scholarly journals Follicular Lymphoma in a Single Cancer Center and Validation of FLIPI, FLIPI2, PRIMA and POD24 in Non-Caucasian Patients from Peru

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4518-4518
Author(s):  
Jule F Vasquez ◽  
Alonso Diaz ◽  
Any S Mendoza ◽  
Carlos Barrionuevo ◽  
Cesar Samanez-Figari
Keyword(s):  
Follicular Lymphoma ◽  
Systemic Treatment ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Cancer Center ◽  
Bulky Disease ◽  
Entire Cohort ◽  
Overall Response ◽  
Caucasian Patients ◽  
Single Cancer

Abstract Background Follicular lymphoma (FL) is the second most common non-Hodgkin lymphoma subtype seen in Caucasian countries. Recent data were published on FL from Latin America (LATAM), presenting information of 12 countries. However, this information is widely variable because of the diversity of the Latin population (Caucasian and mestizo individuals). Our aim was to evaluate the clinical features, treatment patterns outcomes of non-Caucasian patients with FL from a single cancer center. Our second aim was to validate FLIPI1, FLIPI2, PRIMA and POD-24 score in our cohort. Methods: This is a retrospective study, including all patients with a pathological diagnosis of FL at the National Institute of Neoplastic Diseases in Lima, Peru from 2010 to 2019. All cases were reviewed by specialized pathologists. Baseline clinical and pathological data were collected. Responses were assessed based on the Lugano criteria. Overall survival (OS) was estimated using the Kaplan-Meier method. Differences were compared with the log-rank test. Results From 2010 to 2019 4480 patients with B-cell lymphoma were diagnosed, 449 patients (10%) had grade 1 to 3A FL, 302 patients had the five variables for FLIPI, 242 for FLIPI2, 257 for the 2 variables for PRIMA prognostic index and 209 received systemic treatment and had enough information to evaluate POD24. The median age for the entire cohort was 59 years old (range 24-92), 49% of patients were ≥60 years, 46% were male, 22% had extranodal involvement, 34% had bulky disease (≥6 cm in diameter), 68% had stage III/IV disease, 32% had hemoglobin <12 g/dl, 8% had serum albumin <3 g/dl, 35% had elevated serum LDH, 33% had B2-microglobulin ≥3,5 mg/l, 22% had bone marrow involvement and 23% had lymph node sites >4. Low, intermediate and high FLIPI were seen in 39%, 27% and 34% of patients, respectively. Low, intermediate and high-risk FLIPI2 was seen in 23%, 54% and 23% of patients, respectively. Low, intermediate, and high PRIMA was seen in 53%, 12% and 35%, respectively. 209 patients received systemic treatment, 60% received CHOP ± rituximab (R), 13% CVP ± R, 15% CHOP, 11% CVP. Response data were available in 158 patients with complete response in 35%, partial response in 57% and no response in 8%, for an overall response rate of 92%. 19% of patient had disease progression within 24 months of first treatment initiation (POD24). For the entire cohort, the median follow-up time was 2.6 years (Interquartile range [IQR] 0.08-13.6), the median OS was not reached (IQR 4.2-not reached). 5y was OS 72% (95% CI 65-77). 5y OS for low, intermediate and high FLIPI were 90% (95% CI 81-94.5), 65% (95% CI 47.3-78.2) and 60.1% (95% CI 46.6-72.4), respectively (p<0.001; Figure a). 5y OS for low, intermediate and high FLIPI2 were 91.9% (95% CI 76.3-97.3), 75.4% (95% CI 63.8-83.7) and 52.9% (95% CI 35.5-67.6), respectively (p<0.001; Figure b). 5y OS for low, intermediate and high PRIMA were 80.5% (95% CI 70-87.6), 79.4% (95% CI 52-92), and 61% (95% CI 47-73), respectively (p=0.004; Figure c). Patients who had and did not have POD24 had median OS of 5.7 years (IQR 2-NR) and NR (IQR 5.1-NR), respectively (p<0.001). 5y OS for patients who had and did not have POD24 was 54.1 % (95% CI 31-63) and 75.2% (95% CI 66-82), respectively (p=0.01). Conclusion: FL has a lower incidence in non-Caucasian patients in Peru compared to those reported for Western countries or other LATAM Caucasian population. FL patients showed higher rates of high FLIPI and FLIPI2 than previously reported in the literature. Chemoimmunotherapy is the standard approach to FL patients, which is associated with high rates of overall response, but low rate of complete response. The OS rates are shorter than those reported in the previously LATAM cohort. Our study validates the prognostic value of FLIPI1, FLIPI2, PRIMA and POD24. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Frontline Therapy with Low Risk Chemotherapy (R-CVP/R-CHOP) in Follicular B-Cell Lymphoma Recently Diagnosed. Clinical Experience in Two Centers of Bogotá, Colombia

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4893-4893
Author(s):  
Carlos Daniel Bermudez ◽  
Martha Leticia Suarez ◽  
Sergio Andres Cancelado ◽  
Carlos Alberto Ramirez
Keyword(s):  
High Risk ◽  
Partial Response ◽  
Follicular Lymphoma ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Low Risk ◽  
Long Term Results ◽  
Severe Toxicity ◽  
Primary Therapy ◽  
Overall Response

Abstract Abstract 4893 Background: The follicular lymphoma (FL) it is a subset of non-Hodgkin lymphomas, accounting for between 15% and 30% of new diagnoses of lymphoma. It has raised many combinations of treatments, but the long-term results remain unchanged. At present there is no consensus on the first line therapy for the management of follicular lymphoma. Since the advent of rituximab use, this change, achieving better response rates and survival, the paradigm is the use of R-CHEMO, but there are many active combinations, including the use CVP, CHOP, FCM, and others, which have shown benefit, but with consequences given for severe toxicity, and treatment-related deaths. In Colombia, the situation it is not different, the use of chemotherapy is left for consideration by the treating physician. This study aimed to assess treatment preferences for patients with new diagnosis of follicular lymphoma in Colombia, evaluate the responses of the combination R-CHEMOTHERAPY in our population, considering the specific ethnic characteristics and limitations of a developing country. Patients and Methods: The study included patients diagnosed with follicular lymphoma confirmed by hematopathologist with experience by performing at least 10 immunohistochemical tumor markers. This study is a descriptive study. During the study took into account the principles of autonomy, beneficence and justice written in the Belmont report. Informed consent was obtained from patients for participation in this study. It also welcomes the resolution expressed law Colombian Ministry of Health No. 008 430 1993 (4 October 1993) Article 11 investigation classified as safe. We analyzed cases diagnosed from January 2007 to July 2011 in two private institutions in the city of Bogotá, Colombia, we obtained 20 cases meeting the inclusion criteria. All the patients were scheduled to undergo primary therapy with 6 cycles of full-dose R-CVP or R-CHOP. Results: in this group, there were 5 men and 15 women (75% of all patients), and the median age at diagnosis was 56 years, the initial stage was 10% for stage II, 40% for stage III and the remaining 50% for stage IV, the bone marrow compromise reached by 45% (9 cases). The initial functional status classified by the ECOG scale was 0: 45%, 1: 50% and 3: 5%. the B symptoms were present in 95% of the patients analyzed. In accordance with the International Prognostic Index (FLIPI), we find the following: low risk: 25% (5 cases), intermediate risk: 35% (7 cases) and high risk: 40% (8 patients). the pathological grading was grade 1: 55% (11 patients), grade 2 for 35% (4 patients) and 3 for 10% (2 patients). When we reviewed found that the preferred treatment, for 80% of the population uses the R-CVP and the remaining 20% use of R-CHOP scheme, one patient in the R-CHOP group was complicated with high-risk febrile neutropenia requiring hospitalization. There were no treatment-related deaths. We found that 80% of patients achieved a complete hematologic remission and 20% partial response for an overall response of 100%. If we analyze separately patients treated with R-CVP scheme was 75% complete response and 25% partial response, with an overall response of 100%. Conclusion: This study shows the preference of treatment in 2 institutions in Bogotá, Colombia, which are in accordance with international guidelines, the results show a population with similar general characteristics with the others studies, in which a 100% overall hematologic response was achieved, 75% complete response for the R-CVP and 100% for the R-CHOP, however the latter with 25% of severe infectious complications. We consider a good treatment strategy for the implementation in our population is the R-CVP scheme, which is well tolerated, showing benefit in our patients and remission rates even higher than the studies previously published. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Phase 1/2a study of 177Lu-lilotomab satetraxetan in relapsed/refractory indolent non-Hodgkin lymphoma

2020 ◽  
Vol 4 (17) ◽  
pp. 4091-4101
Author(s):  
Arne Kolstad ◽  
Tim Illidge ◽  
Nils Bolstad ◽  
Signe Spetalen ◽  
Ulf Madsbu ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Overall Response Rate ◽  
Response Rate ◽  
Phase 1 ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Hematologic Toxicity ◽  
Overall Response ◽  
Non Hodgkin Lymphoma ◽  
Anti Cd20

Abstract For patients with indolent non-Hodgkin lymphoma who fail initial anti-CD20–based immunochemotherapy or develop relapsed or refractory disease, there remains a significant unmet clinical need for new therapeutic approaches to improve outcomes and quality of life. 177Lu-lilotomab satetraxetan is a next-generation single-dose CD37-directed radioimmunotherapy (RIT) which was investigated in a phase 1/2a study in 74 patients with relapsed/refractory indolent non-Hodgkin B-cell lymphoma, including 57 patients with follicular lymphoma (FL). To improve targeting of 177Lu-lilotomab satetraxetan to tumor tissue and decrease hematologic toxicity, its administration was preceded by the anti-CD20 monoclonal antibody rituximab and the “cold” anti-CD37 antibody lilotomab. The most common adverse events (AEs) were reversible grade 3/4 neutropenia (31.6%) and thrombocytopenia (26.3%) with neutrophil and platelet count nadirs 5 to 7 weeks after RIT. The most frequent nonhematologic AE was grade 1/2 nausea (15.8%). With a single administration, the overall response rate was 61% (65% in patients with FL), including 30% complete responses. For FL with ≥2 prior therapies (n = 37), the overall response rate was 70%, including 32% complete responses. For patients with rituximab-refractory FL ≥2 prior therapies (n = 21), the overall response rate was 67%, and the complete response rate was 24%. The overall median duration of response was 13.6 months (32.0 months for patients with a complete response). 177Lu-lilotomab satetraxetan may provide a valuable alternative treatment approach in relapsed/refractory non-Hodgkin lymphoma, particularly in patients with comorbidities unsuitable for more intensive approaches. This trial was registered at www.clinicaltrials.gov as #NCT01796171.

scholarly journals Outcomes of patients with limited-stage aggressive large B-cell lymphoma with high-risk cytogenetics

2020 ◽  
Vol 4 (2) ◽  
pp. 253-262 ◽  
Author(s):  
Pallawi Torka ◽  
Shalin K. Kothari ◽  
Suchitra Sundaram ◽  
Shaoying Li ◽  
L. Jeffrey Medeiros ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Entire Cohort ◽  
Treatment Groups ◽  
Limited Stage ◽  
Field Radiation ◽  
Involved Field

Abstract There is a paucity of data regarding outcomes and response to standard therapy in patients with limited-stage (LS) agressive B-cell lymphoma (LS-ABCL) who harbor MYC rearrangement (MYC-R) with or without BCL2 and/or BCL6 rearrangements. We conducted a multicenter retrospective study of MYC-R LS-ABCL patients who received either rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), or more intensive immunochemotherapy (IIC) plus or minus consolidative involved-field radiation therapy (IFRT). One hundred four patients from 15 academic centers were included. Forty four patients (42%) received R-CHOP, of whom 52% had IFRT. Sixty patients (58%) received IIC, of whom 40% had IFRT. Overall response rate was 91% (84% complete response [CR]; 7% partial response). Patients with double-hit lymphoma (DHL; n = 40) had a lower CR rate compared with patients with MYC-R only (75% vs 98%; P = .003). CR rate was higher in the IFRT vs no-IFRT group (98% vs 72%; P < .001). Median follow-up was 3.2 years; 2-year progression-free survival (PFS) and overal survival (OS) were 78% and 86% for the entire cohort, and 74% and 81% for the DHL patients, respectively. PFS and OS were similar across treatment groups (IFRT vs no IFRT, R-CHOP vs IIC) in the entire cohort and in DHL patients. Our data provide a historical benchmark for MYC-R LS-ABCL and LS-DHL patients and show that outcomes for this population may be better than previously recognized. There was no benefit of using IIC over R-CHOP in patients with MYC-R LS-ABCL and LS-DHL.

scholarly journals Temsirolimus Has Activity in Non–Mantle Cell Non-Hodgkin's Lymphoma Subtypes: The University of Chicago Phase II Consortium

2010 ◽  
Vol 28 (31) ◽  
pp. 4740-4746 ◽  
Author(s):  
Sonali M. Smith ◽  
Koen van Besien ◽  
Theodore Karrison ◽  
Janet Dancey ◽  
Peter McLaughlin ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Response Rate ◽  
Cell Lymphoma ◽  
Single Agent ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Mantle Cell ◽  
Group A ◽  
Group B ◽  
Indolent Lymphomas

PurposeDespite high initial remission rates, most lymphomas relapse and require further therapy. The mammalian target of rapamycin (mTOR) pathway is a validated target in mantle cell lymphoma, but has not been extensively evaluated in other lymphomas.Patients and MethodsWe performed a phase II trial of single-agent temsirolimus 25-mg weekly in patients with relapsed aggressive and indolent lymphomas. The primary objective was overall and complete response rate. Patients were stratified by histology: group A (diffuse large B-cell lymphoma, transformed follicular lymphoma), group B (follicular lymphoma), and group C (chronic lymphocytic leukemia/small lymphocytic lymphoma, and other indolent lymphomas).ResultsEighty-nine patients were treated, with outcome strongly dependent on histology. Group A had an overall and complete response rate of 28.1% and 12.5%, respectively, and median progression-free survival (PFS) of 2.6 months and median overall survival (OS) of 7.2 months. Group B had overall and complete response rates of 53.8% and 25.6%, respectively, and median PFS of 12.7 months; median OS has not yet been reached. Group C had a partial response rate of 11% with no complete responders. Toxicity was mainly mild and/or reversible myelosuppression and mucositis; however, four patients developed pneumonitis.ConclusionsSingle-agent temsirolimus has significant activity in both diffuse large B-cell lymphoma and follicular lymphoma, although the durability of responses and PFS are longer for patients with follicular lymphoma. This is the first report of substantial activity of temsirolimus in lymphomas other than mantle cell lymphoma, and supports further evaluation of mTOR as a target in these diseases.

Phase III Study of R-CVP Compared With Cyclophosphamide, Vincristine, and Prednisone Alone in Patients With Previously Untreated Advanced Follicular Lymphoma

2008 ◽  
Vol 26 (28) ◽  
pp. 4579-4586 ◽  
Author(s):  
Robert Marcus ◽  
Kevin Imrie ◽  
Philippe Solal-Celigny ◽  
John V. Catalano ◽  
Anna Dmoszynska ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Response Duration ◽  
Complete Response ◽  
Phase Iii ◽  
Term Outcome ◽  
Bulky Disease ◽  
Long Term Outcome ◽  
Trial Treatment

PurposeTo compare the long-term outcome of patients with previously untreated follicular lymphoma (FL) needing therapy, after treatment with cyclophosphamide, vincristine and prednisone (CVP) versus CVP plus rituximab (R-CVP) and to evaluate the predictive value of known prognostic factors after treatment with R-CVP.Patients and MethodsPatients with previously untreated CD20-positive stage III/IV FL were randomly assigned to eight cycles of R-CVP (n = 159) or CVP alone (n = 162). The median follow-up period was 53 months.ResultsThe primary end point—time to treatment failure (TTF), which included patients without a response after four cycles as an event—was significantly prolonged in patients receiving R-CVP versus CVP (P < .0001). Improvements in all other end points, including overall and complete response rates (P < .0001), time to progression (TTP; P < .0001), response duration (P < .0001), time to next antilymphoma treatment (P < .0001), and overall survival (OS; P = .029; 4-year OS: 83% v 77%;) were achieved with R-CVP versus CVP alone. Univariate analyses demonstrated an improvement in TTP with R-CVP versus CVP irrespective of the Follicular Lymphoma International Prognostic Index (FLIPI) subgroup, the International Prognostic Index (IPI) subgroup, baseline histology, and the presence or absence of B symptoms or bulky disease. By multivariate analysis, FLIPI retains a strong predictive power for TTP in the presence of the trial treatment effect.ConclusionAnalysis of all outcome measures, including OS, confirm the benefit of adding R to CVP in the front-line treatment of FL.

Comparison of Results from a Phase 1/2 Study of Lumiliximab (Anti-CD23) in Combination with FCR for Patients with Relapsed CLL with Published FCR Results.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 32-32 ◽  
Author(s):  
John C. Byrd ◽  
Januario Castro ◽  
Susan O’Brien ◽  
Ian W. Flinn ◽  
Andres Forero-Torres ◽  
...  
Keyword(s):  
Response Rate ◽  
Phase 1 ◽  
Performance Status ◽  
Randomized Study ◽  
Complete Response ◽  
Cancer Center ◽  
Published Data ◽  
Hematologic Toxicity ◽  
Variable Regions ◽  
Overall Response

Abstract Lumiliximab is a PRIMATIZED® anti-CD23 monoclonal antibody with human IgG1 constant regions and macaque variable regions. Preclinical data demonstrated that lumiliximab enhanced both fludarabine- and rituximab- mediated apoptosis in CLL cells. Thus, a Phase 1/2, open-label, dose-escalation, multicenter study (Study 152–30) evaluating lumiliximab + fludarabine, cyclophosphamide, and rituximab (L + FCR) for relapsed CD23+ B-cell CLL was initiated. Treatment has been completed and follow-up is ongoing. Thirty-one patients (pts) received either 375 mg/m2 (n=3) or 500 mg/m2 (n=28) of lumiliximab in combination with a 28-day cycle of FCR for up to 6 cycles. Median age at study entry was 58 yrs. The majority of pts (74%) were Rai Stage I/II. The most common adverse events included nausea (77%), pyrexia (61%), chills (55%), neutropenia (55%), and fatigue (48%). Twenty pts (65%) experienced a Grade 3 or 4 event. An overall response rate of 71% was demonstrated: 48% complete response (CR), 10% partial response (PR), and 13% unconfirmed PR. Currently, baseline cytogenetic data is available for 21 pts who received 500 mg/m2 of lumiliximab. Although preliminary, 1 of the 4 pts with del(17p13.1) responded; of the 6 pts with del(11q22.3), 5 responded with 4 attaining a CR. A comparison with published data from a study of FCR alone in 177 pts with relapsed or refractory CLL conducted at the M.D. Anderson Cancer Center (MDACC) (Wierda W, O’Brien S, Wen S, et al. J Clin Oncol.2005;23:4070–4078) demonstrated that L + FCR has an acceptable safety profile, does not appear to increase the toxicity (including myelosuppression) of the FCR regimen, and compares favorably with the CR rate of the FCR regimen alone, as displayed in Table 1. Most pt characteristics (age, gender, median number of prior therapies, and WHO performance status) were similar between the 2 studies; however, more pts in the MDACC study were Rai Stage III-IV (50% vs 22%) and were rituximab-naïve (88% vs 40%). Furthermore, there were no obvious differences in hematologic toxicity between the 2 studies and the tolerability of L + FCR was similar to that of FCR, with approximately 50% percent of pts completing 6 cycles of treatment in both studies. These data suggest that L + FCR may produce a higher complete response rate than FCR without additional toxicity. Based upon this data, a multicenter, global, randomized study of L + FCR vs. FCR alone is being initiated. Table 1. Comparison of Responses in Study 152–30 and the MDACC Study Study 152–30, L + FCR (N=31), n (%) MDACC, FCR (N =177), n (%) 1CR and PR response criteria were the same in both studies. 2PRu is included in the OR. Overall Response 22 (71%) 130 (73%) Complete Response1 15 (48%) 45 (25%) Partial Response1 3 (10%) 85 (48%) Unconfirmed Partial Response2 4 (13%)

Favorable Results of Rituximab in Combination with CHOP in the Front-Line Treatment of Follicular Lymphoma Grade 3.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2770-2770
Author(s):  
Luis Fayad ◽  
Michael Overman ◽  
Barbara Pro ◽  
Peter McLaughlin ◽  
Felipe Samaniego ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
B Cell ◽  
Response Rate ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Bulky Disease ◽  
Large B Cell Lymphoma ◽  
Grade 3 ◽  
Large B Cell

Background: Follicular lymphoma grade 3 has a natural history that is more akin to that of diffuse large B-cell lymphoma. The addition of rituximab to standard CHOP has resulted in improved response and survival in diffuse large B-cell lymphoma. Information about outcomes in follicular lymphoma grade 3 is lacking. Methods: A single institution retrospective review of patients with follicular grade 3 lymphoma evaluated at the UTMDACC from 1999 to 2004. Patients were located from the UTMDACC lymphoma database. All patients were initially treated with R-CHOP. Results: Forty-five patients were identified: 51% male, 47% ≥60 years, and 87% follicular grade 3b. The LDH was elevated in 24%, ECOG performance status was >1 in 2%, and >1 site of extranodal involvement was present in 10%. Stage distribution was 11% stage I, 11% stage II, 42% stage III, and 36% stage IV, bulky disease (>7cm) was present in 11%, and B symptoms occurred in 13%. Beta-2 microglobulin was elevated in 57% with values >3 μg/dL in over 50%. IPI distribution was: 46% IPI Low, 38% LI, 11% IH, and 4% IPI High. Overall response rate was 100% with 96% complete responses. Relapse rate by IPI category was 24% for Low IPI, 18% for IPI LI, and 40% for IPI IH, and 100% for the two patients with High IPI. With median follow-up of 33 months, three year failure-free survival (FFS) is 73% (95% CI: 59 to 87%). One patient died (2%) with an overall survival (OS) at three years of 97% (95% CI: 93 to 100%). Conclusion: The addition of rituximab to CHOP provided a high response rate and excellent early survival in this group of mostly good prognosis patients. Relapses were still seen; longer follow-up is needed.

Long-Term Remission (>3 years) after Rituximab Monotherapy Used for Patients with Relapsed Indolent Non-Hodgkin Lymphomas (NHL)

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1709-1709
Author(s):  
Anne-Sophie Michallet ◽  
Florence Beckerich ◽  
Fadhela Bouafia-Sauvy ◽  
Daniel Espinouse ◽  
Gilles Salles ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Complete Response ◽  
Bulky Disease ◽  
Entire Cohort ◽  
The Subject ◽  
Disseminated Disease ◽  
Question Today ◽  
Term Response

Abstract Background: Rituximab has demonstrated significant clinical efficacy in the treatment of NHL, particularly in combination with chemotherapy, and its use has dramatically changed the treatment and outcome of both indolent and aggressive B-cell NHL over the past decade. Furthermore, consistent toxicity data have been obtained with a safe and tolerable profile in a large majority of patients. Aim: The objective of this retrospective study is to evaluate the long-term efficacy of rituximab monotherapy (4 weekly infusion at induction followed by 4 infusion every 2 months as consolidation) used for patients with relapsed indolent NHL. Results: From May 1998 through January 2011, Among 919 patients with indolent NHL treated in our department, 488 (53%) relapsed and were treated with rituximab alone (first and later relapse). 126 (26%) responded and were still in response 2 years later. These 126 patients (68 (54%) males and 58 (46%) females with a median age of 61 y; range: 17-94) are the subject of our analysis. 24% were over 70 years old, 45% were in first relapsed and 25% in later relapsed. Only 16% of the population have more than one co-morbidities (cardiac and or renal respectively); 79% a normal PS (0-1) with only 4 patients having a PS >2; 80% no bulky disease but 72% a disseminated disease (73% stage III and IV). In this study, 60 (48%) patients had a follicular lymphoma with 50% at an intermediate risk group according to the FLIPI score ; 20 (16%) a marginal zone lymphoma, and 43 (34%) a small lymphocytic or lymphoplasmacytic lymphoma and 3 patients other characteristics of lymphoproliferative disorders. After rituximab monotherapy, 55% of the entire cohort was in complete response (CR) and 31% in CRu or partial response and 5% in stable disease. Among these 126 patients, 74% progressed later than 3 years (38% later than 5 years). With a median follow-up of 6.5 years, 4-year and 8-year PFS were 70% and 30%, respectively. 18% had transformation into Richter syndrome and 12 patients have died. Conclusion: Rituximab monotherapy is an effective therapy in selected relapsed indolent NHL and allows long-term response. This strategy could be used as “spare of chemotherapy” which is an important question today, especially in indolent not curable disease. Disclosures No relevant conflicts of interest to declare.

scholarly journals B Cell Lymphoma, Unclassifiable, Transformed from Follicular Lymphoma: A Rare Presentation with Review of the Literature

2015 ◽  
Vol 2015 ◽  
pp. 1-9
Author(s):  
Anila Kanna ◽  
Swati Agrawal ◽  
Kumar Jayant ◽  
Varun Kumar Pala ◽  
Mohammad Altujjar ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
B Cell ◽  
Cell Lymphoma ◽  
Tumor Regression ◽  
B Cell Lymphoma ◽  
Excisional Biopsy ◽  
Complete Response ◽  
Rare Presentation ◽  
Mediastinal Disease ◽  
The Right

B cell lymphoma, unclassifiable, with features of diffuse large B cell lymphoma and classical Hodgkin’s lymphoma (BCLu-DLBCL/CHL) is more commonly known as gray zone lymphoma. These cases more often present with mediastinal disease. In this report, we present a very rare case of BCLu-DLBCL/CHL without mediastinal involvement, transformed from follicular lymphoma (FL) to BCLu-DLBCL/CHL. This patient initially presented with a mass in the right neck; biopsy of the lymph node showed predominantly nodular, follicular pattern. Immunohistochemical (IHC) staining of tumor cells expressed positivity for mature B cell markers CD20, CD19, CD10, CD23, CD45, and CD38 but negative for CD5,11c. Hence, diagnosed with FL, he was given rituximab, cyclophosphamide, vincristine, and prednisone (RCVP) regimen, followed by maintenance rituximab. He showed good response. After 2 years, he presented again with a mass in the right side of the neck. Although the needle core biopsy of this mass was suggestive of B cell lymphoma, excisional biopsy showed morphological features of DLBCL as well as foci of histological pattern of CHL. IHC staining expressed positivity for CD20, CD79a, PAX5, and CD15 and CD30 consistent with DLBCL and CHL. He was diagnosed with BCLu-DLBCL/CHL. The patient received “ACVBP” (doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone) followed by radiation. BCLu-DLBCL/CHL is clinically an aggressive tumor with poorer outcomes, but our case showed complete response to ACVBP regimen with tumor regression.

scholarly journals A multi-institutional analysis of diffuse large B-cell lymphoma (DLBCL) treated with consolidative radiotherapy and the impact of cell-of-origin on outcomes

2019 ◽  
Vol 53 (4) ◽  
pp. 473-479 ◽  
Author(s):  
Chrishanthi Rajasooriyar ◽  
Jeremy Tey ◽  
Lea Choung Wong ◽  
Michelle Poon ◽  
Rao Nandini ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Disease Free Survival ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Cell Of Origin ◽  
Bulky Disease ◽  
Large B Cell Lymphoma ◽  
The Impact ◽  
Large B Cell

Abstract Background Patients with diffuse large B-cell lymphoma (DLBCL) with bulky disease and/or those who fail to achieve complete response benefit from the addition of radiotherapy (RT). We aim to review the outcome, as well as determine the impact of cell-of-origin, on patients undergoing consolidative RT. Patients and methods Patients with DLBCL treated with radical intent consolidative RT were included. Clinical, pathological and treatment characteristics were extracted from electronic medical records. Survival outcomes and factors that predict for disease-free survival (DFS) were analysed. Results Seventy-four patients were included in this analysis. The median follow up was 3 years (0.7–16 years). Fifty-eight percent of patients had stage I–II disease, and 61% received at least 6 cycles of chemotherapy. Cell-of-origin was discernible in 60% of patients, and approximately half were classified as Germinal centre origin. The 5-year overall survival (OS) of this group was excellent at 92% (median survival not reached). The 5-year DFS was 73% (95% CI 57–83%). Seven percent (n = 5) of patients experienced local recurrence at a median time of 6 months. Failure to achieve complete response post RT and/or initial bulky disease are significant predictors of inferior DFS. There was no association between cell-of-origin and DFS or OS. Conclusions The outcome of patients who received radiotherapy as consolidation is excellent. Patients who fail to achieve complete response after radiotherapy had poorer outcomes. Despite using radiotherapy, presence of bulky disease remains a significant predictor of disease recurrence. We did not find any association of poorer outcomes, with regards to cell-of-origin, in the use of consolidative RT.

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