A Follow-up Investigation with High Response Rate

There is no widely recognized preventive treatment for patients with paroxysmal hypertension (“pseudopheochromocytoma”) who suffer recurrent and often severe paroxysmal elevation of blood pressure, repeated emergency room visits and hospitalizations. In this case series we assessed the effectiveness of treatment with an antidepressant in preventing recurrent paroxysms. A secondary exploratory objective was to examine the psychological profile of patients and its relationship to response to treatment. The charts of 52 patients who reported having experienced at least 3 symptomatic episodes were selected; and and for whom treatment data were included. Treatment with an antidepressant was offered to, and follow-up data were available in 37..Two patients refused treatment, 6 were unable to tolerate an effective dose, 3 were lost to follow-up, and 1 was non-compliant with the medication. Of the remaining 25 evaluable patients, 92% (23/25) responded, with 80% (21/25) achieving complete and persisting cessation of paroxysms, and 8% (2/25), a reduction in frequency. Importantly, an antidepressant was effective in nearly all patients who reported that they were not suffering from anxiety or depression. The data were insufficient to determine superiority of any one antidepressant versus another. We conclude that treatment with an antidepressant is effective in preventing hypertensive paroxysms in a high proportion of patients with paroxysmal hypertension. Given the absence of any other pharmacologic intervention capable of preventing recurrent paroxysms, the similarly high response rate observed in previous reports, and the relatively safe profile of antidepressant agents, the findings support more widespread use of an antidepressant in patients with this disorder to prevent years of continued hypertensive paroxysms and their consequences.

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Interferon-Alpha With Or Without Rituximab Achieves a High Response Rate and Durable Responses In Relapsed FL: 17 years’ Experience In a Single Centre

Blood ◽

10.1182/blood.v122.21.5126.5126 ◽

2013 ◽

Vol 122 (21) ◽

pp. 5126-5126

Author(s):

Sinziana Radesi-Sarghi ◽

Flavie Arbion ◽

Caroline Dartigeas ◽

Martine Delain ◽

Lotfi Benboubker ◽

...

Keyword(s):

Follicular Lymphoma ◽

Interferon Alpha ◽

Response Rate ◽

Progression Free Survival ◽

High Response Rate ◽

High Response ◽

Single Centre ◽

Time To Relapse

Abstract Background Maintenance interferon-alpha (IFNa) immunotherapy after induction chemotherapy prolongs progression-free survival (PFS) in untreated follicular lymphoma (FL). Little information is available about IFNa use in relapsed FL. Objectives To evaluate the benefit of IFNa as treatment for low-burden FL relapse. Methods In this single-centre retrospective study, we analysed all patients with molecular or clinical relapsed low- burden FL who received 3MIU IFNa three times a week alone (16 times) or in combination with 4-weekly rituximab (R) (11 times), without chemotherapy, according to the institution’s policy. All responses were evaluated according to the IWG 1999 criteria, except for molecular relapses which are described separately. Results 20 patients (13 men, 7 women), treated for a total of 27 times with IFNa were identified, with a median follow-up of 85 months. At diagnosis, 17 patients had advanced III-IV stage and 5 of them a high tumour burden, according to GELA criteria. 5 patients were treated for molecular IGH-BCL2 relapses. The FLIPI score was intermediate or high risk in 37% of patients. The median age of patients at the first IFNa +/- R treatment was 51 years (range: 30-65). Patients had previously received a median of three lines of treatment (range: 1-6) and 59% had received anthracycline-based chemotherapy. In the 22 situations with measurable disease, the overall response rate (OR) was 70%, with 59% complete responses (CR). For patients with only detectable molecular disease (n=5), IFNa was used alone for a median duration of 15 months (range: 12- 21 months), MRD becoming negative in 4 patients. The only factor significantly correlated with maximum response was low FLIPI score calculated at study entry (p=0.02). Median PFS was 56.9 months, (95% CI: 0.8-113). The R-IFNa and IFNa subgroup outcomes did not statistically differ in response or PFS. The FLIPI score calculated at initiation of IFNa treatment was predictive of time to relapse (P=0.014). The overall survival at 5 years was 95 % (95%CI: 91-99): 100% in the IFNa group and 91% (95%CI: 82-100) in the R-IFNa group. Reported toxicity was low. Conclusion Interferon alpha with or without rituximab achieve high response rates in relapsed low burden follicular lymphoma. These results compare favorably with previous reports of the efficacy of R alone, and of R with IFNa in relapse. Further research is required to explore the role of IFNa in the management of FL. Disclosures: Gyan: Roche: Research Funding.

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