scholarly journals Management of Metachronous Bilateral Testis Cancer in a Patient with Pre-B Cell ALL

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Kelly T. Harris ◽  
Shakil A. Shaikh ◽  
Mark W. Ball ◽  
Mohamad E. Allaf ◽  
Phillip M. Pierorazio
Keyword(s):  
Testicular Cancer ◽  
B Cell ◽  
Multidisciplinary Approach ◽  
Medical Oncology ◽  
Hematologic Malignancy ◽  
Marrow Transplant ◽  
Testis Cancer ◽  
Close Monitoring

We present a patient with a metachronous, second testicular cancer after being diagnosed with pre-B cell ALL and receiving induction chemotherapy for a bone marrow transplant. We discuss the management of bilateral testis masses in a young patient with a hematologic malignancy as well as the role of immunosuppressive chemotherapy in developing a second cancer. This case illustrates the importance of recognizing bilateral testicular cancer early, as well as the importance of follow-up care in oncology patients including routine measurements of tumor markers. A multidisciplinary approach between medical oncology and urology, including close monitoring of the contralateral testis, remains paramount to patient care.

scholarly journals Real-World Outcome of Dose-Adjusted EPOCH-R, a Single-Centre Experience

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 27-28
Author(s):  
Rachel Wong ◽  
Roopesh R. Kansara
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Time Interval ◽  
Cns Involvement ◽  
Free Survival ◽  
Aggressive B Cell Lymphoma

Introduction Dose adjusted (DA) EPOCH-R is an intensive outpatient infusional regimen, that incorporates intrathecal (IT) methotrexate to treat patients with aggressive B-cell lymphoma including HIV associated aggressive B-cell lymphoma, double-hit lymphoma (DHL), primary mediastinal B-cell lymphoma (PMBCL), Burkitt's lymphoma (BL) ineligible for intensive therapy, and gray zone lymphoma (GZL) with features in between BL and diffuse large B-cell lymphoma (DLBCL). We aimed to evaluate non-trial, progression-free survival (PFS) and overall survival (OS) of Manitoba patients treated with DA-EPOCH-R, assess the role of prophylactic IT chemotherapy and toxicities. Methods Patients in MB approved to receive DA-EPOCH-R were identified through the CCMB Provincial Oncology Drug Program (PODP) database. Patients were included if they were older than 17 years, received at least 1 cycle of DA-EPOCH-R and with a diagnosis of HIV associated aggressive B-cell lymphoma, DHL, PMBCL, BL ineligible for more aggressive therapy, or GZL. All other diagnoses were excluded. Baseline demographic data, treatment characteristics, treatment responses, and treatment toxicity were collected. The primary endpoints of the study were progression free survival (PFS) and overall survival (OS). PFS was the time interval between the date of diagnosis to date of progression, last follow-up, or death from any cause. OS was the time interval between date of diagnosis to date of death by any cause, or last follow-up. The study was approved by the University of Manitoba Research Ethics Board and the CancerCare Manitoba Research Resource Impact Committee. Results A total of 40 patients were approved for DA-EPOCH-R between 2013 and 2019. 10 of these patients were excluded. 4 patients never received the therapy, 4 patients were treated in the relapsed setting, and 2 patients had histologies outside the inclusion criteria. Of the 30 patients included, 19 (63%) were male, 11 (37%) were female. The median age at diagnosis was 55 years (range 20-88). Our cohort was composed of DHL (n=9), triple hit lymphoma (THL, n=5), BL (n=4), GZL (n=3), and HIV-associated DLBCL (n=2). 87% (n=26) had advanced stage disease. By revised-IPI, 19 (63.3%) had poor prognosis (R-IPI ≥ 3). Response rate was 90%; CR 53.3% (n=16) and PR 37% (n=11). At a median follow-up of 25.3 months, the median PFS was 33.3 months and median OS was not reached. By histological subtype, median PFS was not reached in DHL, however THL, BL and PMBCL had worse median PFS (6.1, 8.4, and 5.6 months, respectively). Only 1 patient had CNS involvement at time of diagnosis. Of the patients with no documented CNS disease at presentation (n=29), none developed CNS involvement, including those who did not receive IT methotrexate. Median chemotherapy cycles per patient was 6 (range 1-6) and median IT treatment was 3 (range 0-6). 3 patients did not receive IT prophylaxis, and 2 stopped after 1 cycle due to intolerance. 56.7% (n=17) were able to undergo dose escalation beyond dose level 1, and 40% (n=T12) tolerated maximum dose level 3 or higher.77% of patients (n=23) experienced at least one adverse event of grade 3 or higher. 17 (57%) patients required blood transfusion at least once. 10 (33%) experienced neuropathy, 4 requiring vincristine dose reduction. 9 (30%) patients had febrile neutropenia complicating a total of 22 treatment cycles. 8 patients had grade 2-3 infectious complications. Conclusions While the real-world survival data for patients with DHL and HIV-associated lymphoma treated with DA-EPOCH-R are encouraging, those with THL, BL, and PMBCL did not attain durable response. Considering no patients (including those who did not receive IT chemotherapy) experienced CNS relapse, the role of IT chemotherapy needs to be further clarified. Disclosures No relevant conflicts of interest to declare.

scholarly journals Impact of Interim FDG-PET (iPET) in the Outcomes of Patients with Aggressive B-Cell Lymphomas Receiving DA-EPOCH-R

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2898-2898
Author(s):  
Vania Phuoc ◽  
Leidy Isenalumhe ◽  
Hayder Saeed ◽  
Celeste Bello ◽  
Bijal Shah ◽  
...  
Keyword(s):  
B Cell ◽  
Board Of Directors ◽  
Fdg Pet ◽  
Research Funding ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Advisory Committees ◽  
End Of Treatment

Introduction: 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) remains the standard of care for baseline and end of treatment scans for aggressive non-Hodgkin lymphomas (NHLs). However, the role of interim FDG-PET remains not as well defined across aggressive NHLs, especially in the era of high-intensity chemoimmunotherapy. Interim FDG-PET (iPET) can serve as an early prognostic tool, and prior studies evaluating the utility of iPET-guided treatment strategies primarily focused on diffuse large B-cell lymphomas (DLBCL) and frontline R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Classification criteria systems assessing response also differ between studies with no clear consensus between use of Deauville criteria (DC), International Harmonization Project (IHP), and the ΔSUVmax method. Methods: This study evaluates our institutional experience with iPET during treatment with DA-EPOCH ± R (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin with or without Rituximab) in aggressive NHLs. We retrospectively evaluated 70 patients at Moffitt Cancer Center who started on DA-EPOCH ± R between 1/1/2014 to 12/31/2018 for aggressive NHLs. Response on interim and end-of-treatment (EOT) scans were graded per DC, IHP, and ΔSUVmax methods, and progression free survival (PFS) probability estimates were calculated with chi-square testing and Kaplan Meier method. PFS outcomes were compared between interim negative and positive scans based on each scoring method. Outcomes were also compared between groups based on interim versus EOT positive or negative scans. Results: We identified 70 patients with aggressive NHLs who received DA-EPOCH ± R at our institute. The most common diagnoses were DLBCL (61%) followed by Burkitt's lymphoma (10%), primary mediastinal B-cell lymphoma (9%), plasmablastic lymphoma (7%), gray zone lymphoma (6%), primary cutaneous large B-cell lymphoma (1%), primary effusion lymphoma (1%), and other high-grade NHL not otherwise specified (3%). Of the 43 patients with DLBCL, 21/43 (49%) had double hit lymphoma (DHL) while 7/43 (16%) had triple hit lymphoma (THL), and 3/43 (7%) had MYC-rearranged DLBCL while 2/43 (5%) had double expressor DLBCL. Thirty nine out of 70 (56%) were female, and median age at diagnosis was 58.39 years (range 22.99 - 86.86 years). Most patients had stage IV disease (49/70, 70%), and 43/70 (61%) had more than one extranodal site while 45/70 (64%) had IPI score ≥ 3. Forty-six out of 70 (66%) received central nervous system prophylaxis, most with intrathecal chemotherapy (44/70, 63%). Fifty-five out of 70 (79%) had iPET available while 6/70 (9%) had interim computerized tomography (CT) scans. Fifty-six out of 70 (80%) had EOT PET, and 4/70 (6%) had EOT CT scans. Sustained complete remission occurred in 46/70 (66%) after frontline DA-EPOCH ± R (CR1), and 12/70 (17%) were primary refractory while 5/70 (7%) had relapse after CR1. Four of 70 (6%) died before cycle 3, and 3/70 (4%) did not have long-term follow-up due to transition of care elsewhere. Median follow-up was 15.29 months (range 0.85 - 60.09 months). There was significantly better PFS observed if iPET showed DC 1-3 compared to DC 4-5 (Χ2=5.707, p=0.0169), and PFS was better if iPET was negative by IHP criteria (Χ2=4.254, p=0.0392) or ΔSUVmax method (Χ2=6.411, p=0.0113). Comparing iPET to EOT PET, there was significantly better PFS if iPET was negative with EOT PET negative (iPET-/EOT-) compared to iPET positive with EOT negative (iPET+/EOT-), and iPET+/EOT+ and iPET-/EOT+ had worse PFS after iPET-/EOT- and iPET+/EOT- respectively. This pattern in iPET/EOT PFS probability remained consistent when comparing DC (Χ2=30.041, p<0.0001), IHP (Χ2=49.078, p<0.0001), and ΔSUVmax method (Χ2=9.126, p=0.0104). These findings fit clinical expectations with positive EOT scans indicating primary refractory disease. There was no significant difference in PFS when comparing DLBCL versus non-DLBCL (Χ2=3.461, p=0.0628) or DHL/THL versus non-DHL/THL diagnoses (Χ2=2.850, p=0.0914). Conclusion: Our findings indicate a prognostic role of iPET during treatment with DA-EPOCH ± R for aggressive NHLs. Significant differences in PFS were seen when graded by DC, IHP, and ΔSUVmax methods used in prior studies and when comparing interim versus EOT response. Larger studies are needed to confirm these findings. Disclosures Bello: Celgene: Speakers Bureau. Shah:Novartis: Honoraria; AstraZeneca: Honoraria; Spectrum/Astrotech: Honoraria; Adaptive Biotechnologies: Honoraria; Pharmacyclics: Honoraria; Jazz Pharmaceuticals: Research Funding; Incyte: Research Funding; Kite/Gilead: Honoraria; Celgene/Juno: Honoraria. Sokol:EUSA: Consultancy. Chavez:Janssen Pharmaceuticals, Inc.: Speakers Bureau; Genentech: Speakers Bureau; Kite Pharmaceuticals, Inc.: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees.

scholarly journals Continued dysregulation of the B cell lineage promotes multiple sclerosis activity despite disease modifying therapies

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 1305
Author(s):  
Ana C. Londoño ◽  
Carlos A. Mora
Keyword(s):  
Multiple Sclerosis ◽  
B Cells ◽  
B Cell ◽  
Cell Lineage ◽  
Clear Understanding ◽  
Cellular Activity ◽  
Regulatory B Cells ◽  
Disease Modifying Therapies

A clear understanding of the origin and role of the different subtypes of the B cell lineage involved in the activity or remission of multiple sclerosis (MS) is important for the treatment and follow-up of patients living with this disease. B cells, however, are dynamic and can play an anti-inflammatory or pro-inflammatory role, depending on their milieu. Depletion of B cells has been effective in controlling the progression of MS, but it can have adverse side effects. A better understanding of the role of the B cell subtypes, through the use of surface biomarkers of cellular activity with special attention to the function of memory and regulatory B cells (Bregs), will be necessary in order to offer specific treatments without inducing undesirable effects.

Role of Yttrium-90 Ibritumomab Tiuxetan (Zevalin®) in Inducing and Maintaining Complete Molecular Response in B Non Hodgkin’s Lymphoma Patients in Clinical Complete Remission after Chemotherapy Regimen.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4498-4498 ◽  
Author(s):  
Enrico Orciuolo ◽  
Gabriele Buda ◽  
Sara Galimberti ◽  
Giuseppe Boni ◽  
Nadia Cecconi ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Bone Marrow ◽  
B Cell ◽  
Hodgkin's Lymphoma ◽  
Molecular Response ◽  
Consolidation Therapy ◽  
Ibritumomab Tiuxetan ◽  
Complete Molecular Response

Abstract Introduction: Radioimmunotherapy (RIT) is a new treatment for B non Hodgkin’s lymphoma (NHL) patients. 90Y ibritumomab tiuxetan (Zevalin®) consists of a murine monoclonal antibody to CD20, conjugated to a metal chelator tiuxetan for retention of the beta emitter 90Y. Thus Zevalin® delivers radiation to B-NHL, combining the tumor targeting attributes of a monoclonal antibody and the beta radiation of 90Y. Zevalin® is approved for the treatment of follicular lymphoma (FL) refractory to or relapsed after rituximab, on the bases of clinical trials where it achieved a response rate as high as 83%. Several ongoing registrational trials are evaluating the efficacy of Zevalin® in other NHL, as diffuse large B cell (DLCL) and mantle cell lymphoma (MCL). We are here evaluating the effect of Zevalin® as consolidation therapy in NHL patients that achieved a complete clinical response (CCR) with chemotherapy. Methods: In B cell NHL patients that achieved a CCR after 1st or multiple lines anthracyclines based chemotherapy +/− Rituximab, minimal residual disease was evaluated by PCR on bone marrow samples, for the following rearrangements: JH, Bcl-1, Bcl-2. Patients received Zevalin® 6-9 weeks post chemotherapy. Evaluation of molecular response was assessed after a follow up period at 12 weeks. The aim of the study was the role of Zevalin® in inducing a complete molecular response (CMR). Results: 23 B-NHL patients (13 FL, 6 MCL, 4 DLCL; male:female 13:10, median age 63, range 42–73. See table) in a CCR after chemotherapy (documented by TC scan and/or PET-scan negative for abnormal lesions or glucose captation) have been enrolled. 10 patients had a pathological rearrangement before RIT, while 13 were already in a CMR condition. Zevalin® was completed in all 23 patients and the post infusion evaluation was performed after 12 weeks. In the follow-up period thrombocitopenia was commonly documented, but it was not associated to bleeding or need of platelet transfusion, but in one singular case. After 12 weeks from RIT a new molecular evaluation was performed on bone marrow samples. All the 23 patients have completed the 12 weeks follow-up: 8 of 10 (80%) patients positive before RIT achieved a CMR with Zevalin® administration. The 13 PCR negative patients maintained the CMR. The 21 PCR negative patients are now under follow-up to evaluate the molecular disease free survival after Zevalin® RIT. Conclusion: Zevalin® is an efficient consolidation therapy in B cell NHL patients after chemotherapy. In this series of patients Zevalin® administration allowed to convert 8 of 10 CCR to CMR. In the remaining 13 patients Zevalin® maintained the CMR. Zevalin® addition to medication treatment is feasible and associated with manageable hematological toxicity. Pts disease sex age previous chemotherapy lines molecular response before RIT molecular response after RIT 1 FL M 68 1 POS NEG 2 FL F 53 1 NEG NEG 3 FL M 54 1 NEG NEG 4 FL M 51 4 NEG NEG 5 DLCL F 66 2 POS NEG 6 DLCL F 67 1 NEG NEG 7 FL F 42 1 POS POS 8 FL M 52 1 POS NEG 9 FL F 54 3 NEG NEG 10 FL M 57 2 POS NEG 11 FL F 62 2 POS NEG 12 FL M 58 2 POS NEG 13 FL F 69 2 NEG NEG 14 MCL M 62 1 POS NEG 15 MCL M 66 1 POS POS 16 MCL M 66 2 NEG NEG 17 MCL M 67 1 POS NEG 18 FL F 67 2 NEG NEG 19 DLCL F 67 3 NEG NEG 20 MCL M 70 2 NEG NEG 21 FL M 61 4 NEG NEG 22 DLCL M 43 2 NEG NEG 23 MCL F 73 2 NEG NEG

Final Results of a Multicenter Phase II Trial Assessing the Activity and Efficacy of Helicobacter Pylori-Eradicating Antibiotic Therapy As Exclusive Treatment for Patients with Stage I-II1 Diffuse Large B-Cell Lymphoma of the Stomach (the HGL-1 Trial)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 958-958 ◽  
Author(s):  
Silvia Govi ◽  
Caterina Patti ◽  
Markus Raderer ◽  
Alessandro Andriani ◽  
Daniele Caracciolo ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
B Cell ◽  
De Novo ◽  
Phase Ii Trial ◽  
Objective Response ◽  
B Cell Lymphoma ◽  
Stage I ◽  
Experimental Therapy

Abstract Abstract 958 BACKGROUND: Helicobacter pylori (Hp) infection is associated with the pathogenesis of marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT)-type of the stomach, and Hp-eradicating antibiotic therapy is the standard treatment for this lymphoma, with complete remission rates of 60–80%. Hp is also detected in 35% of diffuse large B-cell lymphomas (DLBCL) of the stomach, being more common in cases with concomitant MALT areas with respect to de novo cases (65% vs. 15%). However, the role of Hp-eradicating antibiotic therapy in gastric DLBCL remains to be elucidated, since only rare and small, monoinstitutional retrospective studies are available. Herein, we report the final results of a multicentre phase II trial, the first one in Western countries, addressing the role of Hp-eradicating therapy as exclusive treatment in patients with gastric DLBCL. AIMS: To assess feasibility, activity and efficacy of Hp-eradicating therapy as exclusive treatment for limited-stage DLBCL of the stomach. METHODS: Inclusion criteria were histopathologic diagnosis of DLBCL, with or without concomitant MALT-type areas; Hp-infection assessed by multiple gastric biopsies and/or breath test; stage I-II1 of disease according to Musshoff staging system; perigastric lymph nodes diameter <1.5 cm; normal lactate dehydrogenase (LDH) serum level; age ≥18 years old; ECOG-Performance Status <3; absence of HIV-infection or history of previous cancer; absence of bleeding lesions (hemoglobin >9 g/dl). Registered patients received clarithromycin 500 mg bid, tinidazole 500 mg bid and omeprazole 20 mg bid, orally, for 7 consecutive days. Objective response and bacterial eradication were assessed at 30 and 60 days from antibiotics by gastric endoscopy-ultrasonography, biopsies and breath test. Patients who did not achieve Hp eradication received a second-line antibiotic therapy according to local guidelines. Eradicated patients who achieved complete lymphoma remission (CR) were referred to follow-up; patients with partial response (PR) received rituximab as complementary therapy; patients with stable (SD) or progressive (PD) disease received conventional treatment (R-CHOP ± radiotherapy). RESULTS: From 2003 to 2010, 16 patients (median age 70; range 38–87; 11 males) were enrolled. Eleven patients had de novo DLBCL, while 5 patients presented concomitant MALT areas. Ten patients had stage II1 disease, 5 had stage IE. Five patients presented anemia; two patients had concomitant HCV infection. None presented systemic symptoms. Eradicating therapy was completed in all patients with excellent tolerability. Eradication was documented at one month in 15 patients and after second-line antibiotic-therapy in the remainder patient. Lymphoma regression was complete in 8 (50%) patients and partial in 3 (ORR= 69%; 95% CI= 47%–91%). Two of the three PRs achieved CR after rituximab, with a CRR after experimental therapy of 63% (95% CI= 39%–87%). Objective response was not associated with stage or concomitant MALT areas. At a median follow-up of 53 months, 9 of the 10 patients who achieved CR after experimental therapy remain relapse-free, the remainder experienced relapse at 10 months, with a median DFS of 68+ months. Treatment failure was observed in 7 patients: 5 patients with SD/PD after antibiotics, one patient in PR who did not receive rituximab and the single patient with relapsing disease; they were referred to conventional chemoradiation treatment, achieving CR in all cases, and none of them experienced relapse after 13–128 months (median 41+). No patient died of lymphoma; two patients died of cardiac failure and gallbladder cancer, respectively; the remaining 14 patients are alive (13 disease-free), with a 5-yr OS of 94%. CONCLUSIONS: Patients with stage I-II1 Hp-associated DLBCL of the stomach can be safely managed with antibiotics alone. Half of treated patients will achieve long-term remission without chemotherapy, a critical issue considering that two-thirds of patients are >65 years old. Importantly, unresponsive patients can be safely salvaged with conventional treatment. Registered cases of Hp-associated DLBCL of the stomach will be characterized under pathologic and molecular perspectives to identify parameters useful to distinguish the best candidates for eradicating therapy. Disclosures: No relevant conflicts of interest to declare.

Complication Rates Among Cancer Patients With Peripherally Inserted Central Catheters

2002 ◽  
Vol 20 (15) ◽  
pp. 3276-3281 ◽  
Author(s):  
Louise J. Walshe ◽  
Sharp F. Malak ◽  
Janet Eagan ◽  
Kent A. Sepkowitz
Keyword(s):  
Home Care ◽  
Cancer Patients ◽  
Hematologic Malignancy ◽  
Clinical Information ◽  
Marrow Transplant ◽  
Cancer Center ◽  
Complication Rates ◽  
Peripherally Inserted Central Catheters ◽  
Central Catheters

PURPOSE: Peripherally inserted central catheters (PICCs) are frequently used to deliver outpatient courses of intravenous therapy. However, the rates and risks of complication for this device have not been well-studied. Our objective was to determine the incidence and risk factors of PICC-related complications with a 1-year prospective observational study. PATIENTS AND METHODS: All PICCs inserted in adult and pediatric patients at Memorial Sloan-Kettering Cancer Center (MSKCC) were followed prospectively. The device insertion team, inpatient nurses, and various home-care companies and outside institutions collected longitudinal data. RESULTS: Three hundred fifty-one PICCs were inserted during the study period and followed for a total of 10,562 catheter-days (median placement, 15 days; range, 1 to 487 days). Two hundred five PICCs (58%) were managed by home-care companies and outside institutions, and 146 PICCs (42%) were managed exclusively at MSKCC. For these 205 PICCs, 131 nurses from 74 home-care companies and institutions were contacted for follow-up clinical information. In all, 115 (32.8%) of 351 PICCs were removed as a result of a complication, for a rate of 10.9 per 1,000 catheter-days. Patients with hematologic malignancy or bone marrow transplant were more likely to develop a complication, whereas those with metastatic disease were less likely. CONCLUSION: Complications occur frequently among cancer patients with PICCs, and long-term follow-up is onerous. Despite a high complication rate, the ease of insertion and removal argues for continued PICC use in the cancer population.

scholarly journals Role of B Cell Profile for Predicting Secondary Autoimmunity in Patients Treated With Alemtuzumab

2021 ◽  
Vol 12 ◽  
Author(s):  
Paulette Esperanza Walo-Delgado ◽  
Enric Monreal ◽  
Silvia Medina ◽  
Ester Quintana ◽  
Susana Sainz de la Maza ◽  
...  
Keyword(s):  
T Cells ◽  
B Cell ◽  
Plasma Cells ◽  
Effector Memory ◽  
Relapsing Remitting ◽  
Multicenter Prospective Study ◽  
One Year ◽  
Relapsing Remitting Multiple Sclerosis

ObjectiveTo explore if baseline blood lymphocyte profile could identify relapsing remitting multiple sclerosis (RRMS) patients at higher risk of developing secondary autoimmune adverse events (AIAEs) after alemtuzumab treatment.MethodsMulticenter prospective study including 57 RRMS patients treated with alemtuzumab followed for 3.25 [3.5-4.21] years, (median [interquartile range]). Blood samples were collected at baseline, and leukocyte subsets determined by flow cytometry. We had additional samples one year after the first cycle of alemtuzumab treatment in 39 cases.ResultsTwenty-two patients (38.6%) developed AIAEs during follow-up. They had higher B-cell percentages at baseline (p=0.0014), being differences mainly due to plasmablasts/plasma cells (PB/PC, p=0.0011). Those with no AIAEs had higher percentages of CD4+ T cells (p=0.013), mainly due to terminally differentiated (TD) (p=0.034) and effector memory (EM) (p=0.031) phenotypes. AIAEs- patients also showed higher values of TNF-alpha-producing CD8+ T cells (p=0.029). The percentage of PB/PC was the best variable to differentiate both groups of patients. Baseline values &gt;0.10% closely associated with higher AIAE risk (Odds ratio [OR]: 5.91, 95% CI: 1.83-19.10, p=0.004). When excluding the 12 patients with natalizumab, which decreases blood PB/PC percentages, being the last treatment before alemtuzumab, baseline PB/PC &gt;0.1% even predicted more accurately the risk of AIAEs (OR: 11.67, 95% CI: 2.62-51.89, p=0.0007). The AIAEs+ group continued having high percentages of PB/PC after a year of alemtuzumab treatment (p=0.0058).ConclusionsA PB/PC percentage &lt;0.1% at baseline identifies MS patients at low risk of secondary autoimmunity during alemtuzumab treatment.​

A Novel Approach to the Treatment of Early Stage Hodgkin Lymphoma with a Mitoxantrone-Based Regimen Followed by Involved Field Radiotherapy: A 12 Year Follow up

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4901-4901
Author(s):  
Arlene Dawravoo ◽  
Neel B. Shah ◽  
Teresa O'Brien ◽  
Stephanie A. Gregory ◽  
Parmeswaran Venugopal
Keyword(s):  
Bone Marrow ◽  
Radiation Therapy ◽  
Early Stage ◽  
Marrow Transplant ◽  
Field Radiation ◽  
Involved Field ◽  
Experienced Grade

Abstract Abstract 4901 Early stage Hodgkin Lymphoma (HL) has been conventionally treated with radiotherapy alone or abbreviated chemotherapy along with involved field radiation therapy. The role of combined modality therapy was investigated to study the favorable effects of lower doses of radiation on acute and long term toxicities without compromising response and cure rates. The goal of this study was to evaluate the role of combined chemotherapy, which incorporated mitoxantrone in place of doxorubicin and dexamethasone in place of dacarbazine, and involved field radiation therapy in patients with early stage, non-bulky (I and II) HL. The patients enrolled in this trial were originally enrolled in 1997–2002 and treated with 4 cycles of chemotherapy with mitoxantrone 6 mg/m2 IV, vinblastine 5 mg/m2 IV, bleomycin 5 units/m2 on day 1 and day 15, and dexamethasone 6 mg/m2 PO on days 1–5 and days 15–19 on a 28 day cycle (MBVD). Restaging was done following 4 cycles of chemotherapy. Subsequently patients received involved field radiation with total dose of 30 Gy at 150 cGy per fraction. Patients were followed for response, duration, toxicity and survival. Results: 15 patients were enrolled, 10 were evaluable. All completed treatment. 7 patients were stage II and 3 were stage I at diagnosis. 4 were males and 6 were females between the ages of 20 to 52 years with a median age 33.5 years. Following completion of treatment with chemotherapy and radiation, 8 patients achieved a complete response and 2 patients remained in partial remission. Duration of response in patients in follow up ranged between 9 and 149 months with a median of 75 months. 2 relapses occurred at 8 and 23 months with increase in size of the mediastinal lymph nodes. 7/10 patients experienced grade 1 toxicities which included anemia, leukopenia, neutropenia, thrombocytopenia, GI upset or cardiomyopathy. 4/10 patients experienced grade 2 toxicities. 2/10 patients had grade 3 toxicities with severe neutropenia. All patients experienced grade 1 skin changes following radiation. One patient's left ventricle ejection fraction decreased from 65% to 52% following therapy. At last follow up, 9/10 patients were alive with 9/10 patients still in remission. 1 patient underwent bone marrow transplant after relapse at 8 months and was lost to follow up. 1 patient experienced recurrence of disease at 23 months and underwent bone marrow transplant at 29 months and was in remission at 73 month follow up. Although the number of patients in this study is small, treatment appears to be well tolerated and acute toxicities less compared to standard therapy with ABVD chemotherapy followed by radiotherapy. At last follow up 9/10 are in remission, with 2 patients in remission for 12 years. No patients have experienced MDS or other long term sequelae. Confirmatory studies should be done to determine the safety of the MBVD regimen compared to standard ABVD. Disclosures: No relevant conflicts of interest to declare.

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