Post-transplant lymphoproliferative disorders after lung transplantation: first-line treatment with rituximab may induce complete remission

2006 ◽  
Vol 20 (2) ◽  
pp. 179-187 ◽  
Author(s):  
Christiane Knoop ◽  
Alain Kentos ◽  
Myriam Remmelink ◽  
Christian Garbar ◽  
Serge Goldman ◽  
...  
Keyword(s):  
Complete Remission ◽  
Lung Transplantation ◽  
Lymphoproliferative Disorders ◽  
Line Treatment ◽  
First Line ◽  
Post Transplant ◽  
First Line Treatment

scholarly journals Outcome of Relapsed or Refractory FLT3-Mutated Acute Myeloid Leukemia before Second-Generation FLT3 Tyrosine Kinase Inhibitors: A Toulouse–Bordeaux DATAML Registry Study

Cancers ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 773 ◽  
Author(s):  
Sarah Bertoli ◽  
Pierre-Yves Dumas ◽  
Emilie Bérard ◽  
Laetitia Largeaud ◽  
Audrey Bidet ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Complete Remission ◽  
Myeloid Leukemia ◽  
Response Rate ◽  
Intensive Chemotherapy ◽  
Line Treatment ◽  
First Line ◽  
Low Intensity ◽  
First Line Treatment ◽  
Acute Myeloid

A recent phase 3 trial showed that the outcome of patients with relapsed/refractory (R/R) FLT3-mutated acute myeloid leukemia (AML) improved with gilteritinib, a single-agent second-generation FLT3 tyrosine kinase inhibitor (TKI), compared with standard of care. In this trial, the response rate with standard therapy was particularly low. We retrospectively assessed the characteristics and outcome of patients with R/R FLT3-mutated AML included in the Toulouse–Bordeaux DATAML registry. Among 347 patients who received FLT3 TKI-free intensive chemotherapy as first-line treatment, 174 patients were refractory (n = 48, 27.6%) or relapsed (n = 126, 72.4%). Salvage treatments consisted of intensive chemotherapy (n = 99, 56.9%), azacitidine or low-dose cytarabine (n = 9, 5.1%), other low-intensity treatments (n = 17, 9.8%), immediate allogeneic stem cell transplantation (n = 4, 2.3%) or best supportive care only (n = 45, 25.9%). Among the 114 patients who previously received FLT3 TKI-free intensive chemotherapy as first-line treatment (refractory, n = 32, 28.1%; relapsed, n = 82, 71.9%), the rate of CR (complete remission) or CRi (complete remission with incomplete hematologic recovery) after high- or low-intensity salvage treatment was 50.0%, with a bridge to transplant in 34.2% (n = 39) of cases. The median overall survival (OS) was 8.2 months (interquartile range, 3.0–32); 1-, 3- and 5-year OS rates were 36.0% (95%CI: 27–45), 24.7% (95%CI: 1–33) and 19.7% (95%CI: 1–28), respectively. In this real-word study, although response rate appeared higher than the controlled arm of the ADMIRAL trial, the outcome of patients with R/R FLT3-mutated AML remains very poor with standard salvage therapy.

Clarithromycin Leading to Complete Remission in the First-Line Treatment of Ocular Adnexal Mucosa-Associated Lymphoid Tissue Lymphoma

2015 ◽  
Vol 33 (35) ◽  
pp. e130-e132 ◽  
Author(s):  
Barbara Kiesewetter ◽  
Julius Lukas ◽  
Andreas Kuchar ◽  
Marius E. Mayerhoefer ◽  
Leonhard Müllauer ◽  
...  
Keyword(s):  
Complete Remission ◽  
Lymphoid Tissue ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

scholarly journals Single Centre Experience of Managing Patients with Double Hit Lymphoma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5868-5868
Author(s):  
Shankaranarayana Paneesha ◽  
Iman Qureshi ◽  
Malahat Saeed ◽  
Richard Lovell ◽  
Emmanouil Nikolousis ◽  
...  
Keyword(s):  
Overall Survival ◽  
Complete Remission ◽  
Progressive Disease ◽  
Salvage Chemotherapy ◽  
Line Treatment ◽  
First Line ◽  
Single Centre ◽  
Single Centre Experience ◽  
First Line Treatment

Abstract Double or triple hit Lymphomas (DHL) are characterized by translocation rearrangements of C-MYC with the addition of BCL2 and/or BCL 6, which are associated with a poor outcome due to their genetic complexity . Clinical controversies remain regarding the optimum treatment for patients with DHL due to lack of consensus regarding the optimal management and also age and frailty being a significant obstacle, limiting the role of dose-escalated or intensified therapy. Literature review suggests overall median survival for DHL patients is from 0.2-1.5years2. We report our single centre experience of treating this patient group. Materials & Methods: This single centre retrospective study evaluated the outcome of DHL patients who underwent various lines of treatment including standard R-CHOP chemotherapy, more intensive chemotherapy regimens and allogeneic stem cell transplantation (AlloSCT). Diagnosis of DHL was as per the 2008 WHO classification. Statistical analysis was performed by using SPSS 23®. Results: Our study included fourteen patients (9M; 5F) with a median age 60.5 years (range 33-65). 4 patients had stage 2B disease, 3 had stage 3B and 7 had 4B disease. R-CHOP chemotherapy only was commenced as first line treatment in 4 patients, R-CHOP plus intrathecal chemotherapy was given to 2 patients and 1 patient received R-CEOP. 5 patients received intensive chemotherapy with R-CODOX-M/R-IVAC where as one patient received EPOCH in a different centre prior to transfer. 1 patient received radiotherapy only. 10 patients were in complete remission following first line chemotherapy. One patient progressed following first line treatment and was managed palliatively. One patient relapsed whilst awaiting AlloSCT and was given mini-DEX BEAM salvage chemotherapy prior to transplant. One patient had a partial response to first line treatment and was given further rituximab but had progressive disease and was also managed palliatively. One patient had progressive disease and received GDP chemotherapy. 8 patients underwent AlloSCT with BEAM Alemtuzumab conditioning with cyclosporine as GvHD prophylaxis (6 unrelated and 2 sibling donors). The mean overall survival from starting treatment for DHL for the non-transplant cohort was 18.5 months (Range: 0.5 to 36.5) and the median OS was 8.3 months (Range: 4 to 12.6) as compared to mean overall survival of 44.2 months (Range: 22.2 to 66.35) in the transplant cohort with median overall survival not reached (p value: 0.46, Log Rank). In our patients, there was no progression after 3 months from Allo SCT. One patient progressed 6 weeks and died 8 weeks post AlloSCT, whereas two patients progressed 12 weeks and died 14 weeks post AlloSCT. In the cohort who did not undergo AlloSCT, 3 patients have died and two remain in complete remission and 1 patient is undergoing salvage chemotherapy for refractory disease. Conclusion: Our single centre experience of limited number of patients with DHL suggests AlloSCT as a consolidative treatment in first complete remission, may offer survival benefit as compared to no consolidation. Our data also shows no progression of DHL 3 months post AlloSCT highlighting the potential graft versus lymphoma effect. This requires further evaluation in a larger cohort to confirm our preliminary findings and identify potential biomarkers of best response. Confirmation of this result in larger cohort will identify the role of AlloSCT in DHL and enable to reach consensus in the DHL management. Disclosures Kishore: celgene: Other: travel grant.

scholarly journals First Line Treatment with Bendamustine in Selected Non Hodgkin's Lymphoma Patients: Prospective Experience in Tuscany Region

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5451-5451
Author(s):  
Luigi Rigacci ◽  
Benedetta Puccini ◽  
Roberta Della Seta ◽  
Enrico Capochiani ◽  
Lorenzo Iovino ◽  
...  
Keyword(s):  
Complete Remission ◽  
Standard Therapy ◽  
Progressive Disease ◽  
Response Rate ◽  
Cell Lymphoma ◽  
Line Treatment ◽  
First Line ◽  
Grade 3 ◽  
Indolent Lymphomas ◽  
First Line Treatment

Abstract Bendamustine was introduced in Italy from 2008 and it was used as salvage therapy in patients pretreated, particularly in indolent lymphomas. Before approval as first-line treatment by the National Health System, starting from 2011 and thanks to our regional regulation, was possible to use Bendamustine in first line therapy as ‘off-label’ drug. The aim of this study was to collect all consecutive patients treated in first line with Bendamustine in 7 Tuscany centers. From June 2011 to December 2012, 72 patients were prospectively included in the study. Diagnosis was: Lymphocytic lymphoma in 25 patients (34%), Follicular lymphoma in 18 (25%), Diffuse large B cell lymphoma in 11 (15%), Mantle cell lymphoma in 10 (14%), Lymphoplasmocytic lymphoma in 5 (7%) and MALT in 3 (5%). Thirty-nine patients were treated with Bendamustine 90 mg/m2 for two days, 28 with 70 mg/m2 and 5 with 120 mg/m2. The analyzed population must be considered negatively selected as such was not proposed the standard therapy. Moreover the data coming from literature and the experience in pre-treated patients increased the interest of clinicians for this drug. In 14 patients Bendamustine was used alone, in 56 in combination with Rituximab or other drug. The overall median age was 69 years (range 45-89), in DLBCL was 81 years and 78 years in MCL. Considering the advanced age of this population we applied the geriatric score assessment and 25% of patients were unfit or frail. The median number of cycles performed was 4 (range 2 - 6). All patients but 2 were evaluable for response, 35 obtained a complete remission, 27 a partial remission considering the intention to treat the overall response rate was 86%, stable disease in 2 patients, progressive disease in 6 patients and not evaluable in 2 patients. According to histotype to note that all but two indolent lymphoma obtained a response; in aggressive lymphomas 4/11 DLBCL and 5/9 MCL reached a complete remission but 4 DLBCL and 2 MCL experienced rapid progression of the disease. Treatment was well tolerated, we observed: grade 3-4 neutropenia in 18 patients, no grade 3-4 anemia or thrombocytopenia. According to extrahematological toxicity was reported only grade 3-4 infection in 3 patients no other grade 3-4 toxicities were reported. Skin rush grade 1 was reported in in 5 patients. No toxic deaths were observed. After a median follow-up of 18 months the overall survival was 83%; 10 patients died all due to progressive disease. Progression free survival, after a median observation period of 12 months, was 60%; sixty-two patients are alive, 31 in continuous complete remission, 3 relapsed and 28 with disease under control. In conclusion in this ‘real life’ negatively selected population, the use of Bendamustine showed a very high response rate particularly in indolent lymphomas, promising results, also, are observed in aggressive lymphoma suggesting that this drug can be used with interesting result in elderly patients who can not receive the standard therapy. Disclosures No relevant conflicts of interest to declare.

First-line treatment of acute promyelocytic leukemia with arsenic trioxide without ATRA and chemotherapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 7073-7073
Author(s):  
A. Ghavamzadeh ◽  
K. Alimoghaddam ◽  
S. Ghaffari ◽  
S. Rostami ◽  
M. Jahani ◽  
...  
Keyword(s):  
Complete Remission ◽  
Arsenic Trioxide ◽  
Single Agent ◽  
Disease Free Survival ◽  
Early Mortality ◽  
Line Treatment ◽  
First Line ◽  
First Line Therapy ◽  
One Year ◽  
First Line Treatment

7073 Background: Standard treatment of APL is ATRA plus chemotherapy but Arsenic Trioxide (ATO) is most potent single agent against APL cells. Role of ATO in first line therapy of APL needs to clarify. Methods: Between may 2000 and September 2006,we treated 141 new cases of APL(Median age 28±12.8 y/o min=11,max=71) by 2 hours iv infusion of 0.15mg/kg ATO until complete remission. Trial approved by IRB and consent form obtained. Diagnosis was by clinical and morphologic characteristics and confirmed by cytogenetic and RT-PCR for detection of t(15,17) and presence of PML-RARa. After complete remission patients received consolidation by 28 days infusion of ATO for one or four courses.(one consolidation one month after CR and for some patients second, third and forth consolidations one month after first one and two another , one year and two year after CR) Results: : complete remission observed in 121 cases(85.8%) and early mortality rate was14.9%(most common cause of early mortality was APL syndrome,61.9%).Median follow up was 28 months. For patients who achieve to complete remission,one, two and three year disease free survival were 95.6%± 2%, 76.9±4% and 57± 6%,respectively. Many relapsed patients salvaged again with ATO alone so, two and three years overall survival for this cohort was 95.6%±2% and 83.7%±4%. Increasing number of consolidation from one to four couldn’t increase DFS or OS in one and two years after CR. Conclusions: ATO is effective in treatment of new cases of APL. Introduction of ATO in first line treatment of APL(with or without ATRA plus chemotherapy) needs a multi center randomized clinical trial. No significant financial relationships to disclose.

A Phase 2 Evaluation of Single Agent Clofarabine as First Line Treatment for Older Patients with AML Who Are Not Considered Fit for Intensive Chemotherapy.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 869-869 ◽  
Author(s):  
Alan K. Burnett ◽  
Nigel Russell ◽  
Jonathan W. Kell ◽  
Donald Milligan ◽  
Dominic Culligan
Keyword(s):  
Complete Remission ◽  
Older Patients ◽  
Liver Toxicity ◽  
Single Agent ◽  
Randomised Trial ◽  
Significant Proportion ◽  
Intensive Chemotherapy ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

Abstract Patients over 70 years represent a significant proportion of patients with AML. They respond poorly to intensive chemotherapy. Although 50% of patients can achieve CR, only 8% are alive at 2 years (MRC Database). In addition significant numbers of these patients either do not wish to undergo, or are not considered fit for intensive chemotherapy. This represents a significant unmet medical need. Nucleoside analogues (Ara-C) provide an active group of agents in AML, Fludarabine however is ineffective at tolerable doses. Clofarabine has been modified by introducing a Fluorine in the 2′ position which confers reduced susceptibility to cleavage of the glycosidic linkage and also reduced toxicity caused by halogenated nucleobases. As such the drug has potential use as an oral formulation. Previous clinical and in vitro studies have established a dose schedule at 40mg/m2 days 1–5. This is associated with CRs in relapse/refractory AML, but with grade ¾ liver toxicity in 25% of patients. Because of these characteristics we undertook a non-randomised study using a dose of 30mg/m2 days 1-5 IV, which could be repeated for up to 4 courses at a minimum of 28 days apart. The target patient group were patients >70 years, or patients 60–70 with a cardiac history, who were not considered fit for conventional chemotherapy. Twenty-eight patients entered the study: 16 males, 12 females of a median age 71 years (range 60 – 79). The FAB distribution was, M0=1;M1=9; M2=8; M4=2; M5=4; M6=3; Unknown=1. The cytogenetic risk group (MRC criteria) were 26 standard and 2 unfavourable risk. All patients received course 1. Five patients died before response could be assessed from causes which were not thought to be associated with the drug. One patient is too early to assess response. Five did not enter complete remission although there was a reduction in bm blasts from 58 to 18%, 55 to 20% and 30 to 15% in 3 cases. Sixteen patients (59%) achieved complete remission after course 1. Grade 3 toxicity was seen in 3 patients, but this recovered in all cases in a few days. Patients who did not enter CR did not show haematological recovery after course 1 and were considered treatment failures. Of the 16 patients who entered CR, haematological recovery to ANC 1.0 x 109/l took 28 days (range 21–42) Platelets to 50x109/l took 25 days (range 21–38). Conclusions: Clofarabine is an active agent when used alone as first line treatment. It is well tolerated but is associated with cytopenia of an average 28 days. At the dose chosen for this study grade ¾ liver toxicity was uncommon. The drug is a candidate for evaluation in a randomised trial and/or in combination schedules, and lower doses should be explored in older patients. This study was partially supported by an unrestricted grant from Bioenvison Inc.

Treatment of CD 20+ Hodgkin Lymphoma (Lymphocyte Predominant) with Monoclonal Antibody Rituximab after First-Line Treatment Is Effective and Might Improve the Outcome

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5007-5007
Author(s):  
Sonja Genadieva-Stavrik ◽  
Alexandra Pivkova ◽  
Ljube Ivkovski ◽  
Lidija Cevreska
Keyword(s):  
Lymph Node ◽  
Complete Remission ◽  
Patient Population ◽  
Early Stage ◽  
Hodgkin Disease ◽  
Line Treatment ◽  
Malignant Cells ◽  
First Line ◽  
Tumor Mass ◽  
First Line Treatment

Abstract Lymphocyte-predominant Hodgkin disease (LPHD) presents as early-stage disease with slow disease progression and excellent initial response to conventional chemotherapy. Although 96% of LPHD patients experience a complete remission (CR) upon first line treatment, many relapses occur. Residual tumor cells in Hodgkin’s patients can survive standard therapy and cause relapse. Thus, the elimination of minimal residual disease after first line treatment might improve the outcome in Hodgkin disease. CD20+ is strongly expressed by malignant cells in LPHD, but so far there is limited information regarding the efficacy of Rituximab in this patient population. A 66 year-old woman presented with bilateral inguinal lymphadenopathy in 2004 and complained on malaise and weight loss. Lymph node biopsy confirmed a diagnosis of LPHD and immunohistochemistry confirmed that CD20 antigen was expressed on more than 30% of malignant cells. Staging revealed II B disease. There were lymph node enlargements in the pelvis on CT. Her blood count, erythrocyte sedimentation rate, and albumin were normal with elevation of and lactate dehydrogenase and alkaline phoshatase. She was treated with ABVD regiment 8 cycles and CR was achieved. After standard chemotherapy patient with CD20+ LPHD received four weekly doses of Rituximab at 375 mg/m2 and maintenance therapy with additional four doses of Rituximab every three months for the next year. Treatment was well tolerated without any complications. Evaluation of disease assessment included physical examination and computed tomography, bone marrow biopsy and routine analyses, after the end of treatment and every 3 months after for the first two years, and on six months for the following year. There were no abnormalities on CT after the end of the treatment. Patient was in complete remission. CT after 36 months showed no detectible tumor mass. Patient remains still in complete remission three years after chemotherapy without detectible tumor mass. Our case report suggests that Rituximab is both safe and effective in patients with CD20+ LPHD. The optimal treatment for patients with LPHD remains uncertain. Current research aims to identify alternative treatment approaches that possess significant activity but less toxicity. Radiotherapy for early-stage patients and chemotherapy or combined modality treatment for advanced-stage patients remains to be standard of care. Initial observed benefit of Rituximab treatment in this group of patients suggests that there is a role for monoclonal antibodies in optimal treatment approach, especially in improving the outcome. Further studies with Rituximab are warranted in this patient population.

scholarly journals Current problems in the first-line treatment of metastatic breast cancer: focus on the role of docetaxel

2010 ◽  
Vol 4 (3) ◽  
pp. 97-107
Author(s):  
Filippo Montemurro
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Complete Remission ◽  
Liver Metastases ◽  
Single Agent ◽  
Metastatic Breast ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

Metastatic breast cancer is a very heterogeneous disease, both from a clinical and a biological point of view. Despite being still incurable, the expanding therapeutic repertoire has determined a progressive increase in median survival. We describe the clinical course of a 67-year-old woman with a locally advanced, hormone-receptor positive breast cancer with synchronous liver metastases. Single-agent docetaxel at the dose of 100 mg/m2 for 8 cycles determined a pathological complete remission in the breast and a near complete remission of liver metastases. After more than 4 years from diagnosis, the patient is alive and without signs of tumour progression. Based on this clinical case, we discuss management issues like the choice of the initial treatment, the use of monochemotherapy vs polychemotherapy, the worth of surgery of the primary tumour in patients with stage IV disease, and the issue of maintenance endocrine therapy. Furthermore, we reviewed the pivotal role of docetaxel in the management of advanced breast cancer. Whether monochemotherapy or polychemotherapy is felt to be an adequate choice in the clinical practice, docetaxel qualifies as one of the most active and manageable agents. Single agent activity ranging from 20-48% in terms of response rate has been reported in several clinical trials in patients treated in various clinical settings. Docetaxel-based combinations with other cytotoxic agents have become established in the first line treatment both in patients with anthracycline-resistant and anthracycline-sensitive metastatic breast cancer. Finally, docetaxel has been shown to be an optimal companion drug for biologically targeted agents like trastuzumab or bevacizumab, resulting in further treatment options.

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