Muroran Hospital
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Wysokińska E, Kolak A, Starosławska E, Kieszko D, Kamińska M, Surdyka D, Mocarska A, Burdan F. [Ten years progression-free survival obtained in a patient with mantle cell lymphoma]. Pol Merkur Lekarski 2015; 38:280-282. [PMID: 26039024] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Mantle cell lymphoma is a rare aggressive lymphoma derived from B cells, characterized by rapid progression and subsequent recurrence. It is considered to be an incurable disease, with exception of a certain group of patients treated with an autogenic stem cell transplantation. The mean survival time is three years, after applying the conventional regimen based on COP (cyclophosphamide, vincristine, prednisone) or CHOP chemotherapy (COP + doxorubicin). An addition of rituximab to CHOP regimen significantly prolongs progression-free survival. The present case reports ten years progression-free survival in a female patient with mantle cell lymphoma with baseline clinical stage IVB (MIPI 5), treated with nine courses of CHOP chemotherapy. Rituximab was added from 3 to 8 course. The complete clinical, radiological and histopathological response has been obtained.
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Ghanima W, Khelif A, Waage A, Michel M, Tjønnfjord GE, Romdhan NB, Kahrs J, Darne B, Holme PA. Rituximab as second-line treatment for adult immune thrombocytopenia (the RITP trial): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2015; 385:1653-61. [PMID: 25662413 DOI: 10.1016/s0140-6736(14)61495-1] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Immune thrombocytopenia is characterised by immune-mediated destruction and suboptimum production of platelets. Despite the absence of supporting evidence, rituximab is frequently used off-label in patients with immune thrombocytopenia. We aimed to assess the efficacy of rituximab as compared with placebo as a splenectomy-sparing treatment in patients who were previously treated with corticosteroids. METHODS In this multicentre, randomised, double-masked, placebo-controlled trial, we enrolled corticosteroid unresponsive adult patients (aged ≥18 years) with primary immune thrombocytopenia and a platelet count of less than 30 × 10(9) platelets per L. Patients were randomly assigned (1:1) to four weekly infusions of 375 mg/m(2) rituximab or placebo. Concurrent treatment with corticosteroids only was allowed during the study. The primary endpoint was rate of treatment failure within 78 weeks--a composite of splenectomy or meeting criteria for splenectomy after week 12 if splenectomy was not done, assessed in all patients who received at least one dose of study treatment. Secondary endpoints were response rates, relapse rates, and duration of response. Efficacy endpoints were assessed with the Kaplan-Meier method. Safety endpoints were assessed in all patients who received at least one dose. This trial is registered with ClinicalTrials.gov, number NCT00344149. FINDINGS Between Aug 17, 2006, and June 30, 2011, we enrolled 112 patients. 32 (58%) of 55 patients in the rituximab group and 37 (69%) of 54 patients in the placebo group had treatment failure within 78 weeks (Kaplan-Meier cumulative incidence 46% for rituximab vs 52% for placebo (hazard ratio [HR] 0·89, 95% CI 0·55-1·45; p=0·65). The cumulative incidence of overall response was 81% in the rituximab group versus 73% in the placebo group (p=0·15) and complete response was 58% in the rituximab group versus 50% in the placebo group (p=0·12). Of those achieving an overall response, 68% relapsed in the rituximab group and 78% relapsed in the placebo group, and of those achieving complete response, 50% relapsed in the rituximab group and 62% relapsed in the placebo group. Time to relapse in the rituximab group was longer in patients who achieved overall response (36 vs 7 weeks; p=0·01) but not complete response (76 vs 49 weeks; p=0·19). Rates of bleeding were similar in the two groups (21 [38%] in the rituximab group vs 27 [50%] in the placebo group; p=0·08) as were rates of infection (22 [40%] vs 13 [24%]; p=0·09). INTERPRETATION Despite no reduction in the rate of long-term treatment failure with rituximab, a small benefit cannot be ruled out, as suggested by an apparently longer duration of response and numerically higher response rates with rituximab. FUNDING South-East Regional Health Authority and Østfold Hospital, Norway; Roche, France; and Roche, Norway.
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Affiliation(s)
- Waleed Ghanima
- Department of Medicine, Østfold Hospital Trust, Fredrikstad, Norway; Haematology Department, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Oslo, Norway.
| | | | - Anders Waage
- Department of Medicine, St Olav Hospital, Trondheim, Norway
| | - Marc Michel
- Department of Medicine, Henri Mondor Hospital, Université Paris-Est Creteil, Créteil, France
| | - Geir E Tjønnfjord
- Haematology Department, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | | | - Johannes Kahrs
- Department of Medicine, Østfold Hospital Trust, Fredrikstad, Norway
| | | | - Pål Andrè Holme
- Haematology Department, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Oslo, Norway
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Hu C, Deng C, Zou W, Zhang G, Wang J. The Role of Consolidative Radiotherapy after a Complete Response to Chemotherapy in the Treatment of Diffuse Large B-Cell Lymphoma in the Rituximab Era: Results from a Systematic Review with a Meta-Analysis. Acta Haematol 2015; 134:111-8. [PMID: 25925586 DOI: 10.1159/000370096] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 06/05/2014] [Accepted: 11/25/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The current standard therapy for patients with diffuse large B-cell lymphoma (DLBCL) is rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone (RCHOP). The role of radiotherapy (RT) after complete response (CR) to RCHOP in patients with DLBCL remains unclear. This systematic review with a meta-analysis is an attempt to evaluate this role. METHODS Studies that evaluated RT versus no-RT after CR to RCHOP for DLBCL patients were searched in databases. Hazard ratios (HR) with their respective 95% confidence intervals (CI) were calculated using a random-effects model. RESULTS A total of 4 qualified retrospective studies (633 patients) were included in this review. The results suggested that RT improved overall survival (OS; HR 0.33, 95% CI 0.14-0.77) and progression-free/event-free survival (PFS/EFS; HR 0.24, 95% CI 0.11-0.50) in all patients compared with no-RT. In a subgroup analysis of patients with stage III-IV DLBCL, RT improved PFS/EFS (HR 0.19, 95% CI 0.07-0.51) and local control (HR 0.12, 95% CI 0.03-0.44), with a trend of improving OS (HR 0.35, 95% CI 0.12-1.05). CONCLUSION Consolidation RT could significantly improve outcomes of DLBCL patients who achieved a CR to RCHOP. However, the significance of these results was limited by these retrospective data. Further investigation of the role of consolidation RT in the rituximab era is needed.
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Affiliation(s)
- Chunhong Hu
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, PR China
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Cellina M, Fetoni V, Baron P, Orsi M, Oliva G. Unusual primary central nervous system lymphoma location involving the fourth ventricle and hypothalamus. Neuroradiol J 2015; 28:120-5. [PMID: 25923685 DOI: 10.1177/1971400915576671] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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] [Indexed: 11/15/2022] Open
Abstract
A previously healthy 65-year-old man presented with a two-week history of weight loss, headaches, blurred vision, asthenia and quickly worsening walking impairment. He denied photophobia, neck stiffness, fever, nausea or vomiting.Neurological examination showed global motor slowing, tendency to fall asleep during the clinical examination, generalized weakness against resistance to head and limbs, and osteotendon reflexes present in the upper limbs, but not evoked in the lower limbs. No sensitive deficit or focal neurologic sign was recognizable.Non-contrast multislice computed tomography (MSCT) of the head was performed in the emergency department, showing diffuse periventricular white matter and thalamic mild hyperdensity.Lumbar puncture, blood tests, including serology for HIV and other infections, were negative.On the third day the patient, showing decreased consciousness, underwent magnetic resonance imaging (MRI) with contrast medium injection. MRI revealed the presence of multiple pseudonodular avidly enhancing lesions, supra and infratentorial, crossing the midline, involving the ventricular system, including the fourth ventricle, with extension into the surrounding white matter, the corpus callosum, the thalamus and the hypothamalus.A stereotactic biopsy led to a diagnosis of diffuse large B-cell lymphoma, primarily located in the central nervous system (PCNSL).After the completion of the first phase of treatment (immunotherapy with intravenous Rituximab and corticosteroid), the MRI showed a marked regression of tumor masses.
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Affiliation(s)
| | - Vincenza Fetoni
- Radiology Department, A.O. Fatebenefratelli e Oftalmico, Italy
| | - Pierluigi Baron
- Radiology Department, A.O. Fatebenefratelli e Oftalmico, Italy
| | - Marcello Orsi
- Radiology Department, A.O. Fatebenefratelli e Oftalmico, Italy
| | - Giancarlo Oliva
- Radiology Department, A.O. Fatebenefratelli e Oftalmico, Italy
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Brodowska-Kania D, Rymarz A, Saracyn M, Geisler P, Niemczyk S. [Use of rituximab in the induction of remission of severe, resistant and recurrent form of polyangiitis associated with c-ANCA antibodies - case report]. Pol Merkur Lekarski 2015; 38:216-218. [PMID: 25938389] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Indications for rituximab (RTX) have recently widened. We present a case of 25-years old patient with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis of high disease activity. The patient in severe condition, massive changes of nasal sinuses, with destruction of the orbit bones, with inflammatory infiltrations of the optical nerves and end stage renal disease was admitted to Nephrology Clinic to begin renal replacement therapy (RRT). Chest HRCT reveled changes of "frosted glass", enlarged mediastinal lymphatic nodes and fluid in pleural cavities. C-ANCA antibodies was 23 IU/ml (norm: <2IU/ml). Due to the lack of therapeutic possibilities (exceeded cumulative dose of cyclophosfamide, recurrence of the disease during treatment with mycophenolate mofetil) rituximab was introduced. After proving high expression of CD 20 antigen on the surface of B lymphocytes, two doses of rituximab were administrated (1,0g every two weeks). 8 weeks after the second dose remission of lungs disorders was observed, c- ANCA level decreased to 3,7IU/ml and the granulomatous mass around the optical nerve was stable. 12 months later another supporting dose of rituximab was administrated. Now, 18 months after relapse of the disease patient is in good condition waiting for kidney transplantation. Rituximab is save, well tolerated and effective. Particularly high efficiency of RTX have been observed against lung disorders. No significant remission of granuloma infiltration in the orbits has been noted. Better evaluation of efficiency and safety of rituximab needs further evaluation.
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Affiliation(s)
- Dorota Brodowska-Kania
- Military Institute of Medicine in Warsaw, Poland, Central Clinical Hospital of the Ministry of National Defense, Department of Internal Diseases, Nephrology and Dialysis
| | - Aleksandra Rymarz
- Military Institute of Medicine in Warsaw, Poland, Central Clinical Hospital of the Ministry of National Defense, Department of Internal Diseases, Nephrology and Dialysis
| | - Marek Saracyn
- Military Institute of Medicine in Warsaw, Poland, Central Clinical Hospital of the Ministry of National Defense, Department of Internal Diseases, Nephrology and Dialysis
| | - Piotr Geisler
- Military Institute of Medicine in Warsaw, Poland, Central Clinical Hospital of the Ministry of National Defense, Department of Internal Diseases, Nephrology and Dialysis
| | - StanisŁaw Niemczyk
- Military Institute of Medicine in Warsaw, Poland, Central Clinical Hospital of the Ministry of National Defense, Department of Internal Diseases, Nephrology and Dialysis
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Dabaja BS, Vanderplas AM, Crosby-Thompson AL, Abel GA, Czuczman MS, Friedberg JW, Gordon LI, Kaminski M, Niland J, Millenson M, Nademanee AP, Zelenetz A, LaCasce AS, Rodriguez MA. Radiation for diffuse large B-cell lymphoma in the rituximab era: analysis of the National Comprehensive Cancer Network lymphoma outcomes project. Cancer 2015; 121:1032-9. [PMID: 25492236 PMCID: PMC5531172 DOI: 10.1002/cncr.29113] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 05/07/2014] [Revised: 08/26/2014] [Accepted: 09/25/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND The role of consolidation radiotherapy was examined for patients with diffuse large B-cell lymphoma who were treated at institutions of the National Comprehensive Cancer Network during the rituximab era. METHODS Failure-free survival (FFS) and overall survival (OS) were analyzed in terms of patient and treatment characteristics. Potential associations were investigated with univariate and multivariate survival analysis and matched pair analysis. RESULTS There were 841 patients, and most (710 or 84%) received 6 to 8 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP); 293 (35%) received consolidation radiation therapy (RT). Failure occurred for 181 patients: 126 patients (70%) who did not receive RT and 55 patients (30%) who did. At 5 years, both OS and FFS rates were better for patients who had received RT versus those who did not (OS, 91% vs 83% [P = .01]; FFS, 83% vs 76% [P = .05]). A matched pair analysis (217 pairs matched by age, stage, International Prognostic Index [IPI] score, B symptoms, disease bulk, and response to chemotherapy) showed that the receipt of RT improved OS (hazard ratio [HR], 0.53 [P = .07]) and FFS (HR, 0.77 [P = .34]) for patients with stage III/IV disease, but too few events took place among those with stage I/II disease for meaningful comparisons (HR for OS, 0.94 [P = .89]; HR for FFS, 1.81 [P = .15]). A multivariate analysis suggested that the IPI score and the response to chemotherapy had the greatest influence on outcomes. CONCLUSIONS There was a trend of higher OS and FFS rates for patients who had received consolidation RT after R-CHOP (especially for patients with stage III/IV disease), but the difference did not reach statistical significance.
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Affiliation(s)
- Bouthaina S Dabaja
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
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Barbarov I, Koren-Michowitz M, Schiby G, Portnoy O, Livingstone D, Segal G. Fulminant HHV-8 associated Castleman's disease in a non-HIV, Kaposi sarcoma patient with borderline hemophagocytic syndrome. Isr Med Assoc J 2015; 17:253-255. [PMID: 26040056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
MESH Headings
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antiviral Agents/administration & dosage
- Castleman Disease/complications
- Castleman Disease/diagnosis
- Castleman Disease/drug therapy
- Castleman Disease/physiopathology
- Disease Progression
- Fatal Outcome
- Ganciclovir/administration & dosage
- Glucocorticoids/administration & dosage
- Herpesvirus 8, Human/isolation & purification
- Humans
- Immunologic Factors/administration & dosage
- Liver Failure/etiology
- Lymph Nodes/pathology
- Lymphohistiocytosis, Hemophagocytic/complications
- Lymphohistiocytosis, Hemophagocytic/diagnosis
- Lymphohistiocytosis, Hemophagocytic/drug therapy
- Lymphohistiocytosis, Hemophagocytic/physiopathology
- Male
- Middle Aged
- Renal Insufficiency/etiology
- Rituximab
- Sarcoma, Kaposi/complications
- Sarcoma, Kaposi/drug therapy
- Sarcoma, Kaposi/physiopathology
- Sarcoma, Kaposi/virology
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50
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Rohlfing S, Aurich M, Schöning T, Ho AD, Witzens-Harig M. Nonpegylated Liposomal Doxorubicin as a Component of R-CHOP Is an Effective and Safe Alternative to Conventional Doxorubicin in the Treatment of Patients With Diffuse Large B-Cell Lymphoma and Preexisting Cardiac Diseases. Clin Lymphoma Myeloma Leuk 2015; 15:458-63. [PMID: 25899891 DOI: 10.1016/j.clml.2015.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 03/12/2015] [Accepted: 03/18/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The aim of this retrospective analysis was to investigate the efficacy and safety of nonpegylated liposomal doxorubicin (NPLD) as part of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) in patients with diffuse large B-cell lymphoma (DLBCL) and preexisting cardiac diseases. PATIENTS AND METHODS Twenty-five patients were evaluated, median age was 73 (range 24-85) years, 23 patients received NPLD as part of their first-line therapy. Most patients suffered from more than 1 cardiac disease and in 14 patients left ventricular ejection fraction (LVEF) was reduced. One hundred nineteen cycles of NPLD were applied with a median of 5 (range 2-8) cycles per patient. Median dose per cycle was 95 mg (50 mg/m(2)). RESULTS The overall response rate was 96% (44% complete remission, 52% partial remission). After a median follow-up of 23 months, 4 patients had disease relapse. Seven patients died, translating to an estimated 3-year progression-free and overall survival of 66% and 73%, respectively. Reasons for death were progressive disease or infection in 2 patients each and cardiovascular disease in 3 patients. After chemotherapy, LVEF decreased significantly in 28% and improved in 12% of patients, whereas median LVEF did not change (51% vs. 50%). No higher frequencies of decreased LVEF was observed in the group of patients with preexisting reduced LVEF. Five adverse events induced therapy termination: 2 myocardial infarctions, 2 pneumonias, and 1 reduced condition. No hand-foot-syndrome was observed. CONCLUSION NPLD as a component of R-CHOP is an effective treatment in patients with DLBCL and preexisting cardiac diseases, whereas cardiac events were observed in 36% of patients in this cardiac high-risk group. However, these results need to be confirmed in a prospective randomized trial.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/pharmacology
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/pharmacology
- Cyclophosphamide/therapeutic use
- Disease-Free Survival
- Doxorubicin/administration & dosage
- Doxorubicin/analogs & derivatives
- Doxorubicin/pharmacology
- Doxorubicin/therapeutic use
- Female
- Heart Diseases/drug therapy
- Humans
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Polyethylene Glycols/administration & dosage
- Polyethylene Glycols/pharmacology
- Polyethylene Glycols/therapeutic use
- Prednisone/administration & dosage
- Prednisone/pharmacology
- Prednisone/therapeutic use
- Retrospective Studies
- Rituximab
- Treatment Outcome
- Vincristine/administration & dosage
- Vincristine/pharmacology
- Vincristine/therapeutic use
- Young Adult
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Affiliation(s)
- Sarah Rohlfing
- Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany.
| | - Matthias Aurich
- Department of Cardiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Tilman Schöning
- Pharmacy, University Hospital of Heidelberg, Heidelberg, Germany
| | - Anthony D Ho
- Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Mathias Witzens-Harig
- Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany
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