scholarly journals Follicular Lymphoma Frontline Immuno-Chemotherapy: Survival Outcomes and Infection-Related Morbidity

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5884-5884
Author(s):  
Faouzi Djebbari ◽  
Furqaan Kaji ◽  
Louise Stanton ◽  
Graham P. Collins ◽  
Toby A. Eyre
Keyword(s):  
Follicular Lymphoma ◽  
Progression Free Survival ◽  
Continuous Variable ◽  
Smoking History ◽  
Factors Associated ◽  
Increased Risk ◽  
Potential Factors ◽  
Conference Attendance ◽  
Anti Cd20

Background Follicular lymphoma (FL) patients (pts) receiving immunochemotherapy now have a median overall survival (OS) of 15-20 years (y). ~80% of pts demonstrate an age/sex-matched OS compared to the population (Casulo et al, 2015). As such, optimizing therapy and minimizing toxicities are key outcome measures. The GALLIUM trial (Marcus et al, 2017) reported excess toxicity with front line (1L) obinutuzumab (O) compared to rituximab (R) (neutropenic fever, infection) and with bendamustine (B) (treated-related mortality ~4-5%). Methods We performed a single institution retrospective analysis of 132 consecutively 1L FL pts (2009-19) to assess factors associated with progression-free survival (PFS), OS, and morbidity following chemotherapy (R or O with CVP, CHOP, or B) +/- anti-CD20 antibody (ab) maintenance. Transformed FL was excluded. We collected data on all-cause infection over a 3y period, including infective-related admissions and grade (G) 1-2 infections regardless if they received maintenance. Univariable (UVA) and multivariable analyses (MVA) assessed factors for infective complications. Potential factors included were: age, baseline Hb (<12), CIRS-G, CIRS-G severity (CIRS-G/number of comorbidities), FLIPI, smoking history, COPD, immunochemotherapy, and maintenance. Results Across all pts, the median age was 63 y (range 28-90). Time from diagnosis to 1L was 1.6 months (range 0.03-110). Regimens included R-CHOP (n=34), R-CVP (n=53), R-B (n=32), O-B (n=9). B-treated pts were younger (median 57 y) than R-CHOP (median 62 y) and R-CVP (median 71 y). The mean CIRS-G (R-CHOP 1.38 vs R-CVP 2.76 vs B-R 1.1) and CIRS-G severity score (R-CHOP 0.81 vs R-CVP 1.38 vs R-B 0.81) were both higher in R-CVP pts. R-CVP pts had lower FLIPI scores (FLIPI 3-5: B-R/O 71%, R-CHOP 68%, R-CVP 55%). 68% R-CHOP, 51% R-CVP and 76% B-R/O of pts started anti-CD20 ab maintenance. The 3y PFS was 70% (95% confidence interval (CI) 61-78%) (Fig A) and 3y OS 89% (95% CI 82-93%) (Fig B) across all pts. Pts receiving R-CVP had an inferior PFS (Fig C) than RCHOP or B-R/O (3y PFS 52% (95% CI 37-66%) vs R-CHOP 3y PFS: 82% (95% CI 63-92%) vs BR 88% (95% 70-95%) vs B-O 63% (CI 24-87%) p=0.004). This translated to R-CVP pts having an inferior OS (Fig D) compared to RCHOP or B-R/O (3y OS 82% (95% CI 68-90%) vs R-CHOP 100% vs BR 91% (95% 74-97%) vs B-O 88% (95% CI 39-98%) p=0.006); reflecting both pt characteristics and treatment efficacy. Across all pts, the 3y PFS was 81% (95% CI 70-89%) with anti-CD20 ab maintenance versus 53% (95% CI 37-66%) without maintenance (p=0.001) (Fig E). There was an OS difference in favour of maintenance (3y OS 75% vs 97%) (p=0.012) (Fig F). There were 74 documented infective episodes (G1+) across all pts over 3y follow up. There were 43 infective-related admissions (G3+) during induction (n=132) and 16 during maintenance (n=83). The highest numerical risk of any infective episode(s) within 3 y follow up was BR (69% 22/32) and lowest R-CVP (50% 25/50) (p=0.09). G3+ infection during induction was significantly higher with R-CHOP (52% 17/33) compared to BR 6/32 (19% 6/32) (p=0.006). Conversely during maintenance, infective-related admissions were numerically higher in B-treated (R+O) (23% 7/31) compared to RCVP/RCHOP pts (16% 8/50) (p=0.46). Factors associated with an increased risk for all grade infections by UVA included: maintenance (odds ratio (OR): 2.1 (95% CI 1-4.4), p=0.05), CIRS-G* (OR: 1.2 (95% CI 1-4.4), p=0.07), CIRS-G severity* (OR: 1.5 (1.0-2.2) p=0.04). On MVA, the only risk factor for all grade infective episodes (ref: R-CVP) was BR (OR 3.8 (95% CI 1.2-11.6); p=0.02). Factors associated with an increased infective-related admission by UVA included high CIRS-G* (OR:1.15 (95% CI 1-4.4), p=0.09). On MVA, the factors of significance for an increased infective admissions were CIRS-G* (OR 1.34 (95% CI 1.0-1.8) and R-CHOP (ref: R-CVP OR:1.0) OR 3.2 (95% CI 1.1-9.1); p=0.03). Conclusions OS and PFS were superior in pts receiving R-CHOP or B-based treatment compared to R-CVP. Similarly, superior OS and PFS were seen in pts receiving anti-CD20 maintenance. Consistent with GALLIUM, we show the risk of infective-related episodes across 3 y following bendamustine when accounting for other factors. Careful anti-infective measures (anti-viral, anti-PCP) are required following B-based therapy, including on maintenance. Infective-related admissions (G3+) were independently associated with R-CHOP. *continuous variable Disclosures Djebbari: Takeda: Honoraria, Other: support with conference attendance; Novartis: Honoraria; Celgene: Honoraria, Other: support with conference attendance, Research Funding; Amgen: Honoraria. Collins:Gilead: Consultancy, Honoraria. Eyre:Roche: Honoraria; Gilead: Consultancy, Honoraria, Other: commercial research support; Janssen: Honoraria; Abbvie: Honoraria.

Factors associated with regression of cervical dysplasia in adolescents: A retrospective study

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5582-5582
Author(s):  
C. Chen ◽  
F. Campbell ◽  
J. Patruno ◽  
S. Kimmel ◽  
R. Boulay ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Pap Smear ◽  
Demographic Data ◽  
Cervical Dysplasia ◽  
Smoking History ◽  
Pap Smears ◽  
Factors Associated ◽  
Increased Risk ◽  
Chi Square Analysis

5582 Background: Sexually active adolescents have high rates of infection with human papilloma virus (HPV) and abnormal pap smears. They are considered a special population as they are likely to regress to normal cytology. The aim of our study was to identify factors associated with regression of cervical dysplasia in adolescents. Methods: We identified adolescent patients (aged 12–21 years) who had abnormal pap smears at the Center for Women's Medicine at Lehigh Valley Hospital in Allentown, PA, by CPT code from a database between Jan 2004 and Dec 2006. A chart review was performed to capture demographic data, cytology, smoking history, number of sexual partners, parity, race, contraceptive choice, use of barrier contraception. Chi-square analysis with logistic regression and multivariate analysis were used to identify factors associated with regression of cervical dysplasia. Results: Two-hundred two patients were identified. Mean age was 18.84 years (14–22 years). One hundred twenty-two (57.8%) were Hispanic, 71 (33.6%) Caucasian, and 16 (7.6%) Black. Fifty-two (24.6%) were pregnant at the time of diagnosis. Seventy-six (36%) were smokers. There were 125 (61.9%) cases of ASCUS, 33.7% (68 cases) LGSIL and 4.5% (9 cases) HGSIL on initial pap smear. One hundred eighteen (55.9%) patients had colposcopy, and of these, 32 (15.2%) had surgical intervention. Follow-up demonstrated that 72 (57.6%) patients had disease regression, 24 (19.2%) persistence and 29 (23.2%) progression. On multivariate analysis, patients who did not smoke were significantly more likely to show regression of cervical dysplasia on pap smear than women who smoked (OR 2.17, 95% CI 1.03–4.55, p = 0.039). Other factors were not statistically significant in predicting regression of cervical dysplasia. Conclusions: Adolescents who smoke were more likely to have persistent cervical dysplasia than non-smoking adolescents, putting smokers at an increased risk of advanced disease. We suggest that this subset have follow-up at shorter intervals and be enrolled in a smoking cessation program. No significant financial relationships to disclose.

Scaphotrapeziotrapezoid Arthrodesis: A 10-Year Follow-up Study of Complications in 58 Wrists

Hand ◽  
2020 ◽  
pp. 155894472096497
Author(s):  
Miranda J. Rogers ◽  
Chao-Chin Lu ◽  
Andrew R. Stephens ◽  
Brittany N. Garcia ◽  
Wei Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Smoking History ◽  
Fixation Method ◽  
Veterans Health ◽  
Health Administration ◽  
Opioid Use ◽  
Factors Associated ◽  
Increased Risk ◽  
Stt Arthrodesis

Background: Scaphotrapeziotrapezoid (STT) arthrodesis is a procedure used for specific degenerative arthritis and instability patterns of the wrist. This study evaluates nonunion rate and risk factors for reoperation after STT arthrodesis in the Veterans Affairs Department patient population. The purpose of our study was to assess the long-term nonunion rate following STT arthrodesis and to identify factors associated with reoperation. Methods: The national Veterans Health Administration Corporate Data Warehouse and Current Procedural Terminology codes identified STT arthrodesis procedures from 1995 to 2016. Frequencies of total wrist arthrodesis (TWA) and secondary operations were determined. Univariate analyses provided odds ratios for risk factors associated with complications. Results: Fifty-eight STT arthrodeses were performed in 54 patients with a mean follow-up of 120 months. Kirschner wires (K-wires) were the most common fixation method (69%). Six wrists (10%) required secondary procedures: 5 TWAs and 1 revision STT arthrodesis. Four patients underwent additional procedures for nonunion (7%). Twenty-four patients required K-wire removal, 8 (14%) of these in the operating room, which were not included in regression analysis. Every increase in 1 year of age resulted in a 15% decrease in likelihood of reoperation (95% confidence interval: 0.77-0.93; P < .0001). Opioid use within 90 days before surgery ( P = 1.00), positive smoking history ( P = 1.00), race ( P = .30), comorbidity count ( P = .25), and body mass index ( P = .19) were not associated with increased risk of reoperation. Conclusions: At a mean follow-up of 10 years, patients undergoing STT arthrodesis have a 10% risk of reoperation, and this risk decreases with older patient age. There was a symptomatic nonunion rate of 7%, similar to prior published rates. Patient demographics, comorbidity, smoking history, and opioid use did not appear to increase risk of reoperation.

I131-tositumomab monotherapy as frontline treatment for follicular lymphoma: Updated results after a median follow-up of 8 years

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 8033-8033 ◽  
Author(s):  
M. S. Kaminski ◽  
J. Estes ◽  
M. Tuck ◽  
C. W. Ross ◽  
R. L. Wahl
Keyword(s):  
Follicular Lymphoma ◽  
Single Agent ◽  
Progression Free Survival ◽  
Single Institution ◽  
Free Survival ◽  
Frontline Treatment ◽  
Anti Cd20 ◽  
High Degree ◽  
The Impact

8033 Background: Monoclonal antibody-based therapies are improving the outcome for patients (pts) with follicular lymphoma (FL). Radioimmunotherapy has been found to be effective for pts with relapsed/refractory disease, but even more so when used as frontline treatment. Methods and Results. We previously reported the results of a phase II, single-institution, study of anti-CD20 I-131- Tositumomab (Bexxar) given as a single agent and as a single one-week treatment for 76 pts with Stage 3 or 4 FL (NEJM 352:441, 2005). An overall response (OR) rate and complete remission (CR) rate of 95% and 75%, respectively, were observed. With a median follow-up of 5.1 yrs, 5-yr overall survival (OS) and progression-free survival (PFS) were 89% and 59%, respectively, with a median PFS reached at 6.1 yrs. We now report on this pt cohort after a median follow-up of 7.93 yrs. The 8-year and 10-yr OS is estimated (by KM) now at 86% and 8-yr PFS is 50% (95% CI: 38.8 - 61.7%). Only 3 additional relapses have occurred in the additional follow-up period (at 8.0, 8.3, and 9.2 years) in those with CRs. The 8-yr PFS for the 57 pts who achieved CR is now 64%. The median for PFS has now being reached for CRs at 9.2 yrs. When the impact of baseline FLIPI scores were analyzed, only 8-yr OS was significantly affected when low-risk (LR) and intermediate-risk (IR) categories were combined and compared to the high-risk (HR) category (92% vs. 75%; p = 0.029). The 8-yr PFS for LR + IR pts was 56% vs. 35% for HR pts (p = 0.317). 27 of the 76 total pts (35%) had HR scores. Of additional importance, no cases of MDS or AML have yet been observed. Other longterm toxicities including thyroid status and second non-hematologic cancers will be updated at the meeting. Conclusions. These data underscore the high degree of effectiveness and durability of remissions achieved with a single, one-week course of frontline Bexxar and should serve as a benchmark for comparison to other studies using more prolonged and toxic treatments, including those combining unlabeled or radiolabeled antibodies with chemotherapy. No significant financial relationships to disclose.

Prognostic Relevance of Celiac Lymph Node Involvement in Ovarian Cancer

2014 ◽  
Vol 24 (1) ◽  
pp. 48-53 ◽  
Author(s):  
Alejandra Martínez ◽  
Cristophe Pomel ◽  
Thomas Filleron ◽  
Marjolein De Cuypere ◽  
Eliane Mery ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Oncologic Outcome ◽  
Progression Free Survival ◽  
Disease Spread ◽  
Short Term ◽  
Free Survival ◽  
Increased Risk

ObjectiveThe aim of the study was to report on the oncologic outcome of the disease spread to celiac lymph nodes (CLNs) in advanced-stage ovarian cancer patients.MethodsAll patients who had CLN resection as part of their cytoreductive surgery for epithelial ovarian, fallopian, or primary peritoneal cancer were identified. Patient demographic data with particular emphasis on operative records to detail the extent and distribution of the disease spread, lymphadenectomy procedures, pathologic data, and follow-up data were included.ResultsThe median follow-up was 26.3 months. The median overall survival values in the group with positive CLNs and in the group with negative CLNs were 26.9 months and 40.04 months, respectively. The median progression-free survival values in the group with metastatic CLNs and in the group with negative CLNs were 8.8 months and 20.24 months, respectively (P = 0.053). Positive CLNs were associated with progression during or within 6 months after the completion of chemotherapy (P = 0.0044). Tumor burden and extensive disease distribution were significantly associated with poor progression-free survival, short-term progression, and overall survival. In multivariate analysis, only the CLN status was independently associated with short-term progression.ConclusionsDisease in the CLN is a marker of disease severity, which is associated to a high-risk group of patients with presumed adverse tumor biology, increased risk of lymph node progression, and worst oncologic outcome.

scholarly journals Factors associated with being lost to follow-up before completing tuberculosis treatment: analysis of surveillance data

2012 ◽  
Vol 141 (6) ◽  
pp. 1223-1231 ◽  
Author(s):  
E. R. C. MILLETT ◽  
D. NOEL ◽  
P. MANGTANI ◽  
I. ABUBAKAR ◽  
M. E. KRUIJSHAAR
Keyword(s):  
Surveillance Data ◽  
Sputum Smear ◽  
Tuberculosis Patients ◽  
Factors Associated ◽  
Increased Risk ◽  
Patients At Risk ◽  
Treatment Analysis ◽  
The Uk ◽  
Lost To Follow Up

SUMMARYCompletion of treatment is key to tuberculosis control. Using national surveillance data we assessed factors associated with tuberculosis patients being lost to follow-up before completing treatment (‘lost’). Patients reported in England, Wales and Northern Ireland between 2001 and 2007 who were lost 12 months after beginning treatment were compared to those who completed, or were still on treatment, using univariable and multivariable logistic regression. Of 41 120 patients, men [adjusted odds ratio (aOR) 1·29; 95% confidence interval (CI) 1·23–1·35], 15- to 44-year-olds (P<0·001), and patients with pulmonary sputum smear-positive disease (aOR 1·25, 95% CI 1·12–1·45) were at higher risk of being lost. Those recently arrived in the UK were also at increased risk, particularly those of the White ethnic group (aOR 6·39, 95% CI 4·46–9·14). Finally, lost patients had a higher risk of drug resistance (aOR 1·41, 95% CI 1·17–1·69). Patients at risk of being lost require enhanced case management and novel case retention methods are needed to prevent this group contributing towards onward transmission.

Factors associated with initiation and use of snus among adolescents

2021 ◽  
pp. 140349482110623
Author(s):  
Vibeke Ansteinsson ◽  
Ibrahimu Mdala ◽  
Rune Becher ◽  
Liv Grøtvedt ◽  
Simen E. Kopperud ◽  
...  
Keyword(s):  
Vocational Education ◽  
Structural Equation ◽  
Strong Association ◽  
School Level ◽  
Smoking History ◽  
Tobacco Prevention ◽  
Cross Sectional ◽  
Factors Associated ◽  
Increased Risk ◽  
Educational Plans

Aim: We investigated factors associated with the initiation and continuation of snus use in adolescents in Norway. The associations with adolescents’ own educational plans, the parents’ educational level(s) and tobacco habits were estimated. Methods: In this cross-sectional questionnaire-based study, 1465 patients aged 18–20 years participated. The questionnaire was administered at regular dental examinations in the public dental health service. To assess the association between individual factors and the initiation of tobacco habits, a generalised structural equation model with random effects at the clinic level was used. Binary responses were modelled using multilevel binary logistic regression, while the number of snus boxes used per month was modelled using a multilevel Poisson regression model. Results: Of current (daily and occasional) tobacco users, 85% were snus users, including dual users of both snus and cigarettes. The median age of snus initiation was 16 years. Both parental snus use and smoking were associated with an increased risk of snus initiation, snus use and a higher amount of use. An increased risk of using snus was associated with male gender and with no educational plans or planning for further vocational education. The amount of snus used was higher among current snus users with a prior smoking history and among those planning for further vocational education. Conclusions: These findings may aid in developing and targeting tobacco prevention strategies aimed at young people. Tobacco prevention measures should start at the elementary school level. The strong association with parental tobacco habits underlines the importance of parents’ influence on their children’s tobacco use.

The role of obinutuzumab in the management of follicular lymphoma

2019 ◽  
Vol 15 (31) ◽  
pp. 3565-3578 ◽  
Author(s):  
Jenny O’Nions ◽  
William Townsend
Keyword(s):  
Clinical Trials ◽  
Follicular Lymphoma ◽  
Progression Free Survival ◽  
Free Survival ◽  
Cd20 Antibody ◽  
Anti Cd20 ◽  
Almost All ◽  
Cd20 Antibodies

The outcomes for follicular lymphoma (FL) have improved significantly in recent years. This has been driven by an improved understanding of the pathobiology of FL and the development of therapeutic anti-CD20 antibodies. Combining rituximab with chemotherapy, coupled with its use as maintenance therapy, has contributed to significant improvements in disease control and progression-free survival. However, FL remains incurable and almost all patients invariably relapse. Therefore, there remains a need to develop novel therapeutic options and optimize existing regimens. Obinutuzumab (a first-in-class, glycoengineered, humanized type 2 anti-CD20 antibody) has been evaluated in a number of clinical trials. In this review, we will summarize the evaluable results of clinical trials investigating the efficacy of obinutuzumab in the treatment of FL.

P5341Predictive factors of atherosclerotic cardiovascular diseases events in HIV-HVC co-infected patients: results from hepavih ANRS co13 cohort

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Boccara ◽  
B K Tan ◽  
M Chalouni ◽  
D Salmon Ceron ◽  
A Cinaud ◽  
...  
Keyword(s):  
Viral Load ◽  
Sustained Viral Response ◽  
Biological Data ◽  
Personal History ◽  
Hiv Viral Load ◽  
Factors Associated ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
History Of

Abstract Introduction Several studies highlighted an increased risk of cardiovascular disease (CVD) in HIV-HCV co-infected patients without clearly identifying specific virologic factors associated with atherosclerotic CVD (ASCVD) events. Purpose Hence, we analyzed data collection from the French nationwide ANRS CO13 HEPAVIH cohort to determine the incidence of ASCVD events in HIV-HCV co-infected patients and the predictive factors associated with its occurrence. Methods The French multicenter nationwide ANRS CO13 HEPAVIH clinic-based cohort collected prospective clinical and biological data from HIV-HCV co-infected patients followed-up in 28 different university hospitals between December 2005 to November 2016. Participants with at least one year of follow-up were included. Primary outcome was the occurrence of major ASCVD events (cardiovascular death, acute coronary syndrome, coronary revascularization and stroke). Secondary outcomes were total ASCVD events including major ASCVD events and minor ASCVD events (peripheral arterial disease [PAD]). Incidence rates were estimated using Aalen-Johansen method and factors associated with ASCVD identified with Cox proportional hazards models. Results A total of 1213 patients were included: median age 45.4 years [42.1–49.0], 70.3% men, current smoking 70.2%, overweight 19.5%, liver cirrhosis 18.9%, chronic alcohol consumption 7.8%, diabetes mellitus (5.9%), personal history of CVD 2.7%, and statins use 4.1%. After a median follow-up of 5.1 years [3.9–7.0], 44 participants experienced at least one ASCVD event (26 major ASCVD event, and 20 a minor event). Incidences for total, major and minor ASCVD events were of 6.98 [5.19; 9.38], 4.01 [2.78; 6.00], and 3.17 [2.05; 4.92] per 1000 person-years, respectively. Personal history of CVD (Hazard Ratio (HR)=13.94 [4.25–45.66]), high total cholesterol (HR=1.63 [1.24–2.15]), low HDL cholesterol (HR=0.08 [0.02–0.34]) and undetectable HIV viral load (HR=0.41 [0.18–0.96]) were identified as independent factors associated with major ASCVD events while cirrhosis status, liver fibrosis and HCV sustained viral response were not. Cumulative incidence of CV events Conclusion HIV-HCV co-infected patients experience a high incidence of ASCVD events both coronary and peripheral artery diseases. Traditional CV risk factors are the main determinants of ASCVD whereas undetectable HIV viral load seems to be protective. Management of cholesterol abnormalities and controlling viral load are essential to modify this high cardiovascular risk. Acknowledgement/Funding Agence Natoinale de Recherche sur le SIDA et les Hépatites virales

scholarly journals Risk of recurrent stroke and antiplatelet choice in breakthrough stroke while on aspirin

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Joon-Tae Kim ◽  
Beom Joon Kim ◽  
Jong-Moo Park ◽  
Soo Joo Lee ◽  
Jae-Kwan Cha ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Risk Score ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Vascular Events ◽  
Factors Associated ◽  
Increased Risk ◽  
Potential Factors ◽  
Predictive Risk ◽  
Multicenter Registry

Abstract Uncertainty regarding an optimal antiplatelet regimen still exists in patients with breakthrough acute ischemic stroke (AIS) while on aspirin. This study provides an analysis of a prospective multicenter registry between April 2008 and April 2014. Eligible patients were on aspirin at the time of AIS and treated with antiplatelet regimens (aspirin, clopidogrel, or clopidogrel-aspirin). Potential factors associated with the choice of each antiplatelet regimen were explored and included a predictive risk score for future vascular events, the Essen Stroke Risk Score (ESRS). A total of 2348 patients (age, 69 ± 11 years; male, 57.7%) were analyzed, and 55.3%, 25.3% and 19.4% were treated with clopidogrel-aspirin, aspirin and clopidogrel, respectively. While the likelihood of choosing clopidogrel-aspirin increased as the ESRS increased, the likelihood of choosing aspirin decreased as the ESRS increased (Ptrend < 0.001). The ESRS category (0–1/2–3/ ≥ 4) modified the effect of antiplatelet regimens for 1-year vascular events (Pinteraction < 0.01). Among patients with ESRS ≥ 4, clopidogrel-aspirin (HR 0.47 [0.30–0.74]) and clopidogrel (HR 0.30 [0.15–0.60]) significantly reduced the risk of outcome events. Our study showed that more than half of the patients with aspirin failure were treated with clopidogrel-aspirin. In particular, a higher ESRS, which indicates an increased risk of recurrent stroke, was associated with the choice of clopidogrel-aspirin rather than aspirin.

scholarly journals Eight-year experience with allogeneic stem cell transplantation for relapsed follicular lymphoma after nonmyeloablative conditioning with fludarabine, cyclophosphamide, and rituximab

Blood ◽  
2008 ◽  
Vol 111 (12) ◽  
pp. 5530-5536 ◽  
Author(s):  
Issa F. Khouri ◽  
Peter McLaughlin ◽  
Rima M. Saliba ◽  
Chitra Hosing ◽  
Martin Korbling ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Follicular Lymphoma ◽  
Cell Transplantation ◽  
Survival Rates ◽  
Conditioning Regimen ◽  
Human Leukocyte ◽  
Progression Free Survival ◽  
Nonmyeloablative Stem Cell Transplantation

Abstract Nonmyeloablative stem cell transplantation in patients with follicular lymphoma has been designed to exploit the graft-versus-lymphoma immunity. The long-term effectiveness and toxicity of this strategy, however, is unknown. In this prospective study, we analyzed our 8-year experience. Patients received a conditioning regimen of fludarabine (30 mg/m2 daily for 3 days), cyclophosphamide (750 mg/m2 daily for 3 days), and rituximab (375 mg/m2 for 1 day plus 1000 mg/m2 for 3 days). They were then given an infusion of human leukocyte antigen-matched hematopoietic cells from related (n = 45) or unrelated donors (n = 2). Tacrolimus and methotrexate were used for graft-versus-host disease (GVHD) prophylaxis. Forty-seven patients were included. All patients experienced complete remission, with only 2 relapses. With a median follow-up time of 60 months (range, 19-94), the estimated survival and progression-free survival rates were 85% and 83%, respectively. All 18 patients who were tested and had evidence of JH/bcl-2 fusion transcripts in the bone marrow at study entry experienced continuous molecular remission. The incidence of grade 2-IV acute GVHD was 11%. Only 5 patients were still undergoing immunosuppressive therapy at the time of last follow-up. We believe that the described results are a step forward toward developing a curative strategy for recurrent follicular lymphoma.

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