1
|
Pettengell R, Uddin R, Boumendil A, Johnson R, Metzner B, Martín A, Romejko-Jarosinska J, Bence-Bruckler I, Giri P, Niemann CU, Robinson SP, Kimby E, Schmitz N, Dreger P, Goldstone AH, Montoto S. Durable benefit of rituximab maintenance post-autograft in patients with relapsed follicular lymphoma: 12-year follow-up of the EBMT lymphoma working party Lym1 trial. Bone Marrow Transplant 2021; 56:1413-1421. [PMID: 33452448 DOI: 10.1038/s41409-020-01182-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 10/12/2020] [Accepted: 11/30/2020] [Indexed: 01/16/2023]
Abstract
We report the 12-year follow-up of the prospective randomized EBMT LYM1 trial to determine whether the benefit of brief duration rituximab maintenance (RM) on progression-free survival (PFS) in patients with relapsed follicular lymphoma (FL) receiving an autologous stem cell transplant (ASCT) is sustained. One hundred and thirty-eight patients received RM with or without purging. The median follow-up after random assignment is 12 years (range 10-13) for the whole series. The 10-year PFS after ASCT is 47% (95% CI 40-54) with only 4 patients relapsing after 7.5 years. RM continues to significantly improve 10-year PFS after ASCT in comparison with NM [P = 0.002; HR 0.548 (95% CI 0.38-0.80)]. Ten-year non-relapse mortality (NRM) was not significantly different between treatment groups (7% overall). 10-year overall survival (OS) after ASCT was 75% (69-81) for the whole series, with no significant differences according to treatment sub-groups. 10-year OS for patients who progressed within 24 months (POD24T) was 60%, in comparison with 85% for patients without progression. Thus the benefit of rituximab maintenance after ASCT on relapse prevention is sustained at 12 years, suggesting that RM adds to ASCT-mediated disease eradication and may enhance the curative potential of ASCT.
Collapse
Affiliation(s)
- R Pettengell
- Institute of Medical & Biomedical Education, St George's University of London, London, United Kingdom.
| | - R Uddin
- EBMT Clinical Trials Office, European Society for Blood and Marrow Transplantation, London, United Kingdom
| | - A Boumendil
- Statistics, European Society for Blood and Marrow Transplantation, Paris, France
| | - R Johnson
- Department of Haematology, St James's University Hospital, Leeds, United Kingdom
| | - B Metzner
- University Clinic for Internal Medicine, Oncology and Haematology, Klinikum Oldenburg, Oldenburg, Germany
| | - A Martín
- Hematology Department, Hospital Universitario de Salamanca, IBSAL, CIBERONC, Salamanca, Spain
| | - J Romejko-Jarosinska
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw, Poland
| | | | - P Giri
- Haematology, Royal Adelaide Hospital, Adelaide, Southern Australia, Australia
| | - C U Niemann
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - S P Robinson
- Department of Haematology, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - E Kimby
- Department of Hematology, Karolinska Institute, Stockholm, Sweden
| | - N Schmitz
- Department of Internal Medicine A, University Hospital Muenster, Muenster, Germany
| | - P Dreger
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - A H Goldstone
- University College London Hospital, London, United Kingdom
| | - S Montoto
- Department of Haemato-oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| |
Collapse
|
2
|
McMillan AK, Phillips EH, Kirkwood AA, Barrans S, Burton C, Rule S, Patmore R, Pettengell R, Ardeshna KM, Lawrie A, Montoto S, Paneesha S, Clifton-Hadley L, Linch DC. Favourable outcomes for high-risk diffuse large B-cell lymphoma (IPI 3-5) treated with front-line R-CODOX-M/R-IVAC chemotherapy: results of a phase 2 UK NCRI trial. Ann Oncol 2020; 31:1251-1259. [PMID: 32464282 PMCID: PMC7487775 DOI: 10.1016/j.annonc.2020.05.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 12/28/2022] Open
Abstract
Background Outcomes for patients with high-risk diffuse large B-cell lymphoma (DLBCL) treated with R-CHOP chemotherapy are suboptimal but, to date, no alternative regimen has been shown to improve survival rates. This phase 2 trial aimed to assess the efficacy of a Burkitt-like approach for high-risk DLBCL using the dose-intense R-CODOX-M/R-IVAC regimen. Patients and methods Eligible patients were aged 18–65 years with stage II–IV untreated DLBCL and an International Prognostic Index (IPI) score of 3–5. Patients received alternating cycles of CODOX-M (cyclophosphamide, vincristine, doxorubicin and high-dose methotrexate) alternating with IVAC chemotherapy (ifosfamide, etoposide and high-dose cytarabine) plus eight doses of rituximab. Response was assessed by computed tomography after completing all four cycles of chemotherapy. The primary end point was 2-year progression-free survival (PFS). Results A total of 111 eligible patients were registered; median age was 50 years, IPI score was 3 (60.4%) or 4/5 (39.6%), 54% had a performance status ≥2 and 9% had central nervous system involvement. A total of 85 patients (76.6%) completed all four cycles of chemotherapy. There were five treatment-related deaths (4.3%), all in patients with performance status of 3 and aged >50 years. Two-year PFS for the whole cohort was 67.9% [90% confidence interval (CI) 59.9–74.6] and 2-year overall survival was 76.0% (90% CI 68.5–82.0). The ability to tolerate and complete treatment was lower in patients with performance status ≥2 who were aged >50 years, where 2-year PFS was 43.5% (90% CI 27.9–58.0). Conclusions This trial demonstrates that R-CODOX-M/R-IVAC is a feasible and effective regimen for the treatment of younger and/or fit patients with high-risk DLBCL. These encouraging survival rates demonstrate that this regimen warrants further investigation against standard of care. Trial Registration ClinicalTrials.gov (NCT00974792) and EudraCT (2005-003479-19). R-CODOX-M/R-IVAC is an effective regimen for treatment of high-risk DLBCL and high-grade B-cell lymphoma (IPI score 3–5). Treatment was well tolerated in patients aged <50 years, or aged 50–65 with performance status 0 or 1. The 2-year PFS was 67.9% (90% CI: 59.9–74.6) for the whole cohort. This regimen warrants further evaluation against standard of care in high-risk DLBCL.
Collapse
Affiliation(s)
- A K McMillan
- Haematology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - E H Phillips
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK; Division of Cancer Sciences, University of Manchester and The Christie Hospital NHS Trust, Manchester, UK
| | - A A Kirkwood
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - S Barrans
- HMDS, St James' University Hospital, Leeds, UK
| | - C Burton
- HMDS, St James' University Hospital, Leeds, UK
| | - S Rule
- Plymouth University Medical School, Plymouth, UK
| | - R Patmore
- Haematology Department, Castle Hill Hospital, Hull, UK
| | - R Pettengell
- Clinical Sciences, St George's University of London, London, UK
| | - K M Ardeshna
- Haematology Department, University College Hospital London, London, UK
| | - A Lawrie
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - S Montoto
- Centre for Haemato-oncology, Barts Health NHS Trust, London, UK
| | - S Paneesha
- Haematology Department, Heart of England NHS Trust, Birmingham, UK
| | - L Clifton-Hadley
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - D C Linch
- Haematology Department, University College Hospital London, London, UK; UCL Cancer Institute, University College London, UK
| |
Collapse
|
3
|
Hathiramani S, Pettengell R, Moir H, Younis A. Lymphoma survivors' experience of participation in a home-based intervention post-chemotherapy. Qual Life Res 2019; 28:2951-2955. [PMID: 31273623 PMCID: PMC6803568 DOI: 10.1007/s11136-019-02244-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2019] [Indexed: 12/14/2022]
Abstract
Purpose Further research on patient experience and involvement is recommended in order to develop evidence-based and meaningful care pathways for lymphoma survivors. This study aims to explore the experience of a sample of lymphoma survivors participating in a home-based intervention following chemotherapy. Methods Eligible participants who completed a 12-week home-based intervention were invited to complete the End of Study Questionnaire designed to explore perceptions, preferences and barriers to participation. Content analysis was used to generate codes, describe frequencies and identify themes. Results Participating in a home-based intervention post-treatment was a positive experience overall, and aided recovery in this sample of lymphoma survivors (n = 35). Participants felt the programme provided structure, motivation and liked contact with the researcher. Participants highlighted their need for advice on healthy lifestyle, diet in particular. Conclusions Lymphoma survivors in this study reported participation in a home-based intervention following treatment beneficial and aided recovery. Implications for cancer survivors A large proportion of lymphoma survivors would benefit from a rehabilitation intervention post-chemotherapy. Intervention programmes should include follow-ups to monitor progress and provide support and motivation. Health professionals should recommend healthy lifestyle guidelines to survivors on completion of treatment or refer patients to appropriate services for rehabilitation and advice.
Collapse
Affiliation(s)
- Suchita Hathiramani
- Faculty of Health, Social Care & Education, Kingston and St. George's University of London, Cranmer Terrace, London, UK.
| | - R Pettengell
- Haematology and Medical Oncology, St. George's Hospital, St. George's Healthcare NHS Trust, Tooting, London, UK
| | - H Moir
- Faculty of Science, Engineering and Computing, Kingston University London, Kingston upon Thames, Surrey, UK
| | - A Younis
- Faculty of Health, Social Care & Education, Kingston and St. George's University of London, Cranmer Terrace, London, UK
| |
Collapse
|
4
|
Radford J, Connors J, Younes A, Gallamini A, Ansell S, Kim W, Cheong J, Flinn I, Kalakonda N, Kaminski M, Pettengell R, Onsum M, Josephson N, Kuroda S, Liu R, Miao H, Gautam A, Trepicchio W, Sureda A. EXPLORATORY BIOMARKER ANALYSIS IN THE PH 3 ECHELON-1 STUDY: WORSE OUTCOME WITH ABVD IN PATIENTS WITH ELEVATED BASELINE LEVELS OF SCD30 AND TARC. Hematol Oncol 2019. [DOI: 10.1002/hon.99_2630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- J. Radford
- Department of Medical Oncology; University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre; Manchester United Kingdom
| | - J.M. Connors
- Centre for Lymphoid Cancer; British Columbia Cancer Centre for Lymphoid Cancer; Vancouver Canada
| | - A. Younes
- Division of Hematologic Oncology; Memorial Sloan Kettering Cancer Center; New York United States
| | - A. Gallamini
- Research; Innovation and Statistics Department, A Lacassagne Cancer Centre; Nice France
| | - S.M. Ansell
- Department of Medicine; Mayo Clinic; Rochester United States
| | - W.S. Kim
- Hematology-Oncology; Samsung Medical Center; Seoul Republic of Korea
| | - J. Cheong
- Division of Hematology; Department of Internal Medicine, Yonsei University College of Medicine; Seoul Republic of Korea
| | - I. Flinn
- Department of Oncology; Sarah Cannon Research Institute; Nashville United States
| | - N. Kalakonda
- Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - M. Kaminski
- Internal Medicine; University of Michigan; Ann Arbor United States
| | - R. Pettengell
- Haematology; St George's Hospital; London United Kingdom
| | - M. Onsum
- Biomarkers; Seattle Genetics, Inc.; Bothell United States
| | - N. Josephson
- Clinical Development; Seattle Genetics, Inc.; Bothell United States
| | - S. Kuroda
- Biostatistics; Takeda Development Center Japan, Takeda Pharmaceutical Company Limited; Osaka Japan
| | - R. Liu
- Biostatistics; Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited; Cambridge United States
| | - H. Miao
- OTAU Clinical Research; Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited; Cambridge United States
| | - A. Gautam
- Global Medical Affairs; Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited; Cambridge United States
| | - W.L. Trepicchio
- Translational and Biomarker Research; Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited; Cambridge United States
| | - A. Sureda
- Clinical Hematology; Institut Català d'Oncologia - Hospital Duran i Reynals; Barcelona Spain
| |
Collapse
|
5
|
El-Sharkawi D, Sharma S, Cook L, Hanley B, Johnston R, Arasaretnam A, Lazana I, Greaves P, Parkinson A, Peng Y, Kassam S, Peacock V, Kaczmarski R, Bower M, Cheung B, De Lord C, Cross M, Vroobel K, Wotherspoon A, Aldridge F, Khwaja J, Sharma B, Cwynarski K, Pettengell R, Chau I, Cunningham D, Naresh K, Iyengar S. COMPARISON OF OUTCOMES BETWEEN PATIENTS WITH MYC
REARRANGED DLBCL AND DOUBLE/ TRIPLE HIT HIGH-GRADE B CELL LYMPHOMA: A PAN-LONDON RETROSPECTIVE REVIEW. Hematol Oncol 2019. [DOI: 10.1002/hon.11_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- D. El-Sharkawi
- Haematology; Royal Marsden Hospital; Sutton United Kingdom
| | - S. Sharma
- Haematology; Royal Marsden Hospital; Sutton United Kingdom
| | - L. Cook
- Haematology; Hammersmith Hospital; London United Kingdom
| | - B. Hanley
- Haematology; Hammersmith Hospital; London United Kingdom
| | - R. Johnston
- Haematology; Royal Sussex County Hospital; Brighton United Kingdom
| | - A. Arasaretnam
- Haematology; Royal Sussex County Hospital; Brighton United Kingdom
| | - I. Lazana
- Haematology; King's College Hospital; London United Kingdom
| | - P. Greaves
- Haematology; Queen's Hospital; Romford United Kingdom
| | - A. Parkinson
- Haematology; Queen's Hospital; Romford United Kingdom
| | - Y. Peng
- Haematology; St George's University Hospitals NHS Foundation Trust; London United Kingdom
| | - S. Kassam
- Haematology; King's College Hospital; London United Kingdom
| | - V. Peacock
- Haematology; King's College Hospital; London United Kingdom
| | - R. Kaczmarski
- Haematology; Hillingdon Hospital; Uxbridge United Kingdom
| | - M. Bower
- Haematology; Chelsea and Westminster Hospital; London United Kingdom
| | - B. Cheung
- Haematology; Croydon University Hospital; Croydon United Kingdom
| | - C. De Lord
- Haematology; St Helier Hospital; Carshalton United Kingdom
| | - M. Cross
- Haematology; Royal Marsden Hospital; Sutton United Kingdom
| | - K. Vroobel
- Histopathology; Royal Marsden Hospital; Sutton United Kingdom
| | - A. Wotherspoon
- Histopathology; Royal Marsden Hospital; Sutton United Kingdom
| | - F. Aldridge
- Clinical Cytogenetics; Royal Marsden Hospital; Sutton United Kingdom
| | - J. Khwaja
- Haematology; University College Hospital; London United Kingdom
| | - B. Sharma
- Radiology; Royal Marsden Hospital; Sutton United Kingdom
| | - K. Cwynarski
- Haematology; University College Hospital; London United Kingdom
| | - R. Pettengell
- Haematology; St George's University Hospitals NHS Foundation Trust; London United Kingdom
| | - I. Chau
- Department of Medicine; Royal Marsden Hospital; Sutton United Kingdom
| | - D. Cunningham
- Department of Medicine; Royal Marsden Hospital; Sutton United Kingdom
| | - K. Naresh
- Histopathology; Hammersmith Hospital; Hammersmith United Kingdom
| | - S. Iyengar
- Haematology; Royal Marsden Hospital; Sutton United Kingdom
| |
Collapse
|
6
|
Hathiramani S, Pettengell R, Moir H, Younis A. Relaxation and Exercise in Lymphoma Survivors (REIL Study): A Randomised Clinical Trial Protocol. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.64900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Cancer survivors commonly report ongoing physical and psychological needs and adverse effects due to disease and treatment exposures including fatigue, pain, depression and decreased quality of life (QoL). Both relaxation and exercise interventions have demonstrated a positive effect on these symptoms. However these benefits have been relative to a control group, and there has been a call for further intervention studies in survivors to move beyond wait-list control groups and to compare with active control or other empirically supported interventions, such as comparison of relaxation to exercise intervention, to determine which is more beneficial. Aim: This paper presents the REIL (Relaxation and Exercise In Lymphoma) study protocol using recommended SPIRIT 2013 guidelines. The primary aim of the REIL Study is to compare the effect of two interventions - exercise and relaxation on QoL in a sample of lymphoma patients in remission postchemotherapy. Secondary aims are to investigate the effects of the two interventions on body composition, cardiovascular status, pulmonary function, muscle strength, functional exercise capacity, well-being and psychological status; and explore perceptions about participation in the posttreatment intervention program. Methods: Eligible participants (n=36) will be randomized to an exercise or relaxation home-based program to perform at least three times per week. The primary outcome measure is QoL, assessed by the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORTC QLQ-C30). Secondary outcome measures include body composition, cardiovascular status, pulmonary function, strength, functional exercise capacity, well-being and psychological status. Total duration of the study will be 12 weeks and outcome measures will be assessed at baseline, 6 weeks and at the end of the study. Results: Results from this study will inform development of effective care pathways for the increasing population of cancer survivors in general, and lymphoma in particular. It is anticipated that preliminary results from this study will be available by October 2018. Conclusion: Although it is well documented that cancer survivors commonly suffer from consequences of treatment which have a negative impact on their QoL, there are currently no recommended care pathways following completion of primary medical treatment. Evidence suggests that both relaxation and exercise can significantly improve ongoing symptoms in cancer survivors, but there is no consensus on which intervention is more effective. Results from the REIL study will aid in the development of evidence-based survivorship care pathways for cancer and lymphoma survivors, potentially prevent long-term complications, and help in a smooth transition from being a cancer patient to a fully-functioning member of society. This may lead to reduced use of healthcare resources by this population.
Collapse
Affiliation(s)
- S. Hathiramani
- St. George's University of London, London, United Kingdom
| | - R. Pettengell
- St. George's University of London, London, United Kingdom
| | - H. Moir
- St. George's University of London, London, United Kingdom
| | - A. Younis
- St. George's University of London, London, United Kingdom
| |
Collapse
|
7
|
Pettengell R, Uddin R, Boumendil A, Robinson S, Smith G, Hawkins T, Metzner B, Caballero M, Tilly H, Romejko-Jarosinska J, Bence-Bruckler I, To B, Niemann C, Kimby E, Dreger P, Schmitz N, Goldstone A, Montoto S. DURABLE BENEFIT OF RITUXIMAB MAINTENANCE POST-AUTOGRAFT IN PATIENTS WITH RELAPSED FOLLICULAR LYMPHOMA: 12-YEAR FOLLOW-UP OF THE EBMT LYMPHOMA WORKING PARTY LYM1 TRIAL. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- R. Pettengell
- Institute of Medical & Biomedical Education; St George's University of London; London UK
| | - R. Uddin
- EBMT Clinical Trials Office; European Society for Blood and Marrow Transplantation; London UK
| | - A. Boumendil
- Statistics; European Society for Blood and Marrow Transplantation; Paris France
| | - S.P. Robinson
- Department of Haematology; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - G. Smith
- Department of Haematology; St James's Hospital; Leeds UK
| | - T. Hawkins
- Haematology; Auckland City Hospital; Auckland New Zealand
| | - B. Metzner
- University Clinic for Internal Medicine; Oncology and Haematology, Klinikum Oldenburg; Oldenburg Germany
| | - M.D. Caballero
- Hematology Department, Hospital Universitario de Salamanca; Instituto Biosanitario, IBSAL; Salamanca Spain
| | - H. Tilly
- Haematology; Centre Henri Becquerel; Rouen France
| | - J. Romejko-Jarosinska
- Department of Lymphoproliferative Diseases; Maria Sklodowska-Curie Memorial Institute and Oncology Center; Warsaw Poland
| | | | - B. To
- Haematology; Royal Adelaide Hospital; Adelaide Australia
| | - C. Niemann
- Hematology; Rigshospitalet; Copenhagen Denmark
| | - E. Kimby
- Dept of Hematology; Karolinska Institute; Stockholm Sweden
| | - P. Dreger
- Hematology; University of Heidelberg; Heidelberg Germany
| | - N. Schmitz
- Hematology; Asklepios Hospital St Georg; Hamburg Germany
| | - A.H. Goldstone
- North London Cancer Network; Univ. College London Hospital; London UK
| | - S. Montoto
- Dept. of Haematology; Queen Mary University of London; London UK
| |
Collapse
|
8
|
Georgiev P, Belada D, Dakhil S, Inhorn L, Andorsky D, Liberati A, Beck J, Quick D, Patti C, Sivcheva L, Zaucha J, Pettengell R, Devries T, Dean J, Pavlyuk M, Failloux N, Hübel K. Phase 3 trial of pixantrone plus rituximab versus gemcitabine plus rituximab in treating relapsed/refractory transplant-ineligible aggressive non-Hodgkin's lymphoma. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw375.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
9
|
Pfeil AM, Imfeld P, Pettengell R, Jick SS, Szucs TD, Meier CR, Schwenkglenks M. Trends in incidence and medical resource utilisation in patients with chronic lymphocytic leukaemia: insights from the UK Clinical Practice Research Datalink (CPRD). Ann Hematol 2014; 94:421-9. [PMID: 25219890 DOI: 10.1007/s00277-014-2217-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 09/06/2014] [Indexed: 11/30/2022]
Abstract
Chronic lymphocytic leukaemia (CLL) is the most common leukaemia in European adults. We aimed to evaluate time trends in CLL incidence and medical resource utilisation of CLL patients in the UK. We conducted a retrospective, observational cohort analysis using the UK Clinical Practice Research Datalink (CPRD) comprising mainly primary care data. We included adult patients with newly diagnosed CLL between January 2000 and June 2012. Descriptive and trend analyses of CLL incidence and medical resource utilisation were performed. A total of 2576 patients with CLL met the eligibility criteria. At diagnosis, the majority of patients (71.7 %) were above 65 years of age. The European age-standardised CLL incidence rate in the CPRD was 6.2/100,000 (95 % confidence interval [CI] 6.0, 6.5/100,000) person-years. There was no statistically significant increase over time. The CLL patients had on average 74.6 general practitioner visits during a median follow-up of 3.3 years. Between 2000 and 2012, the average number of recorded hospitalisations and referrals per year corrected for duration of follow-up significantly (p < 0.001) increased by 8.1 % (95 % CI 6.8 %, 9.3 %) and 16.4 % (95 % CI 15.4 %, 17.3 %), respectively. Referrals and hospitalisations in the second year compared to the first year following the CLL diagnosis significantly decreased. CLL incidence rates in the CPRD were stable over the period from 2000 to 2012. Medical resource utilisation in UK primary care was well documented, but further research is needed to describe secondary and tertiary care medical resource utilisation e.g. chemotherapy administration, which is inadequately captured in the CPRD.
Collapse
Affiliation(s)
- A M Pfeil
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | | | | | | | | | | | | |
Collapse
|
10
|
Vulsteke C, Pfeil AM, Schwenkglenks M, Pettengell R, Szucs TD, Lambrechts D, Peeters M, van Dam P, Dieudonné AS, Hatse S, Neven P, Paridaens R, Wildiers H. Impact of genetic variability and treatment-related factors on outcome in early breast cancer patients receiving (neo-) adjuvant chemotherapy with 5-fluorouracil, epirubicin and cyclophosphamide, and docetaxel. Breast Cancer Res Treat 2014; 147:557-70. [PMID: 25168315 DOI: 10.1007/s10549-014-3105-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 08/16/2014] [Indexed: 01/26/2023]
Abstract
To assess the impact of patient-related factors, including genetic variability in genes involved in the metabolism of chemotherapeutic agents, on breast cancer-specific survival (BCSS) and recurrence-free interval (RFI). We selected early breast cancer patients treated between 2000 and 2010 with 4-6 cycles of (neo-)adjuvant 5-fluorouracil, epirubicin, and cyclophosphamide (FEC) or 3 cycles FEC followed by 3 cycles docetaxel. Tumor stage/subtype; febrile neutropenia and patient-related factors such as selected single nucleotide polymorphisms and baseline laboratory parameters were evaluated. Multivariable Cox regression was performed. Of 991 patients with a mean follow-up of 5.2 years, 152 (15.3 %) patients relapsed and 63 (6.4 %) patients died. Advanced stage and more aggressive subtype were associated with poorer BCSS and RFI in multivariable analysis (p < 0.0001). Associations with worse BCSS in multivariable analysis were: homozygous carriers of the rs1057910 variant C-allele in CYP2C9 (hazard ratio [HR] 30.4; 95 % confidence interval [CI] 6.1-151.5; p < 0.001) and higher white blood cell count (WBC) (HR 1.2; 95 % CI 1.0-1.3; p = 0.014). The GT genotype of the ABCB1 variant rs2032582 was associated with better BCSS (HR 0.5; 95 % CI 0.3-0.9, p = 0.021). Following associations with worse RFI were observed: higher WBC (HR 1.1; 95 % CI 1.0-1.2; p = 0.026), homozygous carriers of the rs1057910 variant C-allele in CYP2C9 (HR 10.9; 95 % CI 2.5-47.9; p = 0.002), CT genotype of the CYBA variant rs4673 (HR 1.8; 95 % CI 1.2-2.7; p = 0.006), and G-allele homozygosity for the UGT2B7 variant rs3924194 (HR 3.4; 95 % CI 1.2-9.7, p = 0.023). Patient-related factors including genetic variability and baseline white blood cell count, impacted on outcome in early breast cancer.
Collapse
Affiliation(s)
- C Vulsteke
- Integrated Cancer Center Ghent, AZ Maria Middelares, Ghent, Belgium,
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Pettengell R, Schwenkglenks M, Bacon P, Lawrinson S, Duehrsen U. Pegfilgrastim primary prophylaxis in patients with non-Hodgkin lymphoma: results from an integrated analysis. Hematol Oncol 2011; 29:177-84. [DOI: 10.1002/hon.982] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 11/02/2010] [Accepted: 12/13/2010] [Indexed: 11/07/2022]
|
12
|
Aapro MS, Bohlius J, Cameron DA, Dal Lago L, Donnelly JP, Kearney N, Lyman GH, Pettengell R, Tjan-Heijnen VC, Walewski J, Weber DC, Zielinski C. 2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours. Eur J Cancer 2010; 47:8-32. [PMID: 21095116 DOI: 10.1016/j.ejca.2010.10.013] [Citation(s) in RCA: 735] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 10/18/2010] [Indexed: 10/18/2022]
Abstract
Chemotherapy-induced neutropenia is a major risk factor for infection-related morbidity and mortality and also a significant dose-limiting toxicity in cancer treatment. Patients developing severe (grade 3/4) or febrile neutropenia (FN) during chemotherapy frequently receive dose reductions and/or delays to their chemotherapy. This may impact the success of treatment, particularly when treatment intent is either curative or to prolong survival. In Europe, prophylactic treatment with granulocyte-colony stimulating factors (G-CSFs), such as filgrastim (including approved biosimilars), lenograstim or pegfilgrastim is available to reduce the risk of chemotherapy-induced neutropenia. However, the use of G-CSF prophylactic treatment varies widely in clinical practice, both in the timing of therapy and in the patients to whom it is offered. The need for generally applicable, European-focused guidelines led to the formation of a European Guidelines Working Party by the European Organisation for Research and Treatment of Cancer (EORTC) and the publication in 2006 of guidelines for the use of G-CSF in adult cancer patients at risk of chemotherapy-induced FN. A new systematic literature review has been undertaken to ensure that recommendations are current and provide guidance on clinical practice in Europe. We recommend that patient-related adverse risk factors, such as elderly age (≥65 years) and neutrophil count be evaluated in the overall assessment of FN risk before administering each cycle of chemotherapy. It is important that after a previous episode of FN, patients receive prophylactic administration of G-CSF in subsequent cycles. We provide an expanded list of common chemotherapy regimens considered to have a high (≥20%) or intermediate (10-20%) risk of FN. Prophylactic G-CSF continues to be recommended in patients receiving a chemotherapy regimen with high risk of FN. When using a chemotherapy regimen associated with FN in 10-20% of patients, particular attention should be given to patient-related risk factors that may increase the overall risk of FN. In situations where dose-dense or dose-intense chemotherapy strategies have survival benefits, prophylactic G-CSF support is recommended. Similarly, if reductions in chemotherapy dose intensity or density are known to be associated with a poor prognosis, primary G-CSF prophylaxis may be used to maintain chemotherapy. Clinical evidence shows that filgrastim, lenograstim and pegfilgrastim have clinical efficacy and we recommend the use of any of these agents to prevent FN and FN-related complications where indicated. Filgrastim biosimilars are also approved for use in Europe. While other forms of G-CSF, including biosimilars, are administered by a course of daily injections, pegfilgrastim allows once-per-cycle administration. Choice of formulation remains a matter for individual clinical judgement. Evidence from multiple low level studies derived from audit data and clinical practice suggests that some patients receive suboptimal daily G-CSFs; the use of pegfilgrastim may avoid this problem.
Collapse
Affiliation(s)
- M S Aapro
- Multidisciplinary Oncology Institute, Clinique de Genolier, 1, route du Muids, 1272 Genolier, Switzerland.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Rieger M, Österborg A, Pettengell R, White D, Gill D, Walewski J, Kuhnt E, Loeffler M, Pfreundschuh M, Ho AD. Primary mediastinal B-cell lymphoma treated with CHOP-like chemotherapy with or without rituximab: results of the Mabthera International Trial Group study. Ann Oncol 2010; 22:664-670. [PMID: 20724576 DOI: 10.1093/annonc/mdq418] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The aim of this subgroup analysis of the Mabthera International Trial Group study was to evaluate the impact of chemotherapy and rituximab in primary mediastinal B-cell lymphoma (PMBCL) in comparison to other diffuse large B-cell lymphoma (DLBCL). METHODS Patients were randomly assigned to six cycles of CHOP-like regimens with or without rituximab. RESULTS Of 824 patients enrolled, 87 had PMBCL and 627 other types of DLBCL. Rituximab increased the rates of complete remission (unconfirmed) in both PMBCL (from 54% to 80%, P = 0.015) and DLBCL (from 72% to 87%, P < 0.001). In PMBCL, rituximab virtually eliminated progressive disease (PD) (2.5% versus 24%, P < 0.001), whereas without rituximab, PD was more frequent in PMBCL than in DLBCL (24% versus 10%, P = 0.010). With a median observation time of 34 months, 3-year event-free survival (EFS) was improved by rituximab for PMBCL (78% versus 52%, P = 0.012) and for DLBCL (81% versus 61%, P < 0.001). Overall survival benefit was similar for DLBCL (93% versus 85%, P < 0.001) and PMBCL (89% versus 78%, P = 0.158). CONCLUSION In young patients with PMBCL (age-adjusted International Prognostic Index 0-1), rituximab added to six cycles of CHOP-like chemotherapy increases response rate and EFS to the same extent as other DLBCL. The combination of rituximab with CHOP chemotherapy is an effective treatment in PMBCL with good prognosis features.
Collapse
Affiliation(s)
- M Rieger
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.
| | - A Österborg
- Departments of Oncology, Haematology, Karolinska University Hospital, Stockholm, Sweden
| | | | - D White
- Dalhousie University, Halifax, Nova Scotia for the NCIC Clinical Trials Group, Kingston, Ontario, Canada
| | - D Gill
- Department of Haematology, Princess Alexandra Hospital, Queensland, Australia
| | - J Walewski
- Department of Lymphoma, Maria Sklodowska-Curie Institute and Oncology Centre, Warszawa, Poland
| | - E Kuhnt
- Clinical Trial Centre Leipzig, University of Leipzig, Leipzig
| | - M Loeffler
- Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig
| | | | - A D Ho
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | | |
Collapse
|
14
|
Pettengell R, Schmitz N, Gisselbrecht C, Caballero D, Colombat P, Conde E, Metzner B, Walewski JA, Geisler C, Goldstone A. Randomized study of rituximab in patients with relapsed or resistant follicular lymphoma prior to high-dose therapy as in vivo purging and to maintain remission following high-dose therapy. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
15
|
Pettengell R, Constenla M, Schwenkglenks M. P76 Incidence of febrile neutropenia, chemotherapy delivery and use of colony-stimulating factor in NHL patients of different age groups. Crit Rev Oncol Hematol 2009. [DOI: 10.1016/s1040-8428(09)70114-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
16
|
Pettengell R, Narayanan G, Mendoza FH, Digumarti R, Gomez H, Cernohous P, Gorbatchevsky I. Randomized phase III trial of pixantrone compared with other chemotherapeutic agents for third-line single-agent treatment of relapsed aggressive non-Hodgkin's lymphoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8523 Background: Currently, treatment options for multiply relapsed aggressive NHL are limited, and response rates are disappointing. Pixantrone, a novel aza-anthracenedione with structural similarities to mitoxantrone, has potentially reduced cardiotoxicity and has demonstrated promising clinical activity in phase II studies in heavily pretreated NHL patients. Methods: PIX301 was a controlled, multicenter, open-label phase III study of ≥ third-line treatment of relapsed aggressive (de novo or transformed) NHL. All patients were required to have received ≥ 1 prior anthracycline-containing regimen, with the cumulative doxorubicin-equivalent dose limited to ≤ 450 mg/m2. Randomization was to pixantrone 85 mg/m2 on days 1, 8 and 15 of 28-day cycles, for up to 6 cycles, or to investigator's choice of a single-agent comparator (vinorelbine, oxaliplatin, ifosfamide, etoposide, or mitoxantrone; in the US only, gemcitabine and rituximab were permitted). The primary study endpoint was CR/CRu rate. Secondary objectives included safety, OS, and ORR. Originally planned to enroll 320 patients, PIX301 was amended to 140 patients due to slow enrollment. Results: 140 patients (70 per arm) were randomized. Median age was 60 on the pixantrone arm, 58 on the control arm; patients on both arms had received a median of 3 prior chemotherapeutic regimens. Based on independent review in the ITT population, the CR/CRu rate in patients treated with pixantrone was significantly higher than in those receiving other agents (20.0% vs. 5.7%, p-value = 0.02), and there were no CRs in the control group compared to 8 CRs in the pixantrone group. Conclusions: In this study, single-agent therapy with pixantrone achieved significantly superior CR/CRu and ORR rates in ≥ third-line treatment of relapsed/refractory aggressive NHL. [Table: see text] No significant financial relationships to disclose.
Collapse
Affiliation(s)
- R. Pettengell
- St. George's Hospital, London, United Kingdom; Regional Cancer Center, Thiruvananthapuram, India; Hospital Edgardo Rebagliati Marin, Lima, Peru; Nizam's Institute of Medical Science, Hyderabad, India; Oncocenter, Lima, Peru; CTI, Seattle, WA
| | - G. Narayanan
- St. George's Hospital, London, United Kingdom; Regional Cancer Center, Thiruvananthapuram, India; Hospital Edgardo Rebagliati Marin, Lima, Peru; Nizam's Institute of Medical Science, Hyderabad, India; Oncocenter, Lima, Peru; CTI, Seattle, WA
| | - F. H. Mendoza
- St. George's Hospital, London, United Kingdom; Regional Cancer Center, Thiruvananthapuram, India; Hospital Edgardo Rebagliati Marin, Lima, Peru; Nizam's Institute of Medical Science, Hyderabad, India; Oncocenter, Lima, Peru; CTI, Seattle, WA
| | - R. Digumarti
- St. George's Hospital, London, United Kingdom; Regional Cancer Center, Thiruvananthapuram, India; Hospital Edgardo Rebagliati Marin, Lima, Peru; Nizam's Institute of Medical Science, Hyderabad, India; Oncocenter, Lima, Peru; CTI, Seattle, WA
| | - H. Gomez
- St. George's Hospital, London, United Kingdom; Regional Cancer Center, Thiruvananthapuram, India; Hospital Edgardo Rebagliati Marin, Lima, Peru; Nizam's Institute of Medical Science, Hyderabad, India; Oncocenter, Lima, Peru; CTI, Seattle, WA
| | - P. Cernohous
- St. George's Hospital, London, United Kingdom; Regional Cancer Center, Thiruvananthapuram, India; Hospital Edgardo Rebagliati Marin, Lima, Peru; Nizam's Institute of Medical Science, Hyderabad, India; Oncocenter, Lima, Peru; CTI, Seattle, WA
| | - I. Gorbatchevsky
- St. George's Hospital, London, United Kingdom; Regional Cancer Center, Thiruvananthapuram, India; Hospital Edgardo Rebagliati Marin, Lima, Peru; Nizam's Institute of Medical Science, Hyderabad, India; Oncocenter, Lima, Peru; CTI, Seattle, WA
| |
Collapse
|
17
|
Willis F, Woll P, Theti D, Jamali H, Bacon P, Baker N, Pettengell R. Pegfilgrastim for peripheral CD34+ mobilization in patients with solid tumours. Bone Marrow Transplant 2009; 43:927-34. [DOI: 10.1038/bmt.2008.411] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
18
|
|
19
|
Clamp AR, Ryder WDJ, Bhattacharya S, Pettengell R, Radford JA. Patterns of mortality after prolonged follow-up of a randomised controlled trial using granulocyte colony-stimulating factor to maintain chemotherapy dose intensity in non-Hodgkin's lymphoma. Br J Cancer 2008; 99:253-8. [PMID: 18594529 PMCID: PMC2480980 DOI: 10.1038/sj.bjc.6604468] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The effect of utilising granulocyte colony-stimulating factor (G-CSF) to maintain chemotherapy dose intensity in non-Hodgkin's lymphoma (NHL) on long-term mortality patterns has not been formally evaluated. We analysed prolonged follow-up data from the first randomised controlled trial investigating this approach. Data on 10-year overall survival (OS), progression-free survival (PFS), freedom from progression (FFP) and incidence of second malignancies were collected for 80 patients with aggressive subtypes of NHL, who had been randomised to receive either VAPEC-B chemotherapy or VAPEC-B+G-CSF. Median follow-up was 15.7 years for surviving patients. No significant differences were found in PFS or OS. However, 10-year FFP was better in the G-CSF arm (68 vs 47%, P=0.037). Eleven deaths from causes unrelated to NHL or its treatment occurred in the G-CSF arm compared to five in controls. More deaths occurred from second malignancies (4 vs 2) and cardiovascular causes (5 vs 0) in the G-CSF arm. Although this pharmacovigilance study has insufficient statistical power to draw conclusions and is limited by the lack of data on smoking history and other cardiovascular risk factors, these unique long-term outcome data generate hypotheses that warrant further investigation.
Collapse
Affiliation(s)
- A R Clamp
- Department of Medical Oncology, Cancer Research UK, University of Manchester, Christie Hospital, Wilmslow Rd., Manchester M20 4BX, UK.
| | | | | | | | | |
Collapse
|
20
|
Willis F, Theti D, Dean S, Bacon P, Baker N, Pettengell R. Pegfilgrastim successfully mobilizes megakaryocyte progenitors into the peripheral blood in subjects with solid tumours. Bone Marrow Transplant 2008; 42:167-73. [DOI: 10.1038/bmt.2008.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
21
|
Thomson KJ, Peggs KS, Smith P, Cavet J, Hunter A, Parker A, Pettengell R, Milligan D, Morris EC, Goldstone AH, Linch DC, Mackinnon S. Superiority of reduced-intensity allogeneic transplantation over conventional treatment for relapse of Hodgkin's lymphoma following autologous stem cell transplantation. Bone Marrow Transplant 2008; 41:765-70. [PMID: 18195684 DOI: 10.1038/sj.bmt.1705977] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study compares outcome of reduced-intensity conditioned transplant (RIT) with outcome of conventional non-transplant therapy in patients with Hodgkin's lymphoma relapsing following autograft. There were 72 patients in two groups who had relapsed, and received salvage therapy with chemotherapy+/-radiotherapy. One group (n=38) then underwent alemtuzumab-containing RIT. The second group-historical controls (n=34), relapsing before the advent of RIT-had no further high-dose therapy. This group was required to respond to salvage therapy and live for over 12 months post-relapse, demonstrating potential eligibility for RIT, had this been available. Overall survival (OS) from diagnosis was superior following RIT (48% at 10 years versus 15%; P=0.0014), as was survival from autograft (65% at 5 years versus 15%; P< or =0.0001). For the RIT group, OS at 5 years from allograft was 51%, and in chemoresponsive patients was 58%, with current progression-free survival of 42%. Responses were seen in 8 of 15 patients receiving donor lymphocyte infusions (DLI) for relapse/progression, with durable remission in five patients at median follow-up from DLI of 45 months (28-55). These data demonstrate the potential efficacy of RIT in heavily pre-treated patients whose outlook with conventional therapy is dismal, and provide evidence of a clinically relevant graft-versus-lymphoma effect.
Collapse
Affiliation(s)
- K J Thomson
- Department of Haematology, Royal Free and University College Medical School, London, UK.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Pettengell R, Donatti C, Hoskin P, Poynton C, Kettle PJ, Hancock B, Johnson S, Dyer MJS, Rule S, Walker M, Wild D. The impact of follicular lymphoma on health-related quality of life. Ann Oncol 2007; 19:570-6. [PMID: 18056649 DOI: 10.1093/annonc/mdm543] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine whether there was a relationship between disease activity and health functioning, as measured by a range of patient-reported outcome (PRO) measures in patients with follicular lymphoma (FL). PATIENTS AND METHODS A total of 222 patients with FL were recruited from eight sites across the UK and they completed a number of PRO measures. The participants were analyzed across five disease states: 'active disease-newly diagnosed', 'active disease-relapsed', 'partial response', 'complete response' and 'disease free'. The relationship between these disease states and their level of health functioning was assessed as well as the relationship between being 'on' or 'off' chemotherapy and disease state. RESULTS In terms of health-related quality of life (HRQoL), participants in the relapsed category had the lowest mean physical well-being, emotional well-being, functional well-being and social well-being score. In a regression analysis, the 'active disease-relapsed' group acted as a significant predictor for each PRO variable. In addition, the remission group acted as a significant predictor of high anxiety scores as measured by the Hospital Anxiety and Depression Scale. CONCLUSION The results of this study demonstrate that various aspects of patient-reported health outcomes differ according to disease state in patients with FL. For those patients who have relapsed, they are more likely to experience worse HRQoL and other patient-reported health outcomes than patients newly diagnosed, in partial or complete remission or when completely disease free.
Collapse
Affiliation(s)
- R Pettengell
- Haematology and Oncology, St George's Hospital, London, UK.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Gisselbrecht C, Bethge W, Duarte RF, Gianni AM, Glass B, Haioun C, Martinelli G, Nagler A, Pettengell R, Sureda A, Tilly H, Wilson K. Current status and future perspectives for yttrium-90 ((90)Y)-ibritumomab tiuxetan in stem cell transplantation for non-Hodgkin's lymphoma. Bone Marrow Transplant 2007; 40:1007-17. [PMID: 17922042 DOI: 10.1038/sj.bmt.1705868] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Haematopoietic SCT is currently considered a therapeutic option mainly in relapsed or refractory non-Hodgkin's lymphoma (NHL) owing to high post-transplantation relapse rates and significant toxicity of conventional myeloablative conditioning for allogeneic SCT. Radiolabelled immunotherapy combines the benefits of monoclonal antibody targeting with therapeutic doses of radiation, and is a promising advance in the treatment of malignant lymphomas. It is now under investigation as a component of conditioning prior to SCT, with the aim of improving outcomes following SCT without increasing the toxicity of high-dose chemotherapy pre-transplant conditioning. An expert panel met at a European workshop in November 2006 to review the latest data on radiolabelled immunotherapy in the transplant setting, and its potential future directions, with a focus on (90)Y-ibritumomab tiuxetan. They reviewed data on the combination of standard/high/escalating dose (90)Y-ibritumomab tiuxetan with high-dose chemotherapy, and high/escalating dose (90)Y-ibritumomab tiuxetan as the sole myeloablative agent, prior to autologous SCT, and also (90)Y-ibritumomab tiuxetan as a component of reduced intensity conditioning prior to allogeneic SCT. The preliminary data are highly promising in terms of conditioning tolerability and patient outcomes following transplant; further phase II studies are now needed to consolidate these data and to investigate specific patient populations and NHL subtypes.
Collapse
Affiliation(s)
- C Gisselbrecht
- Institut d'Hématologie, Hôpital Saint-Louis, Paris, France.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Pfreundschuh MG, Hensel M, Cavallin-Stahl E, Vasova I, Kvaloey S, Gill D, Walewski J, Zinzani P, Pettengell R, Kuhnt E. Prognostic significance of maximal tumor size (MTS) in young patients with good-prognosis diffuse large B-cell lymphoma (DLBCL) treated with CHOP-like chemotherapy with and without rituximab: Analysis of the MabThera International Trial Group (MInT) study. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8053 Purpose: To determine the impact of MTS in young (18 to 60 years) patients with DLBCL and aaIPI=0,1. Patients and Methods: Outcome of patients treated with CHOP-like chemotherapy with (R-CHEMO) or without rituximab (CHEMO) was analyzed according to MTS. Results: A Martingale residual analysis revealed a linear negative prognostic impact of MTS on event-free (EFS) and overall (OS) survival. The hazard ratios for MTS per centimeter increase were significant for EFS (1.07; 95%-CI: 1.04–1.11; p<0.001) and OS (1.11; 95%-CI: 1.06–1.16; p<0.001). CHEMO 3-year EFS rates ranged between 78% for MTS <5cm and 41% for MTS >10cm. R-CHEMO 3-year EFS ranged from 83% (MTS <5cm) to 73% (MTS >=10cm). CHEMO 3-year OS rates decreased from 93% (MTS <5cm) to 74% (MTS >=10cm). R-CHEMO 3-year OS decreased from 98% (MTS <5cm) to 85% (MTS >=10cm). With CHEMO, any cut-off point between 5 and 10 cm separated a thus defined “non-bulky” from a “bulky” population with a 3-year EFS difference >20% (p<0.0001) and OS difference >12% (p<0.003), while with R-CHEMO only cut-off points >=10cm separated two populations with a significant EFS difference (9.1%; p=0.047), and cut-off points >=6cm discriminated two populations with a significant OS difference (7.6%-11.3%; p=0.037–0.0009). Conclusion: Due to the linear prognostic impact of MTS on outcome, cut-off points for “bulky” disease can be set rather arbitrarily between 5 and 10cm depending on clinical considerations. Rituximab reduces, but does not eliminate the negative prognostic impact of MTS in young patients with good-prognosis DLBCL. [Table: see text]
Collapse
Affiliation(s)
- M. G. Pfreundschuh
- Universitatskliniken des Saarlandes, Homburg, Germany; Ruprecht-Karls-Universitaet, Heidelberg, Germany; University Hospital, Lund, Sweden; HOK, FN, Brno-Bohunice, Czech Republic; Radiumhospitalet, Oslo, Norway; Princess Alexandra Hospital, Woolloogabba, Australia; Klinika Nowotworow Ukladu Chlonnego, Warszawa, Poland; Policlinico S. Orsola, Bologna, Italy; St. George′s Hospital Medical School, London, United Kingdom; IMISE, Leipzig, Germany
| | - M. Hensel
- Universitatskliniken des Saarlandes, Homburg, Germany; Ruprecht-Karls-Universitaet, Heidelberg, Germany; University Hospital, Lund, Sweden; HOK, FN, Brno-Bohunice, Czech Republic; Radiumhospitalet, Oslo, Norway; Princess Alexandra Hospital, Woolloogabba, Australia; Klinika Nowotworow Ukladu Chlonnego, Warszawa, Poland; Policlinico S. Orsola, Bologna, Italy; St. George′s Hospital Medical School, London, United Kingdom; IMISE, Leipzig, Germany
| | - E. Cavallin-Stahl
- Universitatskliniken des Saarlandes, Homburg, Germany; Ruprecht-Karls-Universitaet, Heidelberg, Germany; University Hospital, Lund, Sweden; HOK, FN, Brno-Bohunice, Czech Republic; Radiumhospitalet, Oslo, Norway; Princess Alexandra Hospital, Woolloogabba, Australia; Klinika Nowotworow Ukladu Chlonnego, Warszawa, Poland; Policlinico S. Orsola, Bologna, Italy; St. George′s Hospital Medical School, London, United Kingdom; IMISE, Leipzig, Germany
| | - I. Vasova
- Universitatskliniken des Saarlandes, Homburg, Germany; Ruprecht-Karls-Universitaet, Heidelberg, Germany; University Hospital, Lund, Sweden; HOK, FN, Brno-Bohunice, Czech Republic; Radiumhospitalet, Oslo, Norway; Princess Alexandra Hospital, Woolloogabba, Australia; Klinika Nowotworow Ukladu Chlonnego, Warszawa, Poland; Policlinico S. Orsola, Bologna, Italy; St. George′s Hospital Medical School, London, United Kingdom; IMISE, Leipzig, Germany
| | - S. Kvaloey
- Universitatskliniken des Saarlandes, Homburg, Germany; Ruprecht-Karls-Universitaet, Heidelberg, Germany; University Hospital, Lund, Sweden; HOK, FN, Brno-Bohunice, Czech Republic; Radiumhospitalet, Oslo, Norway; Princess Alexandra Hospital, Woolloogabba, Australia; Klinika Nowotworow Ukladu Chlonnego, Warszawa, Poland; Policlinico S. Orsola, Bologna, Italy; St. George′s Hospital Medical School, London, United Kingdom; IMISE, Leipzig, Germany
| | - D. Gill
- Universitatskliniken des Saarlandes, Homburg, Germany; Ruprecht-Karls-Universitaet, Heidelberg, Germany; University Hospital, Lund, Sweden; HOK, FN, Brno-Bohunice, Czech Republic; Radiumhospitalet, Oslo, Norway; Princess Alexandra Hospital, Woolloogabba, Australia; Klinika Nowotworow Ukladu Chlonnego, Warszawa, Poland; Policlinico S. Orsola, Bologna, Italy; St. George′s Hospital Medical School, London, United Kingdom; IMISE, Leipzig, Germany
| | - J. Walewski
- Universitatskliniken des Saarlandes, Homburg, Germany; Ruprecht-Karls-Universitaet, Heidelberg, Germany; University Hospital, Lund, Sweden; HOK, FN, Brno-Bohunice, Czech Republic; Radiumhospitalet, Oslo, Norway; Princess Alexandra Hospital, Woolloogabba, Australia; Klinika Nowotworow Ukladu Chlonnego, Warszawa, Poland; Policlinico S. Orsola, Bologna, Italy; St. George′s Hospital Medical School, London, United Kingdom; IMISE, Leipzig, Germany
| | - P. Zinzani
- Universitatskliniken des Saarlandes, Homburg, Germany; Ruprecht-Karls-Universitaet, Heidelberg, Germany; University Hospital, Lund, Sweden; HOK, FN, Brno-Bohunice, Czech Republic; Radiumhospitalet, Oslo, Norway; Princess Alexandra Hospital, Woolloogabba, Australia; Klinika Nowotworow Ukladu Chlonnego, Warszawa, Poland; Policlinico S. Orsola, Bologna, Italy; St. George′s Hospital Medical School, London, United Kingdom; IMISE, Leipzig, Germany
| | - R. Pettengell
- Universitatskliniken des Saarlandes, Homburg, Germany; Ruprecht-Karls-Universitaet, Heidelberg, Germany; University Hospital, Lund, Sweden; HOK, FN, Brno-Bohunice, Czech Republic; Radiumhospitalet, Oslo, Norway; Princess Alexandra Hospital, Woolloogabba, Australia; Klinika Nowotworow Ukladu Chlonnego, Warszawa, Poland; Policlinico S. Orsola, Bologna, Italy; St. George′s Hospital Medical School, London, United Kingdom; IMISE, Leipzig, Germany
| | - E. Kuhnt
- Universitatskliniken des Saarlandes, Homburg, Germany; Ruprecht-Karls-Universitaet, Heidelberg, Germany; University Hospital, Lund, Sweden; HOK, FN, Brno-Bohunice, Czech Republic; Radiumhospitalet, Oslo, Norway; Princess Alexandra Hospital, Woolloogabba, Australia; Klinika Nowotworow Ukladu Chlonnego, Warszawa, Poland; Policlinico S. Orsola, Bologna, Italy; St. George′s Hospital Medical School, London, United Kingdom; IMISE, Leipzig, Germany
| |
Collapse
|
25
|
Dungarwalla M, Marsh JCW, Tooze JA, Lucas G, Ouwehand W, Pettengell R, Dearden CE, Gordon Smith EC, Elebute MO. Lack of clinical efficacy of rituximab in the treatment of autoimmune neutropenia and pure red cell aplasia: implications for their pathophysiology. Ann Hematol 2006; 86:191-7. [PMID: 17123083 DOI: 10.1007/s00277-006-0202-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [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: 01/18/2006] [Accepted: 09/11/2006] [Indexed: 11/25/2022]
Abstract
We describe 11 patients with severe refractory autoimmune cytopenias treated with the anti-CD20 monoclonal antibody rituximab. Six patients had autoimmune neutropenia (AIN), two had pure red cell aplasia (PRCA), one had AIN and autoimmune haemolytic anaemia, one had AIN and immune thrombocytopaenia purpura (ITP) and one had PRCA and ITP. Rituximab was administered at a dose of 375 mg/m(2) as an intravenous infusion weekly for 4 weeks. Six of eight patients with AIN and all three patients with PRCA did not respond. Two patients died: one with resistant AIN and autoimmune haemolytic anaemia died of pneumocytis pneumonia infection, and one with PRCA and ITP died of an acute exacerbation of bronchiectasis. Rituximab in AIN and PRCA appears to be less effective than Campath-1H when compared to historical data from our group. This supports the hypothesis that T cells may be important in the pathophysiology of AIN and PRCA.
Collapse
MESH Headings
- Adult
- Aged
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/pathology
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Bronchiectasis/chemically induced
- Drug Administration Routes
- Drug Administration Schedule
- Female
- Humans
- Immunologic Factors/administration & dosage
- Immunologic Factors/adverse effects
- Immunologic Factors/therapeutic use
- Male
- Middle Aged
- Neutropenia/drug therapy
- Neutropenia/pathology
- Pilot Projects
- Pneumonia, Pneumocystis/chemically induced
- Purpura, Thrombocytopenic/drug therapy
- Purpura, Thrombocytopenic/pathology
- Red-Cell Aplasia, Pure/drug therapy
- Red-Cell Aplasia, Pure/pathology
- Rituximab
- Time Factors
- Treatment Outcome
Collapse
Affiliation(s)
- M Dungarwalla
- Department of Haematology, St George's Hospital, Tooting, London, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Pettengell R. IVB.2 EORTC neutropenia guidelines: adapting to elderly patients. Crit Rev Oncol Hematol 2006. [DOI: 10.1016/s1040-8428(13)70029-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
27
|
Clamp AR, Bhattacharya S, Ryder DW, Pettengell R, Radford JA. Patterns of mortality after prolonged follow-up of a randomized trial using granulocyte colony-stimulating factor (G-CSF) to maintain chemotherapy dose intensity in non-Hodgkin lymphoma (NHL). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7590 Background: Recombinant G-CSF is commonly used to maintain chemotherapy dose intensity and reduce the incidence of infective complications in the management of NHL. The possible impact of this effect on mortality patterns after prolonged follow-up is worthy of investigation. We investigated the long-term survival and incidence of second malignancies in the first randomized trial utilising recombinant G-CSF in NHL (Pettengell R et al Blood 1992, 80: 1430–1436). Methods: Data on overall survival (OS), progression-free survival (PFS), freedom from progression (FFP) and the incidence of second malignancies were extracted from medical records and cancer registry databases for 80 patients with aggressive subtypes of NHL, who had previously been randomised to receive either VAPEC-B chemotherapy alone (39 patients) or VAPEC-B with G-CSF (41 patients). 10 year survival figures were extracted and Kaplan-Meier survival curves were drawn for the above parameters and compared between treatment groups using the log-rank test. Results: Median follow-up was 11.8 years for surviving patients (range 7.8–13.1 yrs). Patients receiving G-CSF achieved a 12% higher median dose intensity of chemotherapy. No significant differences were found in PFS or OS but 10 year FFP appeared to be better in the G-CSF arm (60.8%) compared with the control arm (45.6%) (log-rank test p=0.12). Eleven deaths from non-NHL causes occurred in the G-CSF arm compared with three in the control arm (log- rank test p=0.06). Five second malignancies were detected on long-term follow-up in the G-CSF arm compared with two in the control arm. Conclusions: The demonstration of different mortality patterns in the two arms may be related to the greater dose intensity of chemotherapy received in the G-CSF arm. Although, our study has insufficient statistical power to draw definite conclusions, this finding warrants further investigation. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- A. R. Clamp
- Christie Hospital, Manchester, United Kingdom; St George’s Hospital Medical School, London, United Kingdom
| | - S. Bhattacharya
- Christie Hospital, Manchester, United Kingdom; St George’s Hospital Medical School, London, United Kingdom
| | - D. W. Ryder
- Christie Hospital, Manchester, United Kingdom; St George’s Hospital Medical School, London, United Kingdom
| | - R. Pettengell
- Christie Hospital, Manchester, United Kingdom; St George’s Hospital Medical School, London, United Kingdom
| | - J. A. Radford
- Christie Hospital, Manchester, United Kingdom; St George’s Hospital Medical School, London, United Kingdom
| |
Collapse
|
28
|
Aapro MS, Cameron DA, Pettengell R, Bohlius J, Crawford J, Ellis M, Kearney N, Lyman GH, Tjan-Heijnen VC, Walewski J, Weber DC, Zielinski C. EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphomas and solid tumours. Eur J Cancer 2006; 42:2433-53. [PMID: 16750358 DOI: 10.1016/j.ejca.2006.05.002] [Citation(s) in RCA: 436] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Accepted: 05/16/2006] [Indexed: 11/22/2022]
Abstract
Chemotherapy-induced neutropenia is not only a major risk factor for infection-related morbidity and mortality, but is also a significant dose-limiting toxicity in cancer treatment. Patients developing severe (grade 3/4) or febrile neutropenia (FN) during chemotherapy frequently receive dose reductions and/or delays to their chemotherapy. This may impact on the success of treatment, particularly when treatment intent is either curative or to prolong survival. The incidence of severe or FN can be reduced by prophylactic treatment with granulocyte-colony stimulating factors (G-CSFs), such as filgrastim, lenograstim or pegfilgrastim. However, the use of G-CSF prophylactic treatment varies widely in clinical practice, both in the timing of therapy and in the patients to whom it is offered. While several academic groups have produced evidence-based clinical practice guidelines in an effort to standardise and optimise the management of FN, there remains a need for generally applicable, European-focused guidelines. To this end, we undertook a systematic literature review and formulated recommendations for the use of G-CSF in adult cancer patients at risk of chemotherapy-induced FN. We recommend that patient-related adverse risk factors such as elderly age (>or=65 years), be evaluated in the overall assessment of FN risk prior to administering each cycle of chemotherapy. In addition, when using a chemotherapy regimen associated with FN in >20% patients, prophylactic G-CSF is recommended. When using a chemotherapy regimen associated with FN in 10-20% patients, particular attention should be given to patient-related risk factors that may increase the overall risk of FN. In situations where dose-dense or dose-intense chemotherapy strategies have survival benefits, prophylactic G-CSF support is recommended. Similarly, if reductions in chemotherapy dose intensity or density are known to be associated with a poor prognosis, primary G-CSF prophylaxis may be used to maintain chemotherapy. Finally, studies have shown that filgrastim, lenograstim and pegfilgrastim have clinical efficacy and we recommend the use of any of these agents to prevent FN and FN-related complications, where indicated.
Collapse
Affiliation(s)
- M S Aapro
- Multidisciplinary Oncology Institute, Clinique de Genolier, 1, route du Muids, 1272 Genolier, Switzerland, and Department of Oncology, University of Edinburgh and Western General Hospital, Scotland.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Osuji N, Pettengell R. Growth factors in haematological cancers. Expert Opin Emerg Drugs 2005; 7:175-88. [PMID: 15989543 DOI: 10.1517/14728214.7.1.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Since their discovery just under a century ago, growth factors (GFs) have been used almost ubiquitously in haematology. Many haematological cancers are associated with bone marrow failure, either as a direct consequence of the disease or its treatment. Colony stimulating factors (CSFs) have been used to address the problems associated with the resulting cytopenias, however, concerns about the potential leukaemogenic effects of some of these CSFs led to a degree of initial hesitancy in usage, particularly in the management of acute myeloid leukaemia (AML). This has now been largely overcome. Other limitations have included cost and side effect profiles (the latter particularly with the multilineage factors). There has been wide variation locally, nationally and internationally in the usage of GFs. The American Society of Clinical Oncologists (ASCO) attempted to rationalise the usage of GFs by producing a consensus document enumerating the evidence-based indications for use of GFs. There is little information on cost effectiveness, this remains an important issue for the future. Peripheral blood stem cell transplantation (PBSCT) has revolutionised the management of many malignant conditions and has contributed to the increased use of growth factors. Many other indications are emerging for GFs used singly or in combination. Current clinical applications of GFs include: i) amelioration of cytopenias following chemotherapy and stem cell transplantation, ii) chemotherapy dose maintenance and escalation, iii) chemosensitisation and modification of disease states, iv) optimisation of methods for mobilisation of progenitor stem cells, v) immunotherapy, and vi) as therapeutic targets for treatment of haematolgical malignancies.
Collapse
Affiliation(s)
- Nnenna Osuji
- Department of Haematology, St. George's Hospital, Cranmer Terrace, London, SW17 0RE, UK.
| | | |
Collapse
|
30
|
Lofts FJ, Pettengell R. Myeloid growth factors in oncology. Expert Opin Investig Drugs 2005; 7:1955-76. [PMID: 15991939 DOI: 10.1517/13543784.7.12.1955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Within the last decade haemopoietic growth factors have become established in the pharmacopoeia of oncology. In the form of granulocyte colony-stimulating factor (G-CSF), and to a lesser extent granulocyte-macrophage colony-stimulating factor (GM-CSF), these proteins are routinely used to accelerate restoration of neutrophil count after chemotherapy or bone marrow transplant. Their main advance has been the development of mobilisation protocols. Peripheral blood progenitor cells are induced to egress from the bone marrow and re-transfusion after myelosuppressive chemotherapy allows for a simple and more rapid form of autologous transplantation than bone marrow transplantation. This review will give a brief overview of the biology of haemopoiesis in relation to growth factors and the potential lines of further research. Although the established clinical uses of G-CSF will be discussed the main focus will be on the developmental applications, such as ex vivo haemopoiesis, dose intensification schedules and the application of growth factors in the therapy of haematological malignancies. The relevance of novel or more recently introduced recombinant haemopoietic growth factors will also be discussed in relation to these indications.
Collapse
Affiliation(s)
- F J Lofts
- Medical Oncology Department, St George's Hospital Medical School, Cranmer Terrace, London, SW17 0RE, UK
| | | |
Collapse
|
31
|
Woll PJ, Fyfe DW, Willis F, Pledge SD, Steward WP, Gallagher C, Davidson N, Barker P, Baker N, Pettengell R. Dose intensive administration of carboplatin and paclitaxel with pegfilgrastim and whole blood support. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- P. J. Woll
- Univ of Sheffield, Sheffield, United Kingdom; Nottingham City Hosp, Nottingham, United Kingdom; St George’s Hosp Medcl Sch, London, United Kingdom; Weston Park Hosp, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; St Barts and Royal London Hospitals, London, United Kingdom; Broomfield Hosp, Chelmsford, United Kingdom; Amgen Ltd, Cambridge, United Kingdom
| | - D. W. Fyfe
- Univ of Sheffield, Sheffield, United Kingdom; Nottingham City Hosp, Nottingham, United Kingdom; St George’s Hosp Medcl Sch, London, United Kingdom; Weston Park Hosp, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; St Barts and Royal London Hospitals, London, United Kingdom; Broomfield Hosp, Chelmsford, United Kingdom; Amgen Ltd, Cambridge, United Kingdom
| | - F. Willis
- Univ of Sheffield, Sheffield, United Kingdom; Nottingham City Hosp, Nottingham, United Kingdom; St George’s Hosp Medcl Sch, London, United Kingdom; Weston Park Hosp, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; St Barts and Royal London Hospitals, London, United Kingdom; Broomfield Hosp, Chelmsford, United Kingdom; Amgen Ltd, Cambridge, United Kingdom
| | - S. D. Pledge
- Univ of Sheffield, Sheffield, United Kingdom; Nottingham City Hosp, Nottingham, United Kingdom; St George’s Hosp Medcl Sch, London, United Kingdom; Weston Park Hosp, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; St Barts and Royal London Hospitals, London, United Kingdom; Broomfield Hosp, Chelmsford, United Kingdom; Amgen Ltd, Cambridge, United Kingdom
| | - W. P. Steward
- Univ of Sheffield, Sheffield, United Kingdom; Nottingham City Hosp, Nottingham, United Kingdom; St George’s Hosp Medcl Sch, London, United Kingdom; Weston Park Hosp, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; St Barts and Royal London Hospitals, London, United Kingdom; Broomfield Hosp, Chelmsford, United Kingdom; Amgen Ltd, Cambridge, United Kingdom
| | - C. Gallagher
- Univ of Sheffield, Sheffield, United Kingdom; Nottingham City Hosp, Nottingham, United Kingdom; St George’s Hosp Medcl Sch, London, United Kingdom; Weston Park Hosp, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; St Barts and Royal London Hospitals, London, United Kingdom; Broomfield Hosp, Chelmsford, United Kingdom; Amgen Ltd, Cambridge, United Kingdom
| | - N. Davidson
- Univ of Sheffield, Sheffield, United Kingdom; Nottingham City Hosp, Nottingham, United Kingdom; St George’s Hosp Medcl Sch, London, United Kingdom; Weston Park Hosp, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; St Barts and Royal London Hospitals, London, United Kingdom; Broomfield Hosp, Chelmsford, United Kingdom; Amgen Ltd, Cambridge, United Kingdom
| | - P. Barker
- Univ of Sheffield, Sheffield, United Kingdom; Nottingham City Hosp, Nottingham, United Kingdom; St George’s Hosp Medcl Sch, London, United Kingdom; Weston Park Hosp, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; St Barts and Royal London Hospitals, London, United Kingdom; Broomfield Hosp, Chelmsford, United Kingdom; Amgen Ltd, Cambridge, United Kingdom
| | - N. Baker
- Univ of Sheffield, Sheffield, United Kingdom; Nottingham City Hosp, Nottingham, United Kingdom; St George’s Hosp Medcl Sch, London, United Kingdom; Weston Park Hosp, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; St Barts and Royal London Hospitals, London, United Kingdom; Broomfield Hosp, Chelmsford, United Kingdom; Amgen Ltd, Cambridge, United Kingdom
| | - R. Pettengell
- Univ of Sheffield, Sheffield, United Kingdom; Nottingham City Hosp, Nottingham, United Kingdom; St George’s Hosp Medcl Sch, London, United Kingdom; Weston Park Hosp, Sheffield, United Kingdom; Leicester Royal Infirmary, Leicester, United Kingdom; St Barts and Royal London Hospitals, London, United Kingdom; Broomfield Hosp, Chelmsford, United Kingdom; Amgen Ltd, Cambridge, United Kingdom
| |
Collapse
|
32
|
Imrie K, Belch A, Pettengell R, Rueda A, McKendrick J, Solal-Céligny P, Offner F, Bence-Buckler I, Walewski J, Raposo J, Marcus R. Rituximab plus CVP chemotherapy vs. CVP alone as first-line treatment for follicular lymphoma: Treatment effect according to baseline prognostic factors. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6525] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- K. Imrie
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
| | - A. Belch
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
| | - R. Pettengell
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
| | - A. Rueda
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
| | - J. McKendrick
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
| | - P. Solal-Céligny
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
| | - F. Offner
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
| | - I. Bence-Buckler
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
| | - J. Walewski
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
| | - J. Raposo
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
| | - R. Marcus
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
| |
Collapse
|
33
|
Pfreundschuh MG, Ho A, Wolf M, Cavallin-Stahl E, Pettengell R, Vasova I, Belch A, Walewski J, Zinzani PL, Mingrone W, Loeffler M. Treatment results of CHOP-21, CHOEP-21, MACOP-B and PMitCEBO with and without rituximab in young good-prognosis patients with aggressive lymphomas: Rituximab as an “equalizer” in the MInT (MABTHERA International Trial Group) study. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6529] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. G. Pfreundschuh
- Univklin des Saarlandes, Homburg, Germany; Med. Poliklinik, Universität Heidelberg, Germany; Peter MacCallum Cancer Ctr, East Melbourne, Australia; Univ Hosp, Lund, Sweden; St George Hosp, London, United Kingdom; Masaryk Univ Hosp, Brno-Bohunice, Czech Republic; Cross Cancer Institute, Edmonton, AB, Canada; M. Sklodowska-Curie Memorial Institute, Warsaw, Poland; Inst di Ematologia, Bologna, Italy; Kantonsspital, Aarau, Switzerland; IMISE, Leipzig, Germany
| | - A. Ho
- Univklin des Saarlandes, Homburg, Germany; Med. Poliklinik, Universität Heidelberg, Germany; Peter MacCallum Cancer Ctr, East Melbourne, Australia; Univ Hosp, Lund, Sweden; St George Hosp, London, United Kingdom; Masaryk Univ Hosp, Brno-Bohunice, Czech Republic; Cross Cancer Institute, Edmonton, AB, Canada; M. Sklodowska-Curie Memorial Institute, Warsaw, Poland; Inst di Ematologia, Bologna, Italy; Kantonsspital, Aarau, Switzerland; IMISE, Leipzig, Germany
| | - M. Wolf
- Univklin des Saarlandes, Homburg, Germany; Med. Poliklinik, Universität Heidelberg, Germany; Peter MacCallum Cancer Ctr, East Melbourne, Australia; Univ Hosp, Lund, Sweden; St George Hosp, London, United Kingdom; Masaryk Univ Hosp, Brno-Bohunice, Czech Republic; Cross Cancer Institute, Edmonton, AB, Canada; M. Sklodowska-Curie Memorial Institute, Warsaw, Poland; Inst di Ematologia, Bologna, Italy; Kantonsspital, Aarau, Switzerland; IMISE, Leipzig, Germany
| | - E. Cavallin-Stahl
- Univklin des Saarlandes, Homburg, Germany; Med. Poliklinik, Universität Heidelberg, Germany; Peter MacCallum Cancer Ctr, East Melbourne, Australia; Univ Hosp, Lund, Sweden; St George Hosp, London, United Kingdom; Masaryk Univ Hosp, Brno-Bohunice, Czech Republic; Cross Cancer Institute, Edmonton, AB, Canada; M. Sklodowska-Curie Memorial Institute, Warsaw, Poland; Inst di Ematologia, Bologna, Italy; Kantonsspital, Aarau, Switzerland; IMISE, Leipzig, Germany
| | - R. Pettengell
- Univklin des Saarlandes, Homburg, Germany; Med. Poliklinik, Universität Heidelberg, Germany; Peter MacCallum Cancer Ctr, East Melbourne, Australia; Univ Hosp, Lund, Sweden; St George Hosp, London, United Kingdom; Masaryk Univ Hosp, Brno-Bohunice, Czech Republic; Cross Cancer Institute, Edmonton, AB, Canada; M. Sklodowska-Curie Memorial Institute, Warsaw, Poland; Inst di Ematologia, Bologna, Italy; Kantonsspital, Aarau, Switzerland; IMISE, Leipzig, Germany
| | - I. Vasova
- Univklin des Saarlandes, Homburg, Germany; Med. Poliklinik, Universität Heidelberg, Germany; Peter MacCallum Cancer Ctr, East Melbourne, Australia; Univ Hosp, Lund, Sweden; St George Hosp, London, United Kingdom; Masaryk Univ Hosp, Brno-Bohunice, Czech Republic; Cross Cancer Institute, Edmonton, AB, Canada; M. Sklodowska-Curie Memorial Institute, Warsaw, Poland; Inst di Ematologia, Bologna, Italy; Kantonsspital, Aarau, Switzerland; IMISE, Leipzig, Germany
| | - A. Belch
- Univklin des Saarlandes, Homburg, Germany; Med. Poliklinik, Universität Heidelberg, Germany; Peter MacCallum Cancer Ctr, East Melbourne, Australia; Univ Hosp, Lund, Sweden; St George Hosp, London, United Kingdom; Masaryk Univ Hosp, Brno-Bohunice, Czech Republic; Cross Cancer Institute, Edmonton, AB, Canada; M. Sklodowska-Curie Memorial Institute, Warsaw, Poland; Inst di Ematologia, Bologna, Italy; Kantonsspital, Aarau, Switzerland; IMISE, Leipzig, Germany
| | - J. Walewski
- Univklin des Saarlandes, Homburg, Germany; Med. Poliklinik, Universität Heidelberg, Germany; Peter MacCallum Cancer Ctr, East Melbourne, Australia; Univ Hosp, Lund, Sweden; St George Hosp, London, United Kingdom; Masaryk Univ Hosp, Brno-Bohunice, Czech Republic; Cross Cancer Institute, Edmonton, AB, Canada; M. Sklodowska-Curie Memorial Institute, Warsaw, Poland; Inst di Ematologia, Bologna, Italy; Kantonsspital, Aarau, Switzerland; IMISE, Leipzig, Germany
| | - P.-L. Zinzani
- Univklin des Saarlandes, Homburg, Germany; Med. Poliklinik, Universität Heidelberg, Germany; Peter MacCallum Cancer Ctr, East Melbourne, Australia; Univ Hosp, Lund, Sweden; St George Hosp, London, United Kingdom; Masaryk Univ Hosp, Brno-Bohunice, Czech Republic; Cross Cancer Institute, Edmonton, AB, Canada; M. Sklodowska-Curie Memorial Institute, Warsaw, Poland; Inst di Ematologia, Bologna, Italy; Kantonsspital, Aarau, Switzerland; IMISE, Leipzig, Germany
| | - W. Mingrone
- Univklin des Saarlandes, Homburg, Germany; Med. Poliklinik, Universität Heidelberg, Germany; Peter MacCallum Cancer Ctr, East Melbourne, Australia; Univ Hosp, Lund, Sweden; St George Hosp, London, United Kingdom; Masaryk Univ Hosp, Brno-Bohunice, Czech Republic; Cross Cancer Institute, Edmonton, AB, Canada; M. Sklodowska-Curie Memorial Institute, Warsaw, Poland; Inst di Ematologia, Bologna, Italy; Kantonsspital, Aarau, Switzerland; IMISE, Leipzig, Germany
| | - M. Loeffler
- Univklin des Saarlandes, Homburg, Germany; Med. Poliklinik, Universität Heidelberg, Germany; Peter MacCallum Cancer Ctr, East Melbourne, Australia; Univ Hosp, Lund, Sweden; St George Hosp, London, United Kingdom; Masaryk Univ Hosp, Brno-Bohunice, Czech Republic; Cross Cancer Institute, Edmonton, AB, Canada; M. Sklodowska-Curie Memorial Institute, Warsaw, Poland; Inst di Ematologia, Bologna, Italy; Kantonsspital, Aarau, Switzerland; IMISE, Leipzig, Germany
| |
Collapse
|
34
|
Pettengell R, Willis F, Woll P, Desborough C, Buchanan K. Pegfilgrastim alone successfully mobilizes peripheral CD34+ cells in chemotherapy naive subjects with solid tumors: Initial results of a phase 1–2 study. Biol Blood Marrow Transplant 2005. [DOI: 10.1016/j.bbmt.2004.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
35
|
Pettengell R, Bosly A, Constenla M, Jackisch C, Leonard R, Paridaens R, Schwenkglenks M, Szucs T. P71 INC-EU prospective observational Europeanneutropenia study: Design and current status. Breast 2005. [DOI: 10.1016/s0960-9776(05)80108-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
36
|
McGuckin CP, Forraz N, Pettengell R, Thompson A. Thrombopoietin, flt3-ligand and c-kit-ligand modulate HOX gene expression in expanding cord blood CD133 cells. Cell Prolif 2004; 37:295-306. [PMID: 15245565 PMCID: PMC6496215 DOI: 10.1111/j.1365-2184.2004.00313.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Haemopoietic stem/progenitor cell (HSPC) development is regulated by extrinsic and intrinsic stimuli. Extrinsic modulators include growth factors and cell adhesion molecules, whereas intrinsic regulation is achieved with many transcription factor families, of which the HOX gene products are known to be important in haemopoiesis. Umbilical cord blood CD133+ HSPC proliferation potential was tested in liquid culture with 'TPOFLK' (thrombopoietin, flt-3 ligand and c-kit ligand, promoting HSPC survival and self-renewal), in comparison to 'K36EG' (c-kit-ligand, interleukins-3 and -6, erythropoietin and granulocyte colony-stimulating factor, inducing haemopoietic differentiation). TPOFLK induced a higher CD133+ HSPC proliferation (up to 60-fold more, at week 8) and maintained a higher frequency of the primitive colony-forming cells than K36EG. Quantitative polymerase chain reaction analysis revealed opposite expression patterns for specific HOX genes in expanding cord blood CD133+ HSPC. After 8 weeks in liquid culture, TPOFLK increased the expression of HOX B3, B4 and A9 (associated with uncommitted HSPC) and reduced the expression of HOX B8 and A10 (expressed in committed myeloid cells) when compared to K36EG. These results suggest that TPOFLK induces CD133+ HSPC proliferation, self-renewal and maintenance, up-regulation of HOX B3, B4 and A9 and down-regulation of HOX B8 and A10 gene expression.
Collapse
Affiliation(s)
- C P McGuckin
- King-George Stem Cell Therapy Laboratory, St George's Hospital Medical School and Kingston University, London, UK.
| | | | | | | |
Collapse
|
37
|
Szucs TD, Leonard R, Pettengell R, Paridaens R, Jackisch C, Constenla M, Bosly A, Schwenkglenks M. Dose-limiting effects of neutropenic events in six European audits of adjuvant breast cancer chemotherapy. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- T. D. Szucs
- South West Wales Cancer Institute, Swansea, United Kingdom; European Center of Pharmaceutical Medicine, Basel, Switzerland; St George's Hospital, London, United Kingdom; University Hospital Gasthuisberg, Leuven, Belgium; University Hospital Marburg, Marburg, Germany; Complexo Hospitalario de Pontevedra, Pontevedra, Spain; Cliniques Universitaires UCL, Godinne, Belgium
| | - R. Leonard
- South West Wales Cancer Institute, Swansea, United Kingdom; European Center of Pharmaceutical Medicine, Basel, Switzerland; St George's Hospital, London, United Kingdom; University Hospital Gasthuisberg, Leuven, Belgium; University Hospital Marburg, Marburg, Germany; Complexo Hospitalario de Pontevedra, Pontevedra, Spain; Cliniques Universitaires UCL, Godinne, Belgium
| | - R. Pettengell
- South West Wales Cancer Institute, Swansea, United Kingdom; European Center of Pharmaceutical Medicine, Basel, Switzerland; St George's Hospital, London, United Kingdom; University Hospital Gasthuisberg, Leuven, Belgium; University Hospital Marburg, Marburg, Germany; Complexo Hospitalario de Pontevedra, Pontevedra, Spain; Cliniques Universitaires UCL, Godinne, Belgium
| | - R. Paridaens
- South West Wales Cancer Institute, Swansea, United Kingdom; European Center of Pharmaceutical Medicine, Basel, Switzerland; St George's Hospital, London, United Kingdom; University Hospital Gasthuisberg, Leuven, Belgium; University Hospital Marburg, Marburg, Germany; Complexo Hospitalario de Pontevedra, Pontevedra, Spain; Cliniques Universitaires UCL, Godinne, Belgium
| | - C. Jackisch
- South West Wales Cancer Institute, Swansea, United Kingdom; European Center of Pharmaceutical Medicine, Basel, Switzerland; St George's Hospital, London, United Kingdom; University Hospital Gasthuisberg, Leuven, Belgium; University Hospital Marburg, Marburg, Germany; Complexo Hospitalario de Pontevedra, Pontevedra, Spain; Cliniques Universitaires UCL, Godinne, Belgium
| | - M. Constenla
- South West Wales Cancer Institute, Swansea, United Kingdom; European Center of Pharmaceutical Medicine, Basel, Switzerland; St George's Hospital, London, United Kingdom; University Hospital Gasthuisberg, Leuven, Belgium; University Hospital Marburg, Marburg, Germany; Complexo Hospitalario de Pontevedra, Pontevedra, Spain; Cliniques Universitaires UCL, Godinne, Belgium
| | - A. Bosly
- South West Wales Cancer Institute, Swansea, United Kingdom; European Center of Pharmaceutical Medicine, Basel, Switzerland; St George's Hospital, London, United Kingdom; University Hospital Gasthuisberg, Leuven, Belgium; University Hospital Marburg, Marburg, Germany; Complexo Hospitalario de Pontevedra, Pontevedra, Spain; Cliniques Universitaires UCL, Godinne, Belgium
| | - M. Schwenkglenks
- South West Wales Cancer Institute, Swansea, United Kingdom; European Center of Pharmaceutical Medicine, Basel, Switzerland; St George's Hospital, London, United Kingdom; University Hospital Gasthuisberg, Leuven, Belgium; University Hospital Marburg, Marburg, Germany; Complexo Hospitalario de Pontevedra, Pontevedra, Spain; Cliniques Universitaires UCL, Godinne, Belgium
| |
Collapse
|
38
|
Pfreundschuh MG, Trümper L, Ma D, Österborg A, Pettengell R, Trneny M, Shepherd L, Waleswski J, Zinzani PL, Loeffler M. Randomized intergroup trial of first line treatment for patients <=60 years with diffuse large B-cell non-Hodgkin's lymphoma (DLBCL) with a CHOP-like regimen with or without the anti-CD20 antibody rituximab -early stopping after the first interim analysis. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6500] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. G. Pfreundschuh
- Saarland University Medical School, Homburg, Germany; DSHNHL, Homburg, Germany; Australasian Leukaemia and Lymphoma Group ALLG, Sidney, Australia; Swedish Lymphoma Group, Stockholm, Sweden; Britsih National Lymphoma Investigation, London, United Kingdom; Charles University, Prague, Czech Republic; NCI-Canada Lymphoma Group, Homburg, Germany; Polish Lymphoma Group, Warszawa, Poland; Italian Northern Lymphoma Group, Bologna, Italy
| | - L. Trümper
- Saarland University Medical School, Homburg, Germany; DSHNHL, Homburg, Germany; Australasian Leukaemia and Lymphoma Group ALLG, Sidney, Australia; Swedish Lymphoma Group, Stockholm, Sweden; Britsih National Lymphoma Investigation, London, United Kingdom; Charles University, Prague, Czech Republic; NCI-Canada Lymphoma Group, Homburg, Germany; Polish Lymphoma Group, Warszawa, Poland; Italian Northern Lymphoma Group, Bologna, Italy
| | - D. Ma
- Saarland University Medical School, Homburg, Germany; DSHNHL, Homburg, Germany; Australasian Leukaemia and Lymphoma Group ALLG, Sidney, Australia; Swedish Lymphoma Group, Stockholm, Sweden; Britsih National Lymphoma Investigation, London, United Kingdom; Charles University, Prague, Czech Republic; NCI-Canada Lymphoma Group, Homburg, Germany; Polish Lymphoma Group, Warszawa, Poland; Italian Northern Lymphoma Group, Bologna, Italy
| | - A. Österborg
- Saarland University Medical School, Homburg, Germany; DSHNHL, Homburg, Germany; Australasian Leukaemia and Lymphoma Group ALLG, Sidney, Australia; Swedish Lymphoma Group, Stockholm, Sweden; Britsih National Lymphoma Investigation, London, United Kingdom; Charles University, Prague, Czech Republic; NCI-Canada Lymphoma Group, Homburg, Germany; Polish Lymphoma Group, Warszawa, Poland; Italian Northern Lymphoma Group, Bologna, Italy
| | - R. Pettengell
- Saarland University Medical School, Homburg, Germany; DSHNHL, Homburg, Germany; Australasian Leukaemia and Lymphoma Group ALLG, Sidney, Australia; Swedish Lymphoma Group, Stockholm, Sweden; Britsih National Lymphoma Investigation, London, United Kingdom; Charles University, Prague, Czech Republic; NCI-Canada Lymphoma Group, Homburg, Germany; Polish Lymphoma Group, Warszawa, Poland; Italian Northern Lymphoma Group, Bologna, Italy
| | - M. Trneny
- Saarland University Medical School, Homburg, Germany; DSHNHL, Homburg, Germany; Australasian Leukaemia and Lymphoma Group ALLG, Sidney, Australia; Swedish Lymphoma Group, Stockholm, Sweden; Britsih National Lymphoma Investigation, London, United Kingdom; Charles University, Prague, Czech Republic; NCI-Canada Lymphoma Group, Homburg, Germany; Polish Lymphoma Group, Warszawa, Poland; Italian Northern Lymphoma Group, Bologna, Italy
| | - L. Shepherd
- Saarland University Medical School, Homburg, Germany; DSHNHL, Homburg, Germany; Australasian Leukaemia and Lymphoma Group ALLG, Sidney, Australia; Swedish Lymphoma Group, Stockholm, Sweden; Britsih National Lymphoma Investigation, London, United Kingdom; Charles University, Prague, Czech Republic; NCI-Canada Lymphoma Group, Homburg, Germany; Polish Lymphoma Group, Warszawa, Poland; Italian Northern Lymphoma Group, Bologna, Italy
| | - J. Waleswski
- Saarland University Medical School, Homburg, Germany; DSHNHL, Homburg, Germany; Australasian Leukaemia and Lymphoma Group ALLG, Sidney, Australia; Swedish Lymphoma Group, Stockholm, Sweden; Britsih National Lymphoma Investigation, London, United Kingdom; Charles University, Prague, Czech Republic; NCI-Canada Lymphoma Group, Homburg, Germany; Polish Lymphoma Group, Warszawa, Poland; Italian Northern Lymphoma Group, Bologna, Italy
| | - P.-L. Zinzani
- Saarland University Medical School, Homburg, Germany; DSHNHL, Homburg, Germany; Australasian Leukaemia and Lymphoma Group ALLG, Sidney, Australia; Swedish Lymphoma Group, Stockholm, Sweden; Britsih National Lymphoma Investigation, London, United Kingdom; Charles University, Prague, Czech Republic; NCI-Canada Lymphoma Group, Homburg, Germany; Polish Lymphoma Group, Warszawa, Poland; Italian Northern Lymphoma Group, Bologna, Italy
| | - M. Loeffler
- Saarland University Medical School, Homburg, Germany; DSHNHL, Homburg, Germany; Australasian Leukaemia and Lymphoma Group ALLG, Sidney, Australia; Swedish Lymphoma Group, Stockholm, Sweden; Britsih National Lymphoma Investigation, London, United Kingdom; Charles University, Prague, Czech Republic; NCI-Canada Lymphoma Group, Homburg, Germany; Polish Lymphoma Group, Warszawa, Poland; Italian Northern Lymphoma Group, Bologna, Italy
| |
Collapse
|
39
|
Spicer J, Smith P, Maclennan K, Hoskin P, Hancock B, Linch D, Pettengell R. Long-term follow-up of patients treated with radiotherapy alone for early-stage histologically aggressive non-Hodgkin's lymphoma. Br J Cancer 2004; 90:1151-5. [PMID: 15026794 PMCID: PMC2409646 DOI: 10.1038/sj.bjc.6601675] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [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] [Indexed: 12/03/2022] Open
Abstract
Historically localised aggressive non-Hodgkin's lymphoma (NHL) has been treated with involved field radiotherapy (RT), chemotherapy, or a combination of both modalities. The current weight of evidence supports a preference for combined modality treatment (CMT). Increased patient age at diagnosis is well recognised as a poor prognostic indicator in NHL, but despite this some perceive CMT as too toxic for use in the elderly. As a result, some older patients continue to be offered RT alone. Here, we present long-term follow-up of 377 adults of all ages treated with RT alone for early-stage diffuse large-cell lymphoma on British National Lymphoma Investigation trials between 1974 and 1997. 10-year cause-specific survival in patients older than 60 years was poor and significantly inferior to that in younger patients (47 and 75% respectively; P<0.001). There is growing evidence that short-course chemotherapy, with or without RT, is superior to RT alone in early-stage aggressive NHL, in elderly as well as in younger patients. Increased age alone should not exclude patients from systemic treatment for early-stage aggressive NHL.
Collapse
MESH Headings
- Adolescent
- Adult
- Age Factors
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Female
- Follow-Up Studies
- Humans
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/radiotherapy
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, Non-Hodgkin/radiotherapy
- Male
- Middle Aged
- Neoplasm Staging
- Prognosis
- Retrospective Studies
- Treatment Outcome
Collapse
Affiliation(s)
- J Spicer
- Department of Oncology, St George's Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK
| | - P Smith
- British National Lymphoma Investigation (BNLI), Cancer Research UK and UCL Cancer Trials Centre, 222 Euston Road, London NW1 2DA, UK
| | - K Maclennan
- British National Lymphoma Investigation (BNLI), Cancer Research UK and UCL Cancer Trials Centre, 222 Euston Road, London NW1 2DA, UK
| | - P Hoskin
- Mount Vernon Hospital, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK
| | - B Hancock
- University of Sheffield, Weston Park Hospital, Whitham Road, Sheffield S10 2SJ, UK
| | - D Linch
- British National Lymphoma Investigation (BNLI), Cancer Research UK and UCL Cancer Trials Centre, 222 Euston Road, London NW1 2DA, UK
| | - R Pettengell
- Department of Oncology, St George's Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK
- Department of Haematology, St George's Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK
- Departments of Oncology and Haematology, St George's Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK. E-mail:
| |
Collapse
|
40
|
Schwenkglenks M, Bosly A, Constenla M, Jackisch C, Leonard R, Paridaens R, Pettengell R, Szucs T. Neutropenic events in six European audits of breast cancer chemotherapy. EJC Suppl 2004. [DOI: 10.1016/s1359-6349(04)90656-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
41
|
Paridaens R, Lyman G, Leonard R, Crawford J, Bosly A, Constenla M, Jackisch C, Pettengell R, Szucs T. Delivering optimal adjuvant chemotherapy in primary breast cancer: the role of rHuG-CSF. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)00082-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
42
|
Schwenkglenks M, Constenia M, Leonard R, Paridaens R, Bosly A, Jackisch C, Pettengell R, Szucs T. 16 A combined analysis of three European audits of primary breast cancer management. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90050-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
43
|
Kottaridis PD, Milligan DW, Chopra R, Chakraverty RK, Chakrabarti S, Robinson S, Peggs K, Verfuerth S, Pettengell R, Marsh JC, Schey S, Mahendra P, Morgan GJ, Hale G, Waldmann H, Ruiz de Elvira MC, Williams CD, Devereux S, Linch DC, Goldstone AH, MacKinnon S. In vivo CAMPATH-1H prevents GvHD following nonmyeloablative stem-cell transplantation. Cytotherapy 2002; 3:197-201. [PMID: 12171726 DOI: 10.1080/146532401753174025] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND We have investigated a novel nonmyeloablative conditioning regimen in 44 patients with hematological malignancies. The median patient age was 41 years. Many of the patients had high-risk features, including 19 patients with a previous failed transplant. METHODS Recipient conditioning consisted of CAMPATH-1H 20 mg/day on Days -8 to -4, fludarabine 30 mg/m(2) on Days -7 to -3 and melphalan 140 mg/m(2) on Day -2. Thirty-six recipients received unmanipulated G-CSF mobilized PBSC from HLA identical siblings and eight received unmanipulated BM from MUD. GvHD prophylaxis was with CYA alone for 38 patients and CYA plus MTX for six sibling recipients. RESULTS Forty-two of the 43 evaluable patients had sustained engraftment. Results of chimerism analysis using microsatellite PCR indicate that 18 of 31 patients studied were full donor chimeras, while the other patients were mixed chimeras in one or more lineages. At a median follow-up of 9 months (range, 3-29 months) 33 patients remain alive in CR, or with no evidence of disease progression. Seven patients relapsed or progressed post-transplant and four of them subsequently died. Four patients died from regimen-related complications. There were no cases of Grades III-IV acute GvHD. Only two patients developed Grade II acute GvHD and only one had chronic GvHD. The estimated probability of non-relapse mortality at 1 year was 11%.Results: Although longer follow-up is needed to establish the long-term remission rates, this study demonstrates that this nonmyeloablative preparative regimen is associated with durable engraftment, minimal toxicity and low incidence of GvHD.
Collapse
MESH Headings
- Adolescent
- Adult
- Alemtuzumab
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm/immunology
- Antibodies, Neoplasm/therapeutic use
- Antineoplastic Agents, Alkylating/therapeutic use
- Drug Therapy, Combination
- Female
- Graft Survival/drug effects
- Graft Survival/immunology
- Graft vs Host Disease/drug therapy
- Graft vs Host Disease/immunology
- Graft vs Host Disease/prevention & control
- Hematologic Neoplasms/immunology
- Hematologic Neoplasms/physiopathology
- Hematologic Neoplasms/therapy
- Humans
- Immunosuppression Therapy/methods
- Immunosuppression Therapy/trends
- Immunosuppressive Agents/therapeutic use
- Male
- Melphalan/therapeutic use
- Middle Aged
- Recurrence
- Stem Cell Transplantation/adverse effects
- Stem Cell Transplantation/methods
- Survival Rate
- Transplantation Chimera/immunology
- Transplantation Conditioning/methods
- Transplantation Conditioning/trends
- Transplantation, Homologous/adverse effects
- Transplantation, Homologous/methods
- Treatment Outcome
- Vidarabine/analogs & derivatives
- Vidarabine/therapeutic use
Collapse
Affiliation(s)
- P D Kottaridis
- Department of Haematology, University College London Hospital, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
The failure of conventional chemotherapy to improve overall survival rates in follicular non-Hodgkin's lymphoma (NHL) has led to the development of alternative treatment regimens. One such regimen is high-dose chemotherapy (HDT) with autologous stem cell transplantation (ASCT). In ASCT stem cells, harvested predominantly from peripheral blood, are used to repopulate the haemopoietic system after high-dose chemotherapy. Comparison of failure-free survival rates following ASCT, with those previously obtained with conventional chemotherapy, suggests a benefit for ASCT in patients who have previously responded to chemotherapy. Other factors that adversely influence the outcome of ASCT include large tumour burden and bcl-2 overexpression. Although ASCT in follicular NHL can prolong the period of remission, relapse is still common and can be caused either by contamination of the stem cell harvest with tumour cells, or regrowth of residual malignant cells not eradicated by the high-dose chemotherapy. Several strategies have been developed to reduce the rate of relapse, including in vitro purging of the stem cell product to remove tumour cells and using allogenic stem cells from HLA-matched donors with no history of malignant disease. While both these methods may have some benefit, they also have limitations. In vitro purging is labour intensive, costly and, as yet, the effect on relapse is unclear. Allogenic stem cell transplants have been associated with a reduced risk of relapse, but this is offset by increased transplant-related mortality. The most promising strategy to reduce the rate of relapse following ASCT is in vivo purging using rituximab, a monoclonal antibody to CD20. Rituximab mobilises mechanisms to kill lymphoma cells, and causes a rapid depletion of B cells from peripheral blood. Rituximab has demonstrated good efficacy as monotherapy in patients with both aggressive and indolent lymphoma and has shown very high response rates (>95%) when used in combination with HDT.
Collapse
Affiliation(s)
- R Pettengell
- Department of Haematology, St George's Hospital Medical School, London, UK
| |
Collapse
|
45
|
Woll PJ, Thatcher N, Lomax L, Hodgetts J, Lee SM, Burt PA, Stout R, Simms T, Davies R, Pettengell R. Use of hematopoietic progenitors in whole blood to support dose-dense chemotherapy: a randomized phase II trial in small-cell lung cancer patients. J Clin Oncol 2001; 19:712-9. [PMID: 11157022 DOI: 10.1200/jco.2001.19.3.712] [Citation(s) in RCA: 37] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Small-cell lung cancer (SCLC) is exquisitely chemosensitive, but few patients are cured by conventional chemoradiotherapy. Recent studies suggest that increased cytotoxic dose-intensity might improve survival. In this randomized phase II study, we tested the feasibility of dose intensification using sequential reinfusion of hematopoietic progenitors in whole blood. PATIENTS AND METHODS SCLC patients with a favorable prognosis were treated with six cycles of ifosfamide, carboplatin, and etoposide (ICE), at 4-week (standard treatment) or 2-week (intensified treatment) intervals. Intensified treatment was supported by daily subcutaneous filgrastim injections and reinfusion of 750 mL of autologous blood collected immediately before each cycle. RESULTS Fifty consecutive patients were randomized to standard (n = 25) or intensified (n = 25) ICE. A total of 94% completed at least three treatment cycles, and 70% completed six cycles; 96% of treatments were given at full dose. The planned dose-intensity was 1.0 for standard and 2.0 for intensified ICE. The median received dose-intensity for cycles 1 through 3 was 0.99 (range, 0.33 to 1.02) for the standard treatment arm and 1.80 (range, 0.99 to 1.97) for the intensified treatment arm (P <.001). Over all six cycles, the median received dose-intensity was 0.95 (range, 0.17 to 1.03) for the standard treatment arm and 1.60 (range, 0.60 to 2.01) for the intensified treatment arm (P <.001). Febrile neutropenia was more common on the standard treatment arm (84% v 56%), resulting in more days of intravenous antibiotics (median, 10 v 3 days; P =.035). Transfusion requirements were similar in the two groups. CONCLUSION Sequential reinfusion of hematopoietic progenitors in whole blood can safely support substantial increases in dose-intensity of ICE chemotherapy for SCLC.
Collapse
Affiliation(s)
- P J Woll
- Cancer Research Campaign Department of Clinical Oncology, City Hospital, Nottingham, UK.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Hayward-Costa C, Pearce D, Pettengell R, Forraz N, Davies A, Edwards W, McGuckin C. Electron microscopy demonstration of CD34 antigen on progenitor pseudopodia. Exp Hematol 2000. [DOI: 10.1016/s0301-472x(00)00568-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
47
|
Kottaridis PD, Milligan DW, Chopra R, Chakraverty RK, Chakrabarti S, Robinson S, Peggs K, Verfuerth S, Pettengell R, Marsh JC, Schey S, Mahendra P, Morgan GJ, Hale G, Waldmann H, de Elvira MC, Williams CD, Devereux S, Linch DC, Goldstone AH, Mackinnon S. In vivo CAMPATH-1H prevents graft-versus-host disease following nonmyeloablative stem cell transplantation. Blood 2000; 96:2419-25. [PMID: 11001893] [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: 02/17/2023] Open
Abstract
A novel nonmyeloablative conditioning regimen was investigated in 44 patients with hematologic malignancies. The median patient age was 41 years. Many of the patients had high-risk features, including 19 patients with a previous failed transplant. Recipient conditioning consisted of CAMPATH-1H, 20 mg/day on days -8 to -4; fludarabine, 30 mg/m(2) on days -7 to -3; and melphalan, 140 mg/m(2) on day -2. Thirty-six recipients received unmanipulated granculocyte colony-stimulating factor-mobilized peripheral blood stem cells from HLA-identical siblings, and 8 received unmanipulated marrow from matched unrelated donors. GVHD prophylaxis was with cyclosporine A alone for 38 patients and cyclosporine A plus methotrexate for 6 sibling recipients. Forty-two of the 43 evaluable patients had sustained engraftment. Results of chimerism analysis using microsatellite polymerase chain reaction indicate that 18 of 31 patients studied were full-donor chimeras while the other patients were mixed chimeras in one or more lineages. At a median follow-up of 9 months (range 3 to 29 months), 33 patients remain alive in complete remission or with no evidence of disease progression. Seven patients relapsed or progressed post-transplantation, and 4 of them subsequently died. Four patients died of regimen-related complications. There were no cases of grades III-IV acute GVHD. Only 2 patients developed grade II acute GVHD, and only 1 had chronic GVHD. The estimated probability of nonrelapse mortality was 11%. Although longer follow-up is needed to establish the long-term remission rates, this study demonstrates that this nonmyeloablative preparative regimen is associated with durable engraftment, minimal toxicity, and low incidence of GVHD.
Collapse
Affiliation(s)
- P D Kottaridis
- Departments of Hematology, University College London Hospital, London, England
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Woll P, Pettengell R, Diffley J, Clayton K, Carmichael J. Phase I study of dose-intensive carboplatin/paclitaxel (CB/PX) supported with filgrastim and haemopoietic progenitor cells in whole blood (BPC). Lung Cancer 2000. [DOI: 10.1016/s0169-5002(00)80011-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
49
|
|
50
|
Szlosarek PW, Lofts FJ, Pettengell R, Carter P, Young M, Harmer C. Effective treatment of a patient with a high-grade endometrial stromal sarcoma with an accelerated regimen of carboplatin and paclitaxel. Anticancer Drugs 2000; 11:275-8. [PMID: 10898543 DOI: 10.1097/00001813-200004000-00008] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The rarity of endometrial stromal sarcoma (ESS) and its poor response to treatment provides fertile ground for investigational therapies. An accelerated regimen of carboplatin and paclitaxel is investigated. A patient with a recent history of treated tuberculosis of the lung represented with infertility and acute abdominal pain from suspected fibroids, and underwent a laparotomy with a diagnosis of a high-grade ESS. A novel therapeutic approach using a regimen of carboplatin and paclitaxel with the reinfusion of filgrastim-mobilized peripheral blood progenitor cells is described. A partial response was observed following six cycles of chemotherapy. Grade IV thrombocytopenia occurred after the last cycle, with recovery prior to pelvic radiotherapy. The patient remained well 1 year post-diagnosis. High-grade ESS is responsive to combination chemotherapy with paclitaxel and carboplatin, and requires further evaluation. The use of an accelerated regimen may also have contributed to the response and this question awaits randomized trials.
Collapse
Affiliation(s)
- P W Szlosarek
- Department of Medical Oncology, St George's Hospital Medical School, London, UK.
| | | | | | | | | | | |
Collapse
|