Numbers of Lymphoma Associated Macrophages (LAMS) and Regulatory T-Cells (Tregs) in Follicular Lymphoma (FL) Patients (pts) Treated with and without Monoclonal Antibody (MoAb)-Containing Therapy Do Not Correlate with Overall Survival (OS): A Study from the Southwest Oncology Group (SWOG).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2602-2602
Author(s):  
John William Sweetenham ◽  
Eric Hsi ◽  
Bryan Goldman ◽  
Michael LeBlanc ◽  
Raymond R. Tubbs ◽  
...  
Keyword(s):  
Overall Survival ◽  
Follicular Lymphoma ◽  
Prognostic Value ◽  
Cox Regression ◽  
International Prognostic Index ◽  
Prognostic Significance ◽  
Prognostic Index ◽  
Continuous Variables ◽  
Hazard Ratios ◽  
Anti Cd20

Abstract Introduction: Conflicting results have been reported for the prognostic value of LAMs and Tregs in FL. A recent study from the SWOG suggested that survival for pts with FL has improved in the last 30 years, possibly due to the introduction of MoAb-based therapy. We examined the prognostic significance of LAMs and FOX-P3-positive Tregs using tissue microarrays (TMAs) from pts entered onto SWOG studies 8809 (no MoAb) and 9911chemotherapy followed by (including 131I-tositumomab). Pts & methods: Adequate tissue samples were identified from 87 pts on SWOG 8809 and 47 on 9911. Pt characteristics were as follows: 8809: median age - 47.4 yrs (26.1 – 69.4), male 53%, Follicular Lymphoma International Prognostic Index (FLIPI) score: 1–36%, 2–39%, 3–21%. 9911: median age - 49.9 (22.9 – 66.8), male-60%, FLIPI score: 1–36%, 2–45%, 9–19%. The pts with available tissue were comparable with those who did not have available tissue for clinical prognostic factors. Archival blocks were reviewed to confirm FL and to assess for preparation of TMAs containing two 1mm diameter cores per case. Automated immunostaining for CD68 (PGM1) and FOXP3 (236A/E7) was performed. Intrafollicular (IF) and extra follicular (EF) LAMs were quantitated by manual count (5 1000x high power fields [hpf]). FOXP3 was scored for pattern (follicular/perfollicular vs. other) and number/5 hpf .LAM and Treg numbers/patterns were correlated with OS Marker levels were categorized by medians, 3rd quartiles and as continuous variables. Survival differences by marker level/pattern were assessed within each study population by Cox regression. Results: Pt characteristics did not differ by SWOG study. Hazard ratios with 95% confidence intervals for OS according to FOX-P3 and CD68 staining are shown in table 1. LAMS were not associated with OS, except for IF LAMS in S9911. Levels or pattern of FOX-P3 staining were not associated with OS. Conclusion: Levels of LAMs and Tregs were not predictive of overall survival in FL pts on SWOG trials before and after the introduction of anti-CD20 radio-immunotherapy (RIT). While IF LAMs in pts receiving RIT may be associated with shorter OS, the number of cases/events is too small for firm conclusions. Further studies are required to determine the prognostic value of these biomarkers in FL patients receiving anti-CD20 MoAb-containing therapies. Hazard ratios (95% CI) for OS for biomarker levels S8809 S9911 Overall * p<0.05 FOX-P3 (follicular vs other) 0.66 (0.29, 1.46) 0.95 (0.11, 8.10) 0.69 (0.33, 1.46) FOX-P3 (above median vs below) 1.30 (0.66, 2.58) 0.60 (0.11, 3.26) 1.16 (0.62, 2.17) EF LAM (above median vs below) 1.24 (0.59, 2.61) 0.70 (0.16, 3.11) 1.11 (0.56, 2.18) EF LAM (above 3rd quartile vs below) 1.12 (0.42, 2.94) 0.64 (0.13, 3.32) 0.96 (0.41, 2.23) IF LAM (above median vs below) 0.79 (0.35, 1.76) 5.33 (1.03, 27.51)* 1.22 (0.58, 2.57) IF LAM (above 3rd quartile vs below) 1.38 (0.62, 3.06) 2.24 (0.43, 11.56) 1.50 (0.72, 3.11)

High numbers of tumor-infiltrating FOXP3-positive regulatory T cells are associated with improved overall survival in follicular lymphoma

Blood ◽  
2006 ◽  
Vol 108 (9) ◽  
pp. 2957-2964 ◽  
Author(s):  
Joaquim Carreras ◽  
Armando Lopez-Guillermo ◽  
Bridget C. Fox ◽  
Lluis Colomo ◽  
Antonio Martinez ◽  
...  
Keyword(s):  
Overall Survival ◽  
T Cells ◽  
Regulatory T Cells ◽  
Follicular Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Significance ◽  
Prognostic Index ◽  
Specific Cell ◽  
First Relapse ◽  
The Impact

Abstract The tumor microenvironment plays an important role in the biologic behavior of follicular lymphoma (FL), but the specific cell subsets involved in this regulation are unknown. To determine the impact of FOXP3-positive regulatory T cells (Tregs) in the progression and outcome of FL patients, we examined samples from 97 patients at diagnosis and 37 at first relapse with an anti-FOXP3 monoclonal antibody. Tregs were quantified using computerized image analysis. The median overall survival (OS) of the series was 9.9 years, and the FL International Prognostic Index (FLIPI) was prognostically significant. The median Treg percentage at diagnosis was 10.5%. Overall, 49 patients had more than 10% Tregs, 30 between 5% to 10%, and 19 less than 5%, with a 5-year OS of 80%, 74%, and 50%, respectively (P = .001). Patients with very low numbers of Tregs (< 5%) presented more frequently with refractory disease (P = .007). The prognostic significance of Treg numbers was independent of the FLIPI. Seven transformed diffuse large B-cell lymphomas (DLBCLs) had lower Treg percentages (mean: 3.3%) than FL grades 1,2 (mean: 12.1%) or 3 (mean: 9%) (P < .02). In conclusion, high Treg numbers predict improved survival of FL patients, while a marked reduction in Tregs is observed on transformation to DLBCL.

scholarly journals BONE MARROW IN FOLLICULAR LYMPHOMA PROGNOSIS

2016 ◽  
Vol 15 (3) ◽  
pp. 99-102 ◽  
Author(s):  
N. N. Tupitsyn ◽  
N. A. Falaleeva ◽  
A. V. Mozhenkova ◽  
A. I. Pavlovskaya
Keyword(s):  
Bone Marrow ◽  
Overall Survival ◽  
Follicular Lymphoma ◽  
Histological Study ◽  
Bone Marrow Involvement ◽  
International Prognostic Index ◽  
Prognostic Significance ◽  
Prognostic Index ◽  
Prognostic Role ◽  
Long Time

Background. Bone marrow is the mostfrequent metastatic site in follicular lymphoma, 40-70 % cases. It’s unfovourable prognostic role is stated in the index FLIPI-2 (Follicular Lymphoma International Prognostic Index-2). Objective. To study both prognostic role of bone marrow involvement and it’s relation to erythropoiesis peculiarities in follicular lymphoma was the purpose of this research. Materials and methods. Histological study was performed in 269 follicular lymphoma patients. Erythropoiesis peculiarities were studied in that patients according to standard myelogram analysis. Results. Bone marrow involvement was noted according to trephine biopsy section staining in 37,9 % of follicular lymphoma case (102 from 269). Bone marrow involvement did not influenced the prognosis (overall survival) in all period of observation (p = 0,18). Longterm survival (more than 48 months) was negatively influenced by bone marrow involvement (p = 0,04). Intertrabecular pattern of follicular lymphoma growth in bone marrow was negative prognostic factor (p = 0,02). We noted negative correlation between bone marrow involvement and the elevation of orthochromic normoblasts in bone marrow of patients with follicular lymphoma. In cause of bone marrow such elevation was noted in 67 %, and in the absense of involvement - in 78 % (p = 0,043). Elevation of orthochromic normoblasts did not influenced the overall survival of follicular lymphoma patients (p = 0,89). Conclusion. Bone marrow involvement in follicular lymphoma plays prognostically unfavourable role in long-time observation periods (later than 48 months). The most unfavourable are the intertrabecular patchy lesions. Involvement of bone marrow is in opposite relations to elevation of orthochromic normoblast, but the latter sign is of no prognostic significance.

Prognostic significance of bcl-xL gene expression and apoptotic cell counts in follicular lymphoma

Blood ◽  
2004 ◽  
Vol 103 (2) ◽  
pp. 695-697 ◽  
Author(s):  
Wei-Li Zhao ◽  
Marjan Ertault Daneshpouy ◽  
Nicolas Mounier ◽  
Josette Brière ◽  
Christophe Leboeuf ◽  
...  
Keyword(s):  
Gene Expression ◽  
Follicular Lymphoma ◽  
Apoptotic Cell ◽  
International Prognostic Index ◽  
Prognostic Significance ◽  
Prognostic Index ◽  
Pcr Analysis ◽  
Survival Times ◽  
Lymphoma Cells ◽  
Cell Counts

Abstract bcl-xL, a member of the Bcl-2 family, exerts an antiapoptotic effect on lymphocytes. To assess its clinical significance in patients with follicular lymphoma, realtime quantitative reverse transcription–polymerase chain reaction (RT-PCR) analysis of bcl-xL gene expression was investigated in whole lymph node sections and laser-microdissected lymphoma cells of 27 patients. Compared with 10 patients with reactive follicular hyperplasia, the bcl-xL gene was overexpressed in patients with follicular lymphoma at a higher level in microdissected lymphoma cells. The bcl-xL gene level correlated with the number of apoptotic lymphoma cells labeled by terminal deoxytransferase-catalyzed DNA nick-end labeling (TUNEL) assays (r = -0.7736). Clinically, a high bcl-xL level was significantly associated with multiple sites of extranodal involvement (P = .0020), elevated lactate dehydrogenase level (P = .0478), and an International Prognostic Index indicating high risk (P = .0235). Moreover, bcl-xL gene overexpression was linked to short overall survival times (P = .0129). The value of bcl-xL gene expression as a prognostic marker in follicular lymphoma should thus be considered.

scholarly journals Follicular lymphoma patients with a high FLIPI score and a high tumor burden: A risk stratification model

2015 ◽  
Vol 72 (1) ◽  
pp. 26-32 ◽  
Author(s):  
Bosko Andjelic ◽  
Milena Todorovic-Balint ◽  
Darko Antic ◽  
Jelena Bila ◽  
Vladislava Djurasinovic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Follicular Lymphoma ◽  
Histological Grade ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Tumor Burden ◽  
Cox Regression Analysis ◽  
High Tumor Burden

Background/Aim. The widely accepted Follicular Lymphoma International Prognostic Index (FLIPI) divides patients into three risk groups based on the score of adverse prognostic factors. The estimated 5-year survival in patients with a high FLIPI score is around 50%. The aim of this study was to analyse the prognostic value of clinical and laboratory parameters that are not included in the FLIPI and the New Prognostic Index for Follicular Lymphoma developed by the International Follicular Lymphoma Prognostic Factor Project (FLIPI2) indices, in follicular lymphoma (FL) patients with a high FLIPI score and high tumor burden. Methods. The retrospective analysis included 57 newly diagnosed patients with FL, a high FLIPI score and a high tumor burden. All the patients were diagnosed and treated between April 2000 and June 2007 at the Clinic for Hematology, Clinical Center of Serbia, Belgrade. Results. The patients with a histological grade > 1, erythrocyte sedimentation rate (ESR) ? 45 mm/h and hypoalbuminemia had a significantly worse overall survival (p = 0.015; p = 0.001; p = 0.008, respectively), while there was a tendency toward worse overall survival in the patients with an Eastern Cooperative Oncology Group (ECOG) > 1 (p = 0.075). Multivariate Cox regression analysis identified a histological grade > 1, ESR ? 45 mm/h and hypoalbuminemia as independent risk factors for a poor outcome. Based on a cumulative score of unfavourable prognostic factors, patients who had 0 or 1 unfavourable factors had a significantly better 5-year overall survival compared to patients with 2 or 3 risk factors (75% vs 24.1%, p = 0.000). Conclusion. The obtained results suggest that from the examined prognostic parameters histological grade > 1, ESR ? 45 mm/h and hypoalbuminemia can contribute in defining patients who need more aggressive initial treatment approach, if two or three of these parameters are present on presentation.

R-FND Followed by Radioimmunotherapy for High-Risk Follicular Lymphoma

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3056-3056 ◽  
Author(s):  
Peter McLaughlin ◽  
Sattva Neelapu ◽  
Michelle Fanale ◽  
Maria Rodriguez ◽  
Ana Ayala ◽  
...  
Keyword(s):  
High Risk ◽  
Follicular Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Ibritumomab Tiuxetan ◽  
Free Survival ◽  
Grade 3 ◽  
Anti Cd20 ◽  
Better Than

Abstract Follicular lymphoma (FL) patients, (pts) with high-risk features using the FL International Prognostic Index (FLIPI) have an expected 5-year survival of only about 50% with conventional therapy. With the incorporation of anti-CD20 monoclonal antibody (mAb) therapy, results are improving (e.g., Buske, Blood2006; 108: 1504). Starting in 2003, we have treated high-risk (FLIPI ≥3) FL pts with R-FND (rituximab, fludarabine, mitoxantrone, dexamethasone) for 4 cycles, followed by radioimmunotherapy (RIT) with ibritumomab tiuxetan, and subsequent rituximab maintenance. Results for the first 35 pts are: complete (CR) and partial (PR) remission 83% and 14%; 3-year overall (OS) and failure-free survival (FFS) 89% and 74% (median follow-up 24 mo.). RIT converted 5 PR pts to CR. Toxicity was mainly hematologic. Five pts did not receive RIT, one because of neutropenia after R-FND. Following RIT, platelet and neutrophil nadirs were 28 and 0.3, occurring at 4–7 weeks. 16 pts required transfusions, and 27 received growth factors. 13 pts had infections, only 2 of which were grade 3. Recovery occurred by 3 weeks in most, with prolonged cytopenias in 6. There has been 1 case of myelodysplasia. In conclusion, the additional complexity of this RIT intensification strategy is warranted in this high-risk FL population, resulting in OS and FFS outcomes that are better than non-mAb therapies, and at least as good as published chemotherapy-rituximab combination therapy.

scholarly journals Retrospective Analysis of Treatment Outcomes for Patients with Follicular Lymphoma and Comorbidities

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5082-5082
Author(s):  
Aya Watanabe ◽  
Yoichi Imai ◽  
Kenjiro Mitsuhashi ◽  
Akihito Shinohara ◽  
Norina Tanaka ◽  
...  
Keyword(s):  
Decision Making ◽  
Overall Survival ◽  
Liver Disease ◽  
Follicular Lymphoma ◽  
Charlson Comorbidity Index ◽  
Clinical Characteristics ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Chop Regimen ◽  
Comorbidity Index

Abstract Follicular lymphoma (FL) is a low-grade B-cell lymphoma, and the response of FL to treatment, as well as progression-free survival and overall survival (OS), are improved by the application of combined chemotherapy with rituximab (R). The cyclophosphamide, adriamycin, vincristine, and prednisolone with rituximab (R-CHOP) regimen is the standard first-line therapy for patients with FL. However, many patients have coexistent diseases (comorbidities), and it is believed that therapeutic decision-making is influenced by comorbidities. In this study, we retrospectively analyzed treatment decision-making and its outcome for patients with FL. Based on this analysis, we investigated how the presence of comorbidity affects the survival of patients with FL. We analyzed 113 patients who were diagnosed with FL at our institute between September 2001 and March 2014. The treatment strategy was classified as observation without treatment, chemotherapy, radiotherapy, and others. Chemotherapy was subclassified as R-CHOP, reduced R-CHOP (the chemotherapeutic dose was reduced), and other chemotherapy. The severity of the comorbidity present at the time of diagnosis of FL was estimated according to the Charlson Comorbidity Index (CCI) (Table 1). The clinical characteristics of the 113 patients are shown in Table 2. The median age of the patients was 60 years. Six patients were observed without treatment, and 8 patients underwent resection or localized radiation for lymphoma. R-CHOP and other chemotherapy regimens were utilized in 84, and 15 patients, respectively. The 5-year OS rates of patients treated with R-CHOP, reduced R-CHOP, and other chemotherapy regimens were 92.3%, 75.5%, and 74.1%, respectively. As shown in a previous study (Andre Wieringa, et al., Br J Haematol, 2014, 165, 489-496), the 5-year OS rate of patients with CCI score ≥2 was inferior to that of patients with CCI 0-1 (CCI ≥2 (n = 32); 76.5%, CCI 0-1(n=81); 92.4%, p = 0.0361, Figure 1a). When we analyze the patients treated with R-CHOP, the overall response rate was 92.4% (complete response [CR] = 77.2%, partial response [PR] = 15.1%) in patients with a CCI score of 0-1 and 94.4% (CR = 77.8%, PR = 16.7%) in those with CCI score ≥ 2. In addition, there was no significant difference in the 5-year OS rate between patients with a CCI score of 0-1 or ≥2 (91.0% vs. 85.0%, p = 0.779, Figure 1b). Although, the percentage of patients with CCI ≥2 is lower than that of the other therapies (CCI ≥2; R-CHOP 25%, other chemotherapy 67%), it is supposed that R-CHOP is effective even if the patients have severe comorbidities. In 6 patients among these, treatment was discontinued or the chemotherapeutic dose was reduced due to myelosuppression during the designated course of therapy .The 5-year OS rate of these patients was favorable, even among those with high CCI score(CCI 0,1; 94.1%, CCI ≥2; 100%). Thus, it appears that R-CHOP with appropriate dose modification during the designated course will improve patient survival. Our results indicate that patients with severe comorbidities can be treated effectively by adjusting R-CHOP. Table 1. The items used to estimate the Charlson comorbidity index in each patient Comorbidity Score No. of patients Cardiac disease 1 5 Peripheral vascular disease 1 1 Cerebrovascular disease 1 3 Chronic pulmonary disease 1 6 Connective tissue disease 1 8 Ulcers 1 3 Mild liver disease 1 4 Diabetes 1 16 Tumors 2 22 Moderate or severe liver disease 3 1 Metastatic solid tumors 6 2 Table 2. Clinical characteristics of the patients Characteristic No. of patients (n = 113) Percentage (%) Sex Male 53 47 Female 60 53 Age >60 years 56 50 ≤60 years 57 50 IPI Low 55 49 Low-intermediate 38 34 High-intermediate 17 15 High 3 2 FLIPI Low 41 36 Intermediate 36 32 High 36 32 Therapy None 6 4 Resection only 3 3 Radiotherapy only 3 3 Resection and radiotherapy 2 2 R-CHOP 71 63 Discontinued or dose was reduced 23 20 Reduced R-CHOP 13 12 Other chemotherapy 15 13 IPI, international prognostic index; FLIPI, follicular lymphoma international prognostic index; R-CHOP, cyclophosphamide, adriamycin, vincristine, and prednisolone with rituximab Figure 1. Overall survival of patients treated with the cyclophosphamide, adriamycin, vincristine, and prednisolone with rituximab (R-CHOP) regimen according to the Charlson Comorbidity Index (CCI) Figure 1. Overall survival of patients treated with the cyclophosphamide, adriamycin, vincristine, and prednisolone with rituximab (R-CHOP) regimen according to the Charlson Comorbidity Index (CCI) Figure 2. Figure 2. Disclosures No relevant conflicts of interest to declare.

Gastric inflammatory prognostic index (GIPI) to predict efficacy of PD-1/PD-L1 immune checkpoint inhibitors in metastatic gastroesophageal junction (GOJ)/gastric cancer (GC) patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4530-4530
Author(s):  
Cristina Morelli ◽  
Vincenzo Formica ◽  
Anna Patrikidou ◽  
Carmen Murias ◽  
Sabeeh-Ur-Rehman Butt ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Mononuclear Cells ◽  
Cox Regression ◽  
Checkpoint Inhibitors ◽  
Gastroesophageal Junction ◽  
Prognostic Index ◽  
Second Line ◽  
Continuous Variables ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio

4530 Background: ICIs demonstrated improved overall survival (OS) in heavily pre-treated mGOJ/GC pts. Pts selection exclusively based on PD-L1 tissue expression appears to be suboptimal, despite data from subgroup analyses of KEYNOTE trials. Strong rationale suggests a potential predictive role of inflammatory biomarkers in ICIs treated mGOJ/GC pts. Methods: Ten systemic inflammatory markers [platelets, monocytes, neutrophil/lymphocyte ratio (NLR), platelets-lymphocyte ratio, lymphocytes, sum of mononuclear cells, albumin, lactate dehydrogenase, c-reactive protein (CRP) and serum globulin] were retrospectively analyzed at baseline in 57 mGOJ/GC pts with unknown PD-L1 status treated in second-line with ICIs, and correlated with OS. Least Absolute Shrinkage and Selection Operator (LASSO) method was used to select variables (preliminarily subject to optimal coding using HR smoothed curves for OS) with the highest prognostic value. Selected variables were then analyzed in a multivariate Cox Regression Model and used to build a GIPI nomogram. Results: NLR and CRP taken as continuous variables and albumin categorized as < vs > 30 g/dL were found as the most meaningful independent predictors of OS and used to build the GIPI nomogram. Nomogram-based lowest (l), mid-low, mid-high and highest (h) risk quartiles were associated with median(m)OS of 14.9, 7.1, 5.6 and 2.1 months (mos), respectively [HR of l vs h 4.94, p 0.0002]. By optimally dichotomizing CRP and NLR, pts with one or more of the following risk factors: NLR >6, CRP >15 mg/L, albumin <30 g/dL (n: 29) had a mOS of 3.9 mos vs 14.2 mos of pts with no risk factor (n: 28) (HR 2.48, p 0.001). Conclusions: GIPI, combining NLR, CRP and Albumin, is the first inflammatory index with a significant prognostic value in mOGJ/GC pts receiving second-line ICIs. Its implementation in correlation with PD-L1 expression in the present cohort is ongoing. GIPI merits validation in independent cohorts and prospective clinical trials.

Increasing Grades of Follicular Lymphoma Correlate with Better Prognosis in Patients Treated with Rituximab

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1641-1641
Author(s):  
Björn Engelbrekt Wahlin ◽  
Christer Sundström ◽  
Harald Holte ◽  
Birgitta Sander ◽  
Bjørn Østenstad ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Follicular Lymphoma ◽  
Conflicts Of Interest ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
World Health ◽  
Time To Treatment Failure ◽  
Immunologic Factors ◽  
Health Organization ◽  
Anti Cd20

Abstract Abstract 1641 Background: The World Health Organization (WHO) classification allocates indolent follicular lymphoma to grades 1, 2 or 3A according to the proportions of small centrocytes and large centroblasts in the neoplastic follicles. The prognostic value of the WHO's grading system in indolent follicular lymphoma has not been investigated in patients given the anti-CD20 monoclonal antibody rituximab without chemotherapy. Methods: We prospectively reviewed the follicular lymphoma grades in 276 grade 1–3A patients who received upfront rituximab without chemotherapy in two randomized trials. Flow cytometry analyses of malignant and nonmalignant lymphocyte subsets in lymph nodes and blood were also assessed. Results: In these patients given upfront rituximab-containing therapy, increasing grades of 1, 2, and 3A correlated with longer time to treatment-failure (P =0.002) and overall survival (P =0.045), independently of clinical factors (including the follicular lymphoma international prognostic index). The grades' impact was also independent of the levels of CD3+, CD4+, and CD8+ T cells in lymph nodes and in blood. Conclusion: Increasing grades of indolent follicular lymphoma correlate with better outcome in patients treated upfront with rituximab without chemotherapy, independently of clinical and immunologic factors. This suggests that treatment with rituximab acts differentially in tumors depending on the centrocyte/centroblast ratio. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Role of Bone Marrow Infiltration and POD 24 in Follicular Lymphoma

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5336-5336
Author(s):  
Silvia Rivas-Vera ◽  
Brenda Lizeth Acosta-Maldonado ◽  
Lizeth Elisua Estrada-Martínez
Keyword(s):  
Bone Marrow ◽  
Overall Survival ◽  
Follicular Lymphoma ◽  
Conflicts Of Interest ◽  
Independent Predictor ◽  
Statistical Significance ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Bone Marrow Infiltration ◽  
Baseline Risk

Abstract Follicular lymphoma (FL) is the most common indolent lymphoma with a median survival approaching 20 years. However, there is significant clinical heterogeneity with subsets of patients experiencing transformation, early recurrence or refractory disease. Some authors found that progression of disease within 24 months of diagnosis, in patients treated with chemoimmunotherapy (POD24), is associated with poor overall survival (OS). OBJECTIVE Evaluate the POD24 as an early clinical endpoint in FL and evaluate FL international prognostic index (FLIPI), and other baseline risk factors at diagnosis for overall survival and relapse. METHODS We conducted a retrospective and observational study in which 160 patients with follicular lymphoma who received R-CHOP at National Institute of Cancerology, Mexico from 2011 to 2017. We analyze with Kaplan Meier curves, log rank test and logistic regression model. RESULTS We analyze 160 patients, median of age was 53 years (26- 88), with a female : male ratio of 1.17:1. In this group: 86% had hemoglobin >12 mg/dL, LDH was normal in 62%, 1-4 nodal areas were affected in 64%, 56% of patients had high FLIPI score, 27% had B symptoms and we found bone marrow infiltration in 30% of cases; grade 2 Follicular lymphoma was the most common histological subtype (40.5%). Most of patients achieved complete response (81%), 12% partial response after the first line therapy. Only 13 patients (8%) presents relapse. Sixty four percent received maintenance. Only 13 of patients relapsed, 10 after 24 months and only 3 in first 24 months from diagnostic (POD 24). Fig. 1 Overall survival in our population was 89% to 8 years, the factors with statistical significance in the bivariate analysis were the more nodal regions affected (1-4), high FLIPI score and POD 24 POD 24, adjusted to FLIPI score, was an independent predictor of survival in regression analysis (p<0.041, HR:35 IC 95% 1.15-1060.21). The bone marrow infiltration at diagnosis was the only independent predictor for relapse (p<0.007, HR: 6.9, IC 95% 1.7- 28.2). CONCLUSION: In our study group, POD 24, was an important predictor of overall survival, and bone marrow infiltration at diagnosis was the only predictor factor for relapse. Disclosures No relevant conflicts of interest to declare.

Prognostic Significance of Immune Subset Measurement in Individuals With AIDS-Associated Kaposi's Sarcoma

2007 ◽  
Vol 25 (16) ◽  
pp. 2230-2235 ◽  
Author(s):  
Justin Stebbing ◽  
Adam Sanitt ◽  
Alastair Teague ◽  
Tom Powles ◽  
Mark Nelson ◽  
...  
Keyword(s):  
Overall Survival ◽  
Kaposi's Sarcoma ◽  
Cox Regression ◽  
Killer Cell ◽  
Prognostic Significance ◽  
Prognostic Index ◽  
Kaposi’S Sarcoma ◽  
Time To Progression ◽  
Data Set ◽  
Immune Subset

Purpose A prognostic index for AIDS-associated Kaposi's sarcoma (KS) diagnosed in the era of highly active antiretroviral therapy (HAART) was based on routine clinical and laboratory characteristics. Because immune subset measurement is often performed in HIV-positive individuals, we examined whether these were predictive of mortality independently of the prognostic index, or could predict time to progression of KS. Patients and Methods We performed univariate and multivariate Cox regression analyses on a data set of 326 individuals with AIDS-associated KS to identify immune subset covariates predictive of overall survival and time to progression. Adaptive (CD8 T cell and CD19 B cell) and innate (CD16/56 natural-killer cell) immune parameters were studied by flow cytometry. Results In univariate analyses, all three immune subsets had significant effects on overall survival (P < .025). In multivariate analyses including the prognostic index, only CD8 counts remained significant (P = .026), although its effect on the overall prognostic index is small. An increase of 100 cells/mm3 in the CD8 count confers a 5% improvement in overall survival. Individuals with a higher CD8 count did not have an increased time to progression. Patients who were already on HAART at the time of KS diagnosis did not have a shorter time to progression than those who were antiretroviral naïve at KS diagnosis. Conclusion The CD8 count appears to provide independent prognostic information in individuals with AIDS-associated KS. Measurement of the CD8 count is clinically useful in patients with KS.

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