The ECHELON-2 Trial: 5-year results of a randomized, phase 3 study of brentuximab vedotin with chemotherapy for CD30-positive peripheral T-cell lymphoma

Background:

For patients with peripheral T-cell lymphoma (PTCL), outcomes using frontline treatment with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP-like therapy are typically poor. The ECHELON-2 study demonstrated that brentuximab vedotin plus cyclophosphamide, doxorubicin, and prednisone (A+CHP) exhibited statistically superior progression-free survival (PFS) per independent central review and improvements in overall survival versus CHOP for the frontline treatment of patients with systemic anaplastic large cell lymphoma or other CD30-positive PTCL.

Patients and methods:

ECHELON-2 is a double-blind, double-dummy, randomized, placebo-controlled, active-comparator phase III study. We present an exploratory update of the ECHELON-2 study, including an analysis of 5-year PFS per investigator in the intent-to-treat analysis group.

Results:

A total of 452 patients were randomized (1 : 1) to six or eight cycles of A+CHP (N = 226) or CHOP (N = 226). At median follow-up of 47.6 months, 5-year PFS rates were 51.4% [95% confidence interval (CI): 42.8% to 59.4%] with A+CHP versus 43.0% (95% CI: 35.8% to 50.0%) with CHOP (hazard ratio = 0.70; 95% CI: 0.53–0.91), and 5-year overall survival (OS) rates were 70.1% (95% CI: 63.3% to 75.9%) with A+CHP versus 61.0% (95% CI: 54.0% to 67.3%) with CHOP (hazard ratio = 0.72; 95% CI: 0.53–0.99). Both PFS and OS were generally consistent across key subgroups. Peripheral neuropathy was resolved or improved in 72% (84/117) of patients in the A+CHP arm and 78% (97/124) in the CHOP arm. Among patients who relapsed and subsequently received brentuximab vedotin, the objective response rate was 59% with brentuximab vedotin retreatment after A+CHP and 50% with subsequent brentuximab vedotin after CHOP.

Conclusions:

In this 5-year update of ECHELON-2, frontline treatment of patients with PTCL with A+CHP continues to provide clinically meaningful improvement in PFS and OS versus CHOP, with a manageable safety profile, including continued resolution or improvement of peripheral neuropathy.

Effect of nitrogen fertiliser on the rate of lipid peroxidation of different maize hybrids in a long-term multifactorial experiment

The presented research aimed to confirm that the differences in the lipid peroxidation of three maize (Zea mays L.) hybrids with different genotypes and maturity are due to different nitrogen levels, which was observed based on the amount of malondialdehyde (MDA) measured in the leaves at the main phenological stages of plants. The experiments were performed in a multi-factorial long term fertilisation field trial. In the study, phosphorus and potassium were constantly provided at the optimal level for the plants. The phosphorus and potassium fertilisation were applied in autumn. However, N levels varied from 0 to 300 kg ha−1. Sampling was done at different growth stages 5 times during the growing season (4 leaves, 6 leaves, 8 leaves, 14 leaves, silking). The 300 kg ha−1 N (dose 3) resulted in a significant increase in lipid peroxidation (MDA level), but not a statistically significant difference between the control (dose 1) and the 120 kg ha−1 (dose 2) N doses. The H1 hybrid had the lowest level of lipid peroxidation at the first sampling date. High volume nitrogen fertilisation (dose 3: 300 kg ha−1) increased lipid peroxidation in the hybrids. Averaging the values obtained for the same hybrid at the different sampling times, the medium (dose 2) 120 kg ha−1 N treatment had no significant effect on the lipid peroxidation of the hybrids compared to the values of the control plants. Based on the lipid peroxidation response of the hybrids to N treatment, the exact N dose inflection point can be determined to make the fertiliser utilisation of plants more efficient. Based on our results, we found that inadequate, low (120 kg ha−1) or high (300 kg ha−1) nitrogen fertilisation could affect the MDA levels of plants, thereby affecting the functioning of the lipid peroxidation mechanism.

Evaluation of Mannose-Binding Lectin is a Useful Approach to Predict the Risk of Infectious Complications Following Autologous Hematopoietic Stem Cell Transplantation

Hematopoietic stem cell transplantation (HSCT) associated immunocompromised state carries high risk of infectious complications. Mannose-binding lectin (MBL) is an acute phase protein involved in innate immune response. Serum MBL level is genetically determined and quite stable. According to literature, significant association was shown between low MBL concentrations and serious infections. The association between serum MBL level and frequency and severity of infections was studied in 186 patients following autologous HSCT. Double-monoclonal antibody sandwich enzyme-linked immunosorbent assay was used to determine MBL antigen level in sera. MBL levels were measured around 100 days following transplantation, in a period without active infection. Twenty-one patients (11%) were MBL deficient. The median time of first infection and number of infections during the first year post-transplantation were not significantly different between patients with MBL deficiency and those without MBL deficiency. The occurrence and number of infections after HSCT correlated with the MBL/C-reactive protein ratio. The number of severe infections was not higher among those with MBL deficiency. The occurrence of infections after the pre-engraftment period during the first year post-transplantation was significantly different in patient groups separated by MBL cut-off level. The MBL/C-reactive protein ratio might be a useful marker of infectious complications. MBL measurement may be helpful in antibiotic treatment. In case of MBL deficiency, earlier and more intensive treatment may be indicated.