scholarly journals High incidence of fractures after R-CHOP-like chemotherapy for aggressive B-cell non-Hodgkin lymphomas

2021 ◽  
Author(s):  
Li-Wen Huang ◽  
Dong Sun ◽  
Thomas M. Link ◽  
Thomas Lang ◽  
Weiyun Ai ◽  
...  
Keyword(s):  
B Cell ◽  
San Francisco ◽  
Standard Of Care ◽  
Ct Scans ◽  
Logistic Regression Models ◽  
Non Hodgkin Lymphoma ◽  
First Line Therapy ◽  
Prevalent Fracture ◽  
High Doses ◽  
The University

Abstract Purpose Patients with non-Hodgkin lymphoma (NHL) have a median age of 67, with 70% surviving over 5 years. Chemotherapy for aggressive NHL includes cyclophosphamide, anthracycline, and high doses of corticosteroids, which can impair bone health. By reviewing clinical characteristics and standard-of-care CT scans, we evaluate the prevalence and incidence of fractures and the clinical correlates of fractures in patients treated for aggressive B-cell NHL. Methods We retrospectively reviewed patients seen at the University of California San Francisco lymphoma clinic from January 1, 2016, to March 31, 2017 who had (1) aggressive B-cell NHL, (2) received first-line therapy with R-CHOP-like regimens, and had (3) CT scans pre- and post-treatment available for review. Associations between clinical variables and vertebral, rib, and pelvic fracture outcomes were assessed, and multivariate logistic regression models were used to identify predictors of prevalent and incident fractures. Results We identified 162 patients who met the inclusion criteria. Median age at diagnosis was 60 years. Of the 162 patients, 38 patients (28%) had prevalent fractures prior to receiving chemotherapy. Within 1 year after treatment, 16 patients (10%) developed new fractures. Having a prevalent fracture strongly predicted developing a new fracture after treatment, with incident fractures occurring in 12 of 38 patients with prevalent fractures versus 4 of 124 without prevalent fractures (odds ratio 10.45, p<0.0005). Conclusion Our results suggest that patients with aggressive B-cell NHL who receive R-CHOP-like therapy should be screened for fractures prior to treatment and those with existing fractures should be considered for therapy to decrease risk of new fractures.

ADCs, BiTEs, CARs, and Small Molecules: A New Era of Targeted Therapy in Non-Hodgkin Lymphoma

2020 ◽  
pp. 302-313 ◽  
Author(s):  
Jeremy S. Abramson ◽  
Nilanjan Ghosh ◽  
Sonali M. Smith
Keyword(s):  
T Cells ◽  
B Cell ◽  
Kinase Inhibitors ◽  
B Cell Lymphoma ◽  
Standard Of Care ◽  
Initial Therapy ◽  
Second Line ◽  
Car T Cells ◽  
Non Hodgkin Lymphoma ◽  
Car T

Novel immunotherapies and small molecular inhibitors are transforming our approach to previously treated and newly diagnosed patients across the spectrum of non-Hodgkin lymphomas (NHLs). Anti-CD19 CAR T cells are now indicated for the treatment of relapsed/refractory aggressive B-cell lymphomas after at least two previous lines of therapy in which durable remissions are achieved in approximately 40% of previously incurable patients. Second-line chemoimmunotherapy remains the standard of care at first relapse, but poor outcomes with conventional treatment in this setting creates an appealing rationale for earlier use of CAR T cells, which is currently under investigation, along with even earlier use in selected high-risk patients in the frontline setting. Other emerging immunotherapies include antibody-drug conjugates (ADCs), such as polatuzumab vedotin for multiple-relapsed diffuse large B-cell lymphoma (DLBCL) in combination with bendamustine-rituximab. Multiple bispecific antibodies that bring malignant B cells in contact with effector T cells appear promising in early clinical trials and will likely emerge as off-the-shelf immunotherapy options. Chemotherapy-free small molecule–based regimens are increasingly available for mantle cell (MCLs) and follicular lymphomas (FLs). Bruton tyrosine kinase inhibitors (BTKi) now represent standard second-line therapy for MCL and are being investigated in combination and as initial therapy. Lenalidomide-rituximab is an active regimen in both FL and MCL and may be used in either relapsed/refractory or previously untreated disease. Three PI3K inhibitors are approved for multiple-relapsed FL and can induce durable remissions in patients with chemotherapy- and rituximab-refractory disease. Additional emerging targeted therapies include BCL2 inhibition in MCL and EZH2 inhibition in FL.

Correlation between Tumor Uptake on Indium-111 Ibritumomab Tiuxetan Imaging and Size on CT to Disease Response on FDG PET/CT Scans Obtained Pre- and Post-Yttrium-90 Ibritumomab Tiuxetan Therapy for Non-Hodgkin Lymphoma.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4781-4781
Author(s):  
Jacob M. Alexnder ◽  
Judith M. Joyce ◽  
Barry M. McCook ◽  
Norbert Avril ◽  
Stephanie R. Land ◽  
...  
Keyword(s):  
B Cell ◽  
Fdg Pet ◽  
Large Cell ◽  
Ct Scans ◽  
Tumor Uptake ◽  
Ibritumomab Tiuxetan ◽  
Overall Response ◽  
Non Hodgkin Lymphoma ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Background: Yttrium-90 ibritumomab tiuxetan (Zevalin, YZ), the first radioimmunotherapeutic agent approved for the treatment of relapsed or refractory B-cell non-Hodgkin Lymphoma (NHL), had an overall response rate of 80% vs 56% with rituximab alone based on CT assessment (IWRC criteria) without FDG PET correlation. Prior to the therapeutic administration of YZ, normal biodistribution must be confirmed by visual evaluation of whole-body In-111 Zevalin (IZ) images. Tumor uptake on IZ images has been noted to be variable and is not required to proceed with therapy. However, bulky lymphadenopathy has been reported to possibly predict poor response to radioimmunotherapy. We report our evaluation of the relation of tumor uptake on IZ images and size on CT scans to tumor response based on pre- and post-YZ therapy using FDG PET/CT scans. Methods: This retrospective review includes only patients with relapsed or refractory B-cell NHL treated with YZ who had fusion PET/CT scans pre- and post-YZ therapy and fulfilled all other standard eligibility critera for YZ. PET/CT scans were performed within 4 months prior and 8 months following IZ imaging and YZ therapy. The largest tumor mass on the pre-therapy CT was measured and categorized into subgroups of < or ≥5 cm. The IZ scans were reviewed for the presence or absence of tumor uptake over background activity. Response by CT was based on the IWRC criteria (CR/CRu, PR, Stable, and PD). Response on FDG PET was based upon comparison of the intensity of uptake in relation to adjacent background (CR, PR, Mixed and PD). Response rate comparisons by patient groups were performed with Fisher exact tests. Results: 24 patients (16M, 8F, 37–83 y.o.) fulfilled the criteria. The histologic diagnoses included: 14 follicular, 5 diffuse large B-cell, 4 mantle cell, and 1 MALT. All patients had increased FDG uptake in measurable CT lesions on the pre-therapy PET/CT scans. 14 IZ scans were positive, 10 were negative. Seven of 9 patients (78%) with lesions ≥5 cm had positive IZ versus 7 of 15 (47%) with lesions < 5 cm. The following tables display the cross-tabulation of tumor uptake on IZ, CT size, and the response to YZ. The overall response (ORR) based on FDG PET was 13/24 (54%) with a CR of 7/24 (29%) and a PR of 6/24 (25%). Excluding the patients with large cell histology, the ORR was 13/19 (68%). ORR for size ≥5 cm was 3/9 (33%) and for size <5 cm was 10/15 (66%), a suggestive but non-significant difference (p=0.2). The frequency of overall response was significantly reduced for large cell histology versus other histologies (p=0.011). The results show that those patients with tumor uptake on IZ imaging had significantly reduced overall response based on pre- and post-FDG PET/CT findings compared with patients without tumor uptake (p=0.047). Conclusions: The presence of tumor uptake on IZ imaging, tumor size (≥5 cm) and histology (large cell) may all adversely affect response to YZ. The identification of IZ tumor uptake may be related to large tumor size rather than tumor susceptibility to therapy. Responses (CR/CRu and PR) by PET # In+ In− CT≥5cm CT<5cm FL 9 4 5 1 8 DLBC 0 0 0 0 0 MCL 3 1 2 1 2 MALT 1 0 1 1 0 Nonresponses (Mixed and PD) by PET # In+ In− CT≥5cm CT<5cm FL 5 5 0 2 3 DLBC 5 3 2 3 2 MCL 1 1 0 1 0 MALT 0 0 0 0 0

scholarly journals Emerging therapies for the treatment of relapsed or refractory diffuse large B cell lymphoma

2019 ◽  
Vol 26 (4) ◽  
Author(s):  
P. Skrabek ◽  
S. Assouline ◽  
A. Christofides ◽  
D. MacDonald ◽  
A. Prica ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Unmet Need ◽  
B Cell Lymphoma ◽  
Standard Of Care ◽  
High Dose ◽  
Treatment Approaches ◽  
Non Hodgkin Lymphoma ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Diffuse large B cell lymphoma (dlbcl) is an aggressive non-Hodgkin lymphoma, accounting for approximately 30% of lymphoma cases in Canada. Although most patients will achieve a cure, up to 40% will experience refractory disease after initial treatment, or relapse after a period of remission. In eligible patients, salvage therapy followed by high-dose therapy and autologous stem-cell transplantation (asct) is the standard of care. However, many patients are transplant-ineligible, and more than half of those undergoing asct will subsequently relapse. For those patients, outcomes are dismal, and novel treatment approaches are a critical unmet need. In this paper, we present available data about emerging treatment approaches in the latter setting and provide a perspective about the potential use of those approaches in Canada

Lenalidomide Maintenance after R-CHOP Therapy in Diffuse Large B-Cell Lymphoma: Can It Be a Standard of Care

2017 ◽  
Vol 138 (4) ◽  
pp. 216-220 ◽  
Author(s):  
Reyad Dada
Keyword(s):  
B Cell ◽  
Standard Treatment ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Standard Of Care ◽  
Non Hodgkin Lymphoma ◽  
Treatment Standard ◽  
Large B Cell Lymphoma ◽  
Large B Cell ◽  
Lymphoma Subtype

Diffuse large B-cell lymphoma is an aggressive non-Hodgkin lymphoma subtype which requires immediate treatment. Standard treatment is usually a combined immune chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Since R-CHOP was approved, several attempts to combine it with novel agents and/or use them as maintenance therapy failed to improve the outcome. Recently, maintenance with lenalidomide after standard immune chemotherapy showed promising results. This review discusses the most pertinent published and running studies, analyzing study design, results, and practicality.

scholarly journals Real World Evidence of CAR T-Cell Therapies for the Treatment of Relapsed/Refractory B-Cell Non-Hodgkin Lymphoma: A Monocentric Experience

Cancers ◽  
2021 ◽  
Vol 13 (19) ◽  
pp. 4789
Author(s):  
Beatrice Casadei ◽  
Lisa Argnani ◽  
Serafina Guadagnuolo ◽  
Cinzia Pellegrini ◽  
Vittorio Stefoni ◽  
...  
Keyword(s):  
T Cell ◽  
B Cell ◽  
Hodgkin Lymphoma ◽  
Objective Response ◽  
Standard Of Care ◽  
Complete Response ◽  
Cell Therapies ◽  
Car T Cell ◽  
Non Hodgkin Lymphoma ◽  
Car T

Large B-cell lymphomas (LBCL) are the most common types of non-Hodgkin lymphoma. Although outcomes have improved thanks to the introduction of rituximab-based chemoimmunotherapy, certain LBCL still represents a challenge because of initial resistance to therapy or recurrent relapses. Axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) are second-generation autologous CD19-targeted chimeric antigen receptor (CAR) T-cell therapies approved for patients with relapsed/refractory (R/R) LBCL, based on the results of phase II pivotal single-arm trials ZUMA-1 (for axi-cel) and JULIET (for tisa-cel). Here, we report patients outcomes with axi-cel and tisa-cel in the standard of care (SoC) setting for R/R LBCL, treated at our Institution. Data were collected from patients who underwent leukapheresis between August 2019 and February 2021. Toxicities were graded and managed according to the institution’s guidelines. Responses were assessed as per Lugano 2014 classification. Of the 30 patients who underwent leukapheresis, 18 (60%) received axi-cel, while 12 (40%) tisa-cel. Grade 3 or higher cytokine release syndrome and neurotoxicity occurred in 10% and 16% patients, respectively. Best objective and complete response rates were 73.3% and 40%, respectively. Treatment in SoC setting with CD19 CAR T-cell therapies for R/R LBCL showed a manageable safety profile and high objective response rate.

Utilization of imaging and outcomes of care among metastatic colorectal cancer (mCRC) patients (pts) receiving bevacizumab containing regimens.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14011-e14011
Author(s):  
Afsaneh Barzi ◽  
Hanke Zheng ◽  
Jeffrey McCombs
Keyword(s):  
Colorectal Cancer ◽  
Ct Scan ◽  
Standard Of Care ◽  
Median Number ◽  
Ct Scans ◽  
P Value ◽  
First Line ◽  
Probability Of Survival ◽  
First Line Therapy ◽  
Line Therapy

e14011 Background: Chemotherapy combined with bevacizumab is the most commonly used treatment first line therapy in pts with mCRC. Decisions for continuation or change of chemotherapy are based on the findings of CT scan, the most commonly used from of imaging in this population. Modeled after clinical trials, CT scan every 2 months is adopted as a standard of care. Yet, patterns of utilization of CT scan in general population is unknown. We set to explore CT scan utilization and associated outcomes among pts with mCRC. Methods: The De-identified Clinformatics Data Mart (OptumInsight, Eden Prairie, MN) covering January 2008 to December 2016 was used for this analysis. Pts with two out-patient and/or one in-patient ICD codes for colorectal cancer were identified. Pts with at least 180 days of enrollment, no chemotherapy within 120 days prior to chemotherapy, and at least one claim for CT scan were eligible for analysis. Recipients of FOLFOX (CAPOX) or FOLFIRI (XILIRI) +bevacizumab were identified using HCPCS codes and the data of their 1sttreatment was registered as index date. The primary endpoint of the analysis was exposure to both FOLFIRI and FOLFOX, secondary endpoint was survival. SAS software was used for data processing and analysis. Results: A total of 3261 pts met the inclusion criteria 78% with oxaliplatin based regimens and 22% with irinotecan regimens. The median age of the population is 66 (19-89), and 58.3% of the identified pts were male. The median duration of first line therapy was 119 days. Median number of CT scan during first line was 2.3. The median and mean number of CT scan per 2 months were 0.82 and 0.94. There was no difference in age, gender, and comorbidities in those with less than 2 vs. 2 or more CT scans. Exposure to both regimens (measured with switching from one regimen to another) was 35% in pts with less than 2 CT scans and 44% in those with 2 or more CT scan (p-value < 0.0001). Probability of survival at 12 months was 83% for all patients regardless of the frequency of scans. Conclusions: In patients with mCRC more frequent scans is associated with higher probability of access to active agents. However, survival probability at 12 months was not different between the two groups.

R-ICE versus R-ESHAP for salvage therapy in aggressive B-cell non-Hodgkin lymphoma.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e18509-e18509
Author(s):  
Craig Freyer ◽  
Timothy George ◽  
Samantha Price ◽  
Bijal Dinesh Shah ◽  
Celeste M. Bello ◽  
...  
Keyword(s):  
B Cell ◽  
B Cell Lymphoma ◽  
Standard Of Care ◽  
Initial Therapy ◽  
Salvage Chemotherapy ◽  
Tumor Burden ◽  
Primary Objective ◽  
Salvage Regimen ◽  
Non Hodgkin Lymphoma ◽  
Student’S T

e18509 Background: Standard therapy for aggressive Non-Hodgkin’s lymphoma (NHL) consists of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), however the 5 year relapse rate is 20%. Patients with relapsed/refractory (RR) NHL are offered autologous stem cell transplantation (SCT) after salvage chemotherapy demonstrates chemosensitivity and reduces tumor burden. No standard salvage regimen for RR-NHL exists. Frequently used regimens include R-ICE (rituximab, ifosfamide, carboplatin, etoposide) and R-ESHAP (rituximab, etoposide, methylprednisolone, cytarabine, cisplatin). Which regimen provides the greatest efficacy with least toxicity remains unclear. Methods: Patients diagnosed with RR aggressive NHL who received R-ICE or R-ESHAP between 1/1/2000 and 9/30/2011 were identified. Patients may have received either regimen after failure of initial therapy. The primary objective was to determine the overall response rate (ORR) for each regimen. Secondary objectives included determination of overall survival (OS), and proportion of patients able to receive SCT. OS for each regimen was compared using Kaplan-Meier survival curves. Continuous data was compared using the student’s T-test. Results: The median age was 59 years, 27% were female and 90% were described as Caucasian. 78% were diagnosed with diffuse large B cell lymphoma (DLBCL), 13% with transformed follicular lymphoma, 9% with related aggressive NHL subtypes. 55% had a revised International Prognosis Score of 2. Conclusions: No standard of care exists for management of RR-NHL. No regimen has shown superior efficacy or long term outcomes over another. Our trial suggests similar ORR and OS between two commonly used regimens. Although toxicity profiles differ between these regimens, discontinuation rates due to toxicity were similar. The choice of salvage regimen may be determined by ease of administration, toxicity profile and patient/physician preference rather than improved efficacy between R-ICE and R-ESHAP. [Table: see text]

scholarly journals How I treat primary mediastinal B-cell lymphoma

Blood ◽  
2018 ◽  
Vol 132 (8) ◽  
pp. 782-790 ◽  
Author(s):  
Lisa Giulino-Roth
Keyword(s):  
B Cell ◽  
Hodgkin Lymphoma ◽  
Cell Lymphoma ◽  
Adult Population ◽  
B Cell Lymphoma ◽  
Standard Of Care ◽  
Adolescent And Young Adult ◽  
World Health ◽  
Molecular Alterations ◽  
Non Hodgkin Lymphoma

Abstract The World Health Organization now recognizes primary mediastinal B-cell lymphoma (PMBCL) as a unique clinical and biologic entity. PMBCL is distinct from other B-cell non-Hodgkin lymphoma subtypes and has features that overlap with classical Hodgkin lymphoma, including a peak incidence in the adolescent and young adult population, mediastinal presentation of disease, and molecular alterations in JAK2 and programmed death ligands. Because PMBCL is rare, there are few prospective clinical trials to guide therapy, resulting in no single standard of care. Given the long life expectancy of survivors of PMBCL, treatment approaches must balance maximizing cure while minimizing long-term toxicity. In this article, I review my approach to the treatment of PMBCL, incorporating data from adult and pediatric studies, as well as recent advances in our understanding of the molecular basis of PMBCL.

scholarly journals EXTERNAL VALIDATION OF A NOVEL DIGITAL SIGNATURE IN CONTINUOUS CARDIORESPIRATORY MONITORING TO DETECT EARLY RESPIRATORY DETERIORATION OF ICU PATIENTS

2021 ◽  
Author(s):  
Rachael A Callcut ◽  
Yuan Xu ◽  
Christina Tsai ◽  
Andrea Villaroman ◽  
Anamaria Robles ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Early Detection ◽  
San Francisco ◽  
Predictive Analytics ◽  
External Validation ◽  
Emergency Intubation ◽  
Logistic Regression Models ◽  
Surgical Icus ◽  
External Population ◽  
The University

The goal of predictive analytics monitoring is the early detection of patients at high risk of subacute potentially catastrophic illnesses. A good example of a target illness is respiratory failure leading to urgent unplanned intubation, where early detection might lead to interventions that improve patient outcome. Previously, we identified signatures of this illness in the continuous cardiorespiratory monitoring data of Intensive Care Unit patients and devised algorithms to identify patients at rising risk. Here, we externally validated 3 logistic regression models to estimate risk of emergency intubation that were developed in Medical and Surgical ICUs at the University of Virginia. We calculated the model outputs for more than 8000 patients in University of California San Francisco ICUs, 240 of whom underwent emergency intubation as determined by individual chart review. We found that the AUC of the models exceeded 0.75 in this external population, and that the risk rose appreciably over the 12 hours prior to the event. We conclude that abnormal signatures of respiratory failure in the continuous cardiorespiratory monitoring are a generalizable phenomenon.

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