scholarly journals Long‐term overall‐ and progression‐free survival after pentostatin, cyclophosphamide and rituximab therapy for indolent non‐Hodgkin lymphoma

2019 ◽  
Vol 185 (4) ◽  
pp. 670-678 ◽  
Author(s):  
Tamer Khashab ◽  
Fredrick Hagemeister ◽  
Jorge E. Romaguera ◽  
Michelle A. Fanale ◽  
Barbara Pro ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Progression Free Survival ◽  
Free Survival ◽  
Non Hodgkin Lymphoma

scholarly journals Efficacy and safety assessment of prolonged maintenance with subcutaneous rituximab in patients with relapsed or refractory indolent non-Hodgkin lymphoma: results of the Phase III MabCute study

Haematologica ◽  
2021 ◽  
Author(s):  
Simon Rule ◽  
Wolney Gois Barreto ◽  
Javier Briones ◽  
Angelo M. Carella ◽  
Olivier Casasnovas ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
Phase Iii ◽  
Rank Test ◽  
Free Survival ◽  
Non Hodgkin Lymphoma ◽  
Log Rank Test ◽  
Chemotherapy Induction

Rituximab plus chemotherapy induction followed by rituximab maintenance for up to 2 years confers long-term progression-free survival (PFS) benefit in patients with indolent non-Hodgkin lymphoma. It is not known whether further prolonged maintenance with rituximab provides additional benefit. The phase III MabCute study enrolled 692 patients with relapsed or refractory indolent non-Hodgkin lymphoma. Patients who responded to induction with rituximab plus chemotherapy and were still responding after up to 2 years’ initial maintenance with subcutaneous rituximab were randomized to extended maintenance with subcutaneous rituximab (n=138) or observation only (n=138). The primary endpoint of investigator-assessed PFS in the randomized population was un-addressed by the end of study because of an insufficient number of events (129 events were needed for 80% power at 5% significance if approximately 330 patients were randomized). In total, there were 46 PFS events, 19 and 27 in the rituximab and observation arms, respectively (P=0.410 by stratified log rank test; hazard ratio 0.76 [95% confidence interval: 0.37–1.53]). Median PFS was not reached in either randomized arm. There were no new safety signals; however, adverse events were seen slightly more frequently with rituximab than with observation during extended maintenance. Maintenance for up to 2 years with rituximab after response to initial induction therefore remains the standard of care in patients with relapsed or refractory indolent non-Hodgkin lymphoma.

Phase II Study of Rituximab in Newly Diagnosed Stage IA Nodular Lymphocyte-Predominant Hodgkin Lymphoma (NLPHL): A Report From the German Hodgkin Study Group (GHSG)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2711-2711
Author(s):  
Dennis A. Eichenauer ◽  
Michael Fuchs ◽  
Annette Pluetschow ◽  
Beate Klimm ◽  
Teresa Halbsguth ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Phase Ii ◽  
Overall Response Rate ◽  
Phase Ii Trial ◽  
Progression Free Survival ◽  
Free Survival ◽  
Stage Ia ◽  
Cd20 Antibody ◽  
Anti Cd20

Abstract Abstract 2711 Background: Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare subtype of Hodgkin lymphoma (HL) accounting for about 5% of cases. The clinical course is usually more indolent than in classical HL (cHL) resulting in an excellent long-term prognosis. This is particularly true for patients diagnosed with early-stage NLPHL representing the majority of cases. However, current standard treatment consisting of chemotherapy and/or radiotherapy (RT) is associated with an increased risk of late toxicity. Thus, there is a need for novel treatment strategies. Since CD20 is consistently expressed on the malignant lymphocyte-predominant (LP) cells, anti-CD20 antibody treatment appears to be a promising option. After impressive response rates were reported in relapsed NLPHL patients, the German Hodgkin Study Group (GHSG) initiated a trial to evaluate the anti-CD20 antibody rituximab in newly diagnosed stage IA NLPHL without clinical risk factors. Methods: Between June 2006 and October 2007, 29 patients from 23 sites were enrolled in this multicenter phase II trial. Study entry was restricted to adult patients (age 18 to 75) with biopsy-proven stage IA NLPHL without clinical risk factors. Treatment consisted of four weekly infusions of the anti-CD20 antibody rituximab at a dose of 375 mg/m2. Efficacy endpoints included remission status as assessed by computed tomography (CT) four weeks after completion of treatment, overall response rate (ORR), progression-free survival (PFS) and overall survival (OS) at two years; feasibility endpoints were acute treatment-related toxicities, adverse events, dose reductions and therapy delays. Results: Twenty-eight patients were eligible for the final analysis of this phase II trial; 71.4% of patients were male, 72% had supradiaphragmatic disease and the median age was 40 years. Treatment was conducted in the outpatient setting in the majority of cases. Rituximab was well tolerated; no grade III/IV toxicities were observed. Transfusions of erythrocytes or platelets were not required. At final restaging four weeks after the last rituximab application, 24 patients (85.7%) were in CR/CRu and four patients (14.3%) had partial remission (PR). Thus, overall response rate (ORR) was 100%. After a median follow-up of 43 months, all patients were still alive. Progression-free survival rate estimates at two, three and four years were 85.3%, 81.4% and 77.1%, respectively. Seven patients (25%) have relapsed and two patients developed secondary solid tumors. All patients with NLPHL relapse were successfully salvaged. Conclusions: The results of the present trial confirm the previously reported excellent response of NLPHL patients to rituximab. However, with a relapse rate of 25% at a median observation time of 43 months, rituximab does not seem to be as effective as RT alone or combined-modality strategies in stage IA NLPHL patients. Nonetheless, anti-CD20 antibodies have a favorable toxicity profile and may be offered to selected patients who are at particular risk for long-term side effects such as secondary malignancies. In addition, the combination of anti-CD20 antibodies and chemotherapy may also improve efficacy and decrease toxicity of NLPHL treatment in early unfavorable, advanced or relapsed disease. Disclosures: No relevant conflicts of interest to declare.

Long-Term Results of the HD2000 Trial Comparing ABVD Versus BEACOPP Versus COPP-EBV-CAD in Untreated Patients With Advanced Hodgkin Lymphoma: A Study by Fondazione Italiana Linfomi

2016 ◽  
Vol 34 (11) ◽  
pp. 1175-1181 ◽  
Author(s):  
Francesco Merli ◽  
Stefano Luminari ◽  
Paolo G. Gobbi ◽  
Nicola Cascavilla ◽  
Caterina Mammi ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Cumulative Risk ◽  
Progression Free Survival ◽  
Long Term Results ◽  
Entire Group ◽  
Second Malignancies ◽  
Free Survival ◽  
Post Hoc

Purpose The randomized HD2000 trial compared six cycles of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), four escalated plus two standard cycles of BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), and six cycles of COPP-EBV-CAD (cyclophosphamide, lomustine, vindesine, melphalan, prednisone, epidoxorubicin, vincristine, procarbazine, vinblastine, and bleomycin; CEC) in patients with advanced-stage Hodgkin lymphoma. After a median follow-up of 42 months, patients who received BEACOPP were reported to have experienced better progression-free survival (PFS) but not better overall survival (OS) results than those receiving ABVD. We here report a post hoc analysis of this trial after a median follow-up of 10 years. Patients and Methods Three hundred seven patients were enrolled, 295 of whom were evaluable. At the time of our analysis, the median follow-up for the entire group was 120 months (range, 4 to 169 months). Results The 10-year PFS results for the ABVD, BEACOPP, and CEC arms were 69%, 75%, and 76%, respectively; corresponding OS results were 85%, 84%, and 86%. Overall, 13 second malignancies were reported: one in the ABVD arm and six each in the BEACOPP and CEC arms. The cumulative risk of developing second malignancies at 10 years was 0.9%, 6.6%, and 6% with ABVD, BEACOPP, and CEC, respectively; the risk with either BEACOPP or CEC was significantly higher than that reported with ABVD (P = .027 and .02, respectively). Conclusion With these mature results, we confirm that patients with advanced Hodgkin lymphoma have similar OS results when treated with ABVD, BEACOPP, or CEC. However, with longer follow-up, we were not able to confirm the superiority of BEACOPP over ABVD in terms of PFS, mainly because of higher mortality rates resulting from second malignancies observed after treatment with BEACOPP and CEC.

scholarly journals Model-based meta-analysis of progression-free survival in non-Hodgkin lymphoma patients

Medicine ◽  
2017 ◽  
Vol 96 (35) ◽  
pp. e7988 ◽  
Author(s):  
Mengyao Li ◽  
Nimita Dave ◽  
Ahmed Hamed Salem ◽  
Kevin J. Freise
Keyword(s):  
Hodgkin Lymphoma ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Free Survival ◽  
Model Based ◽  
Non Hodgkin Lymphoma

scholarly journals Allotransplantation for Patients Age ≥40 Years with Non-Hodgkin Lymphoma: Encouraging Progression-Free Survival

2014 ◽  
Vol 20 (7) ◽  
pp. 960-968 ◽  
Author(s):  
Brian L. McClune ◽  
Kwang Woo Ahn ◽  
Hai-Lin Wang ◽  
Joseph H. Antin ◽  
Andrew S. Artz ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Progression Free Survival ◽  
Free Survival ◽  
Non Hodgkin Lymphoma

Outcome of limited-stage nodular lymphocyte-predominant Hodgkin lymphoma and the impact of a PET-adapted approach

2021 ◽  
Vol 5 (18) ◽  
pp. 3647-3655
Author(s):  
Phoebe T. M. Cheng ◽  
Diego Villa ◽  
R. Petter Tonseth ◽  
David W. Scott ◽  
Alina S. Gerrie ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Progression Free Survival ◽  
Emission Tomography ◽  
Viable Option ◽  
Free Survival ◽  
Limited Stage ◽  
Positron Emission ◽  
The Impact

Abstract Radiotherapy (RT) is typically incorporated into the treatment of limited-stage nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), although it remains unknown whether chemotherapy alone may be suitable in select patients. We evaluated outcomes of limited-stage NLPHL at BC Cancer on the basis of era-specific guidelines: routine RT era, 1995 to 2005 (n = 36), combined modality with 2 cycles of doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) chemotherapy followed by RT or RT alone; positron emission tomography (PET) era, after 2005 (n = 63), ABVD alone (4 cycles) if the PET scan after the second cycle of ABVD (PET2) is negative, or treatment is changed to RT if PET2 is positive. Median age of patients was 38 years (range, 16-82 years), 73% were male, and 43% had stage II. With a median follow-up of 10.5 years for all patients, 5-year progression-free survival (PFS) was 93% and was 97% for overall survival (OS), with no difference by treatment era (PFS, P = .13; OS, P = .35). For the 49 patients who had a PET2 scan, 86% were PET negative and 14% were PET positive by Deauville criteria with 5-year PFS rates of 92% and 80% (P = .70), respectively. This is the largest study of a PET-adapted approach in NLPHL and supports that ABVD alone may be a viable option in select patients with a negative PET2 scan, with consideration of acute and long-term toxicities.

Front-Line Treatment of Low-Grade Non-Follicular Non-Hodgkin Lymphoma (Final Report of Gisl LL02 Trial).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2332-2332
Author(s):  
Maria Goldaniga ◽  
Francesco Merli ◽  
Caterina Stelitano ◽  
Vincenzo Callea ◽  
Fiorella Ilariucci ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Objective Response ◽  
Progression Free Survival ◽  
Final Report ◽  
Low Grade ◽  
Who Grade ◽  
Free Survival ◽  
Non Hodgkin Lymphoma ◽  
Who Grade Iii ◽  
Grade Iii

Abstract Indolent Non-follicular non-Hodgkin Lymphoma (NFo-NHL) is a group of relatively frequent lymphoproliferative diseases, nevertheless extended clinical and prognostic studies are still lacking. In 2002 the Gruppo Italiano Studio Linfomi (GISL) initiated a LL02 prospective multicenter phase II trial, with the aim to evaluate the efficacy and safety of FC combination in the first-line therapy of NFo-NHL patients younger than 70 years. Between July 2002 and September 2006, 58 adult patients (35 males and 23 females, median age 64 yrs, range 40–75) affected by NFo-NHL in active disease phase, were consecutively enrolled in 12 GISL Hematological Centres. Patients were treated with a dose of 25 mg/mq Fludarabine plus 250 mg/mq Cyclophosphamide administred intravenously daily for 3 days; each cycle was repeated every 28 days for 6 courses. During the treatment patients received oral thrimethoprim-sulphametoxazole prophylaxis. After the intermediate evaluation, 48/58 patients (82.8%) had an objective response (ORR) with a 20.7% of complete remission (CR) plus 62.1% of partial remission (PR); at the final evaluation the ORR percentage was 84.5% with a 41.4% of CR (24 pts) and 43.1% of PR (25 pts); three patients were in progressive disease (5.2%) and one in stable disease (1.7%). The median overall survival (OS) was not reached with an 88% and 84% at 12 and 24 months; the progression free survival (PFS) was 89% and 77% and the event free survival (EFS) was 81% and 66% at 12 and 24 months respectively.About the toxicity profile, the major toxicity was hematological with a 18% cases of WHO grade III or IV anemia, 40% leucopenia, 33% neutropenia and 10% piastrinopenia. The 12% of patients had an infective episode wich a 7.7% of WHO grade III–IV.In conclusion the FC chemotherapy is a useful chance for advanced untreated non follicular low-grade NHL, with an optimal ORR, CR and PFS. The crucial point of FC remains OS, that not seems to be significantly improved in comparison with fludarabine alone or with standard therapy, even though the better quality of responses; Rituximab plus FC association is growing in literature as the probably key to find a real improvement also in this aspect.

Early Lymphocyte Recovery Predicts Superior Disease Free Survival and Overall Survival after High Dose Chemotherapy and Autologous Stem Cell Transplantation in Non-Hodgkin Lymphoma Patients

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3992-3992
Author(s):  
Walter G Borelli ◽  
Cristina Otero ◽  
Ana Ines Landoni ◽  
Alicia Magariños ◽  
Mercedes Zamora ◽  
...  
Keyword(s):  
Overall Survival ◽  
Hodgkin Lymphoma ◽  
Progression Free Survival ◽  
High Dose ◽  
Free Survival ◽  
Cell Dose ◽  
Non Hodgkin Lymphoma ◽  
Group 2 ◽  
Autologous Hsct ◽  
Group 1

Abstract Introduction. An early absolute lymphocyte count (ALC) recovery after high dose therapy (HDT) and autologous hematopoietic stem cell transplantation (HSCT) in non Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), multiple myeloma and acute leukemia patients has been related with an improved outcome due to a better immune restoration. In this retrospective study we analyze a population of NHL patients to evaluate ALC recovery after autologous HSCT and its relation with post-transplant survival. Patients and methods. Fifty-three consecutive adult NHL patients received HDT followed by autologous HSCT in a single center between 2000 and 2012. Only individuals with at least 6 months post-transplant follow up were included. All patients received the same conditioning regimen (BEAM: carmustine, etoposide, cytarabine and melphalan) followed by peripheral blood stem cells previously collected by leukapheresis. Median CD34+ cell dose was 4.13 x 106/kg (1.62 – 12.58). Patients were divided into two groups: ALC at day +15 inferior than 500/mm3 (group 1) and ALC at day +15 superior or equal than 500/mm3 (group 2). Differences between groups were analyzed using t-Student and Chi-Square tests, with statistical significance determined at p<0.05. Progression-free survival (PFS) and overall survival (OS) were analyzed by Kaplan Meier method. Differences in survival between the two groups were determined by log-rank test. Results. No differences were observed between groups regarding gender, histology, disease status at transplant and cell dose. Patients into group 1 were older and more heavily pre-treated. Neutrophil and platelet engraftment were significantly faster in group 2 (Table 1). After a median follow-up of 56 months, progression-free survival (PFS) and overall survival (OS) were superior in group 2 patients. Median PFS was 47 months and not reached (p=0.013) and OS was 51 months and not reached (p=0.016) in groups 1 and 2 respectively (figures 1 and 2). Discussion. An early ALC recovery after autologous HSCT is associated with a better PFS and OS in NHL patients. Patients with ALC major or equal than 500/mm3 had a shorter time to neutrophil and platelet recovery and a shorter stay at transplant unit. In this study, CD34+ cell dose does not appears as a determinant factor for lymphocyte recovery. The extent of pre-transplant chemotherapy may influence ALC recovery after transplant. These results confirm the association between lymphocyte recovery and outcome in NHL patients after autologous HSCT. Table 1.Patient characteristics and comparison between groups 1 and 2.Group 1Group 2pALC< 500 /mm3> 500/mm3N2528Age, median (range)57 (29 - 66)41 (15 - 65)0.008Female gender (n)1214NSHistology (n)DLBCL1316 NSFollicular lymphoma62Mantle cell lymphoma32Peripheral T cell lymphoma13Indolent lymphoma12Others13Individuals who received two or more lines of pre-transplant treatment (n)1180.01Disease status at transplant (n)Complete remission711 NSPartial remission1613Progressive disease21CD34+ cells dose, median (range) (10E6/kg)3.45 (1.62 - 9.12)4.40 (2.28 - 12.58)NSMononuclear cells dose, median (range) (10E8/kg)8,84 (3,55 - 18,74)6,7 (1,94 - 27)NSDays to achieve ANC > 500/mm3, median (range)11 (7 - 30)8 (3 - 16)0.034Days to achieve platelets > 20.000/mm3, median (range)9 (2 - 49)5 (1 - 10)0.003Length of stay in transplant unit, days, median (range)30 (20 - 59)24 (20 - 35)0.001 Figure 1. PFS and ALC on day +15. Group 1: patients with ALC < 500/mm3 (dotted line); group 2: patients with ALC > 500/mm3 (solid line). Figure 1. PFS and ALC on day +15. Group 1: patients with ALC < 500/mm3 (dotted line); group 2: patients with ALC > 500/mm3 (solid line). Figure 2. Figure 2. OS and ALC on day +15. Group 1: patients with ALC < 500/mm3 (dotted line); group 2: patients with ALC > 500/mm3 (solid line). Disclosures No relevant conflicts of interest to declare.

Sign in / Sign up

Export Citation Format

Share Document