Development of Pulmonary Sarcoidosis during Lymphoma Treatment: A Diagnostic Dilemma.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4443-4443
Author(s):  
Angel F. Campos-Gines ◽  
Suresh J. Antony ◽  
Carmen P. Arango ◽  
Mark M. Landeros ◽  
Juan Herrada
Keyword(s):  
Complete Resolution ◽  
White Cell Count ◽  
Oral Prednisone ◽  
B Cell Lymphoma ◽  
Pulmonary Sarcoidosis ◽  
Diagnostic Dilemma ◽  
Tissue Mass ◽  
Pulmonary Infiltrates ◽  
Non Hodgkin Lymphoma

Abstract Background: Although the association of sarcoidosis and malignancy has long been described (Brincker, Br J Cancer 1972), so far only 3 patients (pts) have been documented to have developed sarcoidosis during or immediately after chemotherapy for non-Hodgkin lymphoma (NHL) (Kornacker et al. Ann Hematol 2002; Hollister et al. J Clin Oncol 2005). Methods: Case report. Results: A 50 year-old male with 2-month history of back pain and 20 pound weight loss had a soft tissue mass in the lumbar area biopsied. The pathology revealed a diffuse large B-cell lymphoma. Bone marrow biopsy showed no abnormalities. Computed tomography (CT) and [18F] fluorodioxyglucose positron emission tomography (PET) revealed large bilateral pulmonary masses and extensive periaortic lymphadenopathy. Treatment consisted of chemotherapy with cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab every 21 days. 11 days after completion of the 4th cycle, the pt was hospitalized with febrile neutropenia, and received intravenous cefepime and vancomycin with growth-factor support. Pt was released from the hospital on day 20th of the cycle with a white cell count of 15 thousand / uL, mostly neutrophils, and negative blood, sputum, and urine cultures. Because of persistent fever (38.5 °C) and non-productive cough 3 weeks after discharge, CT studies were obtained. In the chest there was no evidence of the previously noted lung masses, and there was the presence of new bilateral diffuse pulmonary infiltrates. Abdominal CT demonstrated near complete resolution of the periaortic lymphadenopathy. A transbronchial biopsy and a bronchoalveolar lavage were obtained, revealing the presence of non-caseating granulomas, and no evidence of malignancy, mycobacteria, or fungal micro-organisms. The serum level of angiotensin-converting enzyme was markedly elevated (112; normal range 9–67). At this point the pt was diagnosed with symptomatic pulmonary sarcoidosis and he was treated with oral prednisone. Follow-up CT evidenced a complete resolution of the pulmonary infiltrates. No further chemotherapy was administered. After a subsequent follow-up of 14 months, the pt remains in complete remission by clinical, serological, and radiographic (CT and PET) criteria. Conclusions: The diagnosis of new radiographic changes in pts with NHL receiving chemotherapy needs to be histologically confirmed.

Evaluation of R-CHOP and R-CVP in the treatment of elderly patient with non-Hodgkin lymphoma

MedPharmRes ◽  
2019 ◽  
Vol 3 (3) ◽  
pp. 1-6
Author(s):  
Truc Phan ◽  
Tram Huynh ◽  
Tuan Q. Tran ◽  
Dung Co ◽  
Khoi M. Tran
Keyword(s):  
Elderly Patients ◽  
Hodgkin Lymphoma ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
The Elderly ◽  
Free Survival ◽  
Non Hodgkin Lymphoma ◽  
Common Sign ◽  
Related Mortality

Introduction: Little information is available on the outcomes of R-CHOP (rituximab with cyclophosphamide, doxorubicin, vincristine and prednisone) and R-CVP (rituximab with cyclophosphamide, vincristine and prednisone) in treatment of the elderly patients with non-Hodgkin lymphoma (NHL), especially in Vietnam. Material and methods: All patients were newly diagnosed with CD20-positive non-Hodgkin lymphoma (NHL) at Blood Transfusion and Hematology Hospital, Ho Chi Minh city (BTH) between 01/2013 and 01/2018 who were age 60 years or older at diagnosis. A retrospective analysis of these patients was perfomed. Results: Twenty-one Vietnamese patients (6 males and 15 females) were identified and the median age was 68.9 (range 60-80). Most of patients have comorbidities and intermediate-risk. The most common sign was lymphadenopathy (over 95%). The proportion of diffuse large B cell lymphoma (DLBCL) was highest (71%). The percentage of patients reaching complete response (CR) after six cycle of chemotherapy was 76.2%. The median follow-up was 26 months, event-free survival (EFS) was 60% and overall survival (OS) was 75%. Adverse effects of rituximab were unremarkable, treatment-related mortality accounted for less than 10%. There was no difference in drug toxicity between two regimens. Conclusions: R-CHOP, R-CVP yielded a good result and acceptable toxicity in treatment of elderly patients with non-Hodgkin lymphoma. In patients with known cardiac history, omission of anthracyclines is reasonable and R-CVP provides a competitive complete response rate.

A case of primary breast diffuse large B cell lymphoma

2021 ◽  
Vol 148 (12) ◽  
pp. 102-107
Author(s):  
Trinh Le Huy ◽  
Tran Dinh Anh
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Excisional Biopsy ◽  
Needle Aspiration ◽  
Non Hodgkin Lymphoma ◽  
Large B Cell Lymphoma ◽  
Painless Mass ◽  
Large B Cell

Primary breast diffuse large B-cell lymphoma (DLBCL) is a rare non-Hodgkin’s lymphoma with limited data. We here report a case of primary breast diffuse large B-cell lymphoma mimicking breast cancer. A 52-year-old woman had a painless mass in her right breast. Fine needle aspiration cytology and core biopsy were performed which suggested malignant features but could not confirm the specific subtype. Excisional biopsy then was conducted revealing non-Hodgkin lymphoma, which was subsequently confirmed with histopathology and diagnosed as diffuse large B-cell lymphoma (DLBCL). A chest computed tomography scan revealed a 3.5 cm sized breast mass with skin thickening and modest lymphadenopathy in the ipsilateral axilla. The patient received six courses of R-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone plus rituximab) chemotherapy, then whole breast radiation (30Gy in 15 fractions). At 12 months of follow-up, the patient survives with no evidence of disease. No morbidities occurred in this patient during the follow-up period. We briefly review the current practice pattern in patients with primary breast diffuse large B-cell lymphoma.

scholarly journals Dural Plasmacytoma Involving Calvarium with Soft Tissue Extension Mimicking Meningioma: A Diagnostic Dilemma

2019 ◽  
Vol 08 (01) ◽  
pp. 053-056
Author(s):  
Anju Shukla ◽  
Devendra Chhabra ◽  
Tarun Pandey ◽  
Prashant Singh
Keyword(s):  
Soft Tissue ◽  
Postoperative Radiotherapy ◽  
Parietal Bone ◽  
Diagnostic Dilemma ◽  
Tissue Mass ◽  
Soft Tissue Extension ◽  
Dural Tail ◽  
Left Parietal Bone ◽  
Magnetic Resonance Imaging Mri

AbstractHere, the authors describe a case of 25-year-old man diagnosed with dural plasmacytoma involving calvarium with soft tissue extension. Magnetic resonance imaging (MRI) revealed extra-axial heterogeneously enhancing soft tissue mass lesion in the left parieto-occipital region with a dural tail mimicking meningioma, destroying the left parietal bone, and bulging into the scalp. Mass was excised and histopathologic examination revealed plasmacytoma with amyloid deposition. There is no recurrence after postoperative radiotherapy and 2 years of follow-up, although the future course is still not certain. The clinician should consider alternative diagnosis other than meningioma prior to proceeding to surgery if the dural-based lesion is involving calvarium and soft tissue extension.

Modified Magrath IVAC Regimen as Second-Line Therapy for Relapsed and Refractory Aggressive Non-Hodgkin Lymphoma in Developing Countries: The Experience of a Single Center in Brazil.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4588-4588
Author(s):  
Luis F. Pracchia ◽  
Juliana Pereira ◽  
Marcelo Belesso ◽  
Beatriz Beitler ◽  
Dalton A. Chamone
Keyword(s):  
Hodgkin Lymphoma ◽  
Median Overall Survival ◽  
Overall Response Rate ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Non Hodgkin Lymphoma ◽  
Grade 3 ◽  
Relapsed Disease

Abstract In this retrospective study we described the response and toxicity of a modified Magrath IVAC (mIVAC) regimen in 25 patients with refractory/relapsed aggressive non-Hodgkin lymphoma (NHL). The mIVAC consisted of ifosfamide 1,500mg/m2 (one-hour infusion beginning at 9:00; D1 to D5), mesna 300mg/m2 (bolus at hours 9:00, 13:00, 17:00; D1 to D5), citarabine 2,000 mg/m2 (two one-hour infusions beginning at 8:00 and 16:00; D1 and D2) and etoposide 60 mg/m2 (one-hour infusion beginning at 10:00; D1 to D5). Treatment was repeated every four weeks for a maximum of six cycles. Patients who achieved partial remission or complete remission after at least three courses were offered autologous stem cell transplantation (ASCT), if eligible. The median age was 37 years (range 18 to 59 years). Twenty-two (88%) patients had diffuse large B-cell lymphoma, fourteen (56%) had relapsed disease and 10 (40%) were considered high-intermediate and high risk by age-adjusted International Prognostic Index. The overall response rate was 68% (95% CI: 46%–90%). A total of 64 cycles were given, with a median of three courses per patient. Grade 3/4 neutropenia was observed after 85,6% of the courses, and grade 3/4 thrombocytopenia was observed after 87,5% of the courses. Grade 3/4 neutropenic fever occurred after 28% of the courses. Non-hematologic toxic effects were rare, predominantly grade 1/2. No toxic deaths were observed. Fifteen (88%) of the 17 responding patients underwent ASCT. With a median follow-up of 14 months, the median overall survival time for mIVAC sensitive patients was 16 months. This regimen may be feasible for patient with relapsed and refractory aggressive NHL in countries with inadequate numbers of hospital beds.

VNCOP-B (Etoposide, Mitoxantrone, Cyclophosphamide, Vincristine, Prednisolone, Bleomycin) Plus Rituximab Therapy in Elderly Patients with Aggressive B-Cell Non-Hodgkin Lymphoma: A Phase II Study of Efficacy and Safety

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3586-3586
Author(s):  
Kazuyoshi Ishii ◽  
Masahiro Manabe ◽  
Toshiya Yagi ◽  
Hirofumi Teshima ◽  
Yasuaki Nagare ◽  
...  
Keyword(s):  
Elderly Patients ◽  
B Cell ◽  
Phase Ii ◽  
Induction Therapy ◽  
Phase Ii Study ◽  
B Cell Lymphoma ◽  
Non Hodgkin Lymphoma ◽  
Large B Cell Lymphoma ◽  
Grade 3

Abstract [Background and Objectives] CHOP (cyclophosphamide, adriamycin, vincristine, prednisolone) plus rituximab is a standard chemotherapy used to treat patients with aggressive B-cell non-Hodgkin lymphoma (B-NHL). However, among elderly patients, this regimen has not been completely satisfactory in its efficacy and safety because of agespecific comorbidity, increased toxicities of chemo-agents, and the more aggressive aspect of the lymphoma itself. Zinzani reported that a combination therapy including etoposide, mitoxantrone, cyclophosphamide, vincristine, prednisolone, and bleomycin (VNCOP-B) was effective in elderly aggressive NHL patients (Blood1999;94:33–38). We conducted a phase II multicenter study in 8 collaborative institutions to determine if VNCOP-B plus rituximab was effective and safe to treat elderly patients with aggressive B-NHL. The primary endpoint was to detect overall survival (OS). The second endpoint was to detect the response rate (RR) and progression-free survival (PFS). [Patients and Treatment] Eligible patients were those aged over 60 years, with aggressive B-NHL documented as CD20 surface antigen positive, performance status (PS) 0 to 2, clinical stage over II or I with a bulky disease, measurable lesions, no prior chemotherapy nor radiation, no severe complications, no major organ dysfunction, no other active cancer, not a HBV carrier, no central nervous system involvement with lymphoma, and who gave the required written informed consent. VNCOP-B plus rituximab was administered as an induction therapy. This protocol was completed in 8 weeks and consisted of weekly doses of chemotherapy combined with rituximab every two weeks. During the 8 weeks of therapy, granulocyte colony-stimulating factor (G-CSF) was administered on a prophylactic base. Rituximab was administered weekly four times a month as a sequential therapy, following one month after the end of the induction therapy. [Results] Between September 2004 and December 2007, 23 patients, median age 73 years, 50.0% classified as high-intermediate/high risk on the age-adjusted International Prognostic Index (IPI), entered this trial and 21 were evaluated for feasibility, toxicity, and efficacy. Twenty-two patients (95.2%) were diagnosed with diffuse large B-cell lymphoma and one (4.8%) with mediastinal large B-cell lymphoma. The nineteen patients (90.5%) completed the induction therapy and all these then received a sequential rituximab therapy. Complete remission rate was 90.5%, with a 100% overall RR at the end of induction therapy; OS rate at 3 years was 76.4% (median follow-up 744days); with an 82.6% 3-year PFS rate (median follow-up 744days). Average Relative dose intensity (RDI) in MIT was 0.61, no significant difference in survival was found regarding RDI. Although IgG level decreased during the induction therapy, it recovered to the prior level after sequential rituximab (IgG means±standard error: pre-treatment 1355.2±146.4mg/dl, post-induction therapy 785.3±107.0mg/dl, post-sequential rituximab 1010.4±60.2mg/dl). According to the IPI, there was a trend suggesting a lower probability of OS and PFS in high/high-intermediate risk than in low/low-intermediate risk cases (3-year OS: 67.5% versus 100.0%, P=0.51; 3-year PFS: 66.7% versus 100.0%, P NA). The most common grade 3/4 toxicities were hematologic, including neutropenia in 75.0% of the 21 patients despite prophylactic administration of G-CSF, febrile neutropenia in 30.0%, and thrombocytopenia in 10.0%, respectively. Regarding non-hematologic grade 3/4 toxicities, hepatitis occurred in one patient (5.0%) from HCV reactivation, intestinal perforation involving the lymphoma in one patient (5.0%). There was no treatment-related mortality. We had conducted a phase II study of VNCOP-B therapy in 16 elderly patients with aggressive B-NHL (Gan To Kagaku Ryoho2005;32:39–44, in Japanese). Against this historical comparison, the present protocol seemed better in PFS than that without rituximab (3-year PFS: 82.6% versus 56.0%, P=0.11), although OS was almost the same (3-year OS: 76.4% versus 73.4%, P=0.22). [Conclusion] Although our enrolled patients were quite elderly with a median age of 73 years, and half of them had a poor prognosis index, VNCOP-B combined with rituximab was well tolerated and showed promise.

Impact of absolute lymphocyte count on prognosis of aggressive non-Hodgkin lymphoma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e19034-e19034
Author(s):  
Anahat Kaur ◽  
Punita Grover ◽  
Sheetal Bulchandani ◽  
Thomas A Odeny ◽  
Sheshadri Madhusudhana ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
B Cell ◽  
Hodgkin Lymphoma ◽  
Lymphocyte Count ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Absolute Lymphocyte Count ◽  
Intermediate Risk ◽  
Non Hodgkin Lymphoma

e19034 Background: Multiple studies have attempted to identify parameters to predict prognosis and overall survival (OS) in Non-Hodgkin Lymphoma (NHL). Revised International Prognostic Index (R-IPI) is commonly used but does not capture all predictive risk factors in the Rituximab era. Low absolute lymphocyte count (ALC) on follow up after first line therapy has been reported to predict relapse. The prognostic value and exact cut off for low ALC at diagnosis is not known. We aimed to investigate whether ALC at time of diagnosis is an independent predictor for OS in aggressive NHL. Methods: We retrospectively evaluated patients with aggressive NHL treated at our center from 1/2000 to 12/2016 with at least 2 year longitudinal follow up after diagnosis. We retrieved data for baseline characteristics including age, sex, Ann Arbor stage, R-IPI score, HIV status, histopathological diagnosis (Diffuse Large B Cell Lymphoma (DLBCL), Burkitt′s lymphoma, Follicular Lymphoma Grade IIIB, high-grade B cell lymphoma), type of chemotherapy and clinical response. Patients were divided into four subgroups based on ALC at diagnosis: < 500, 501-1000, 1001-1500 and > 1500X109/L. Statistical analysis was done using REDCAP and Stata v13. Results: A total of 92 patients were identified. The average age at diagnosis was 53.4 years, 63% were male and 73.5% were diagnosed with DLBCL. Per R-IPI score, 16.3% were high risk, 31.3% were high intermediate risk, 22.5% low intermediate risk and 30% were low risk. The median OS for patients with ALC < 500 x109/L (5.4%) was 1.5 years, ALC 501-1000 (38%) was 2.3 years, ALC 1001-1500 (23.9%) was 4.25 years and ALC > 1500 (32.6%) was 5.2 years. On multivariate analysis this difference was not statistically significant due to small sample size. Conclusions: We found that low ALC at diagnosis trended towards worse OS in aggressive NHL but did not reach statistical significance on multivariate analysis. Our study is limited by retrospective nature and sample size. Multicenter studies need to be done to validate these results. Studies are also needed to know the exact cut off for low ALC. [Table: see text]

scholarly journals A Prospective Analysis of Erythrocyte Membrane Fatty Acid Concentrations and Risk of Non-Hodgkin Lymphoma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1789-1789
Author(s):  
Brenda M. Birmann ◽  
Yu-Han Chiu ◽  
Kimberly A. Bertrand ◽  
Shumin Zhang ◽  
Francine Laden ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Fatty Acid ◽  
Follicular Lymphoma ◽  
Hodgkin Lymphoma ◽  
Trans Fatty Acids ◽  
B Cell Lymphoma ◽  
Inverse Association ◽  
Non Hodgkin Lymphoma ◽  
Clear Association

Abstract Introduction: Circulating fatty acids, which can serve as biomarkers of diet or activity of specific metabolic pathways, may influence non-Hodgkin lymphoma (NHL) risk by modulating inflammation or lymphocyte membrane stability. We performed prospective studies to evaluate red blood cell (RBC) membrane fatty acids as biomarkers of future NHL risk, hypothesizing a positive association for RBC saturated and trans fatty acids and an inverse association for polyunsaturated fatty acids (PUFAs) with risk of NHL and major NHL subtypes. Methods: We conducted a nested case-control study among Nurses' Health Study (NHS) and Health Professionals Follow-up Study (HPFS) participants who provided blood samples in 1989-90 (NHS) or 1993-4 (HPFS). We confirmed 583 incident NHL cases through 2010 and matched one control per case on age, gender, race, and blood draw date. By gas chromatography we identified and determined membrane concentrations of 33 individual fatty acids in RBCs. We estimated the odds ratio (OR) and 95% confidence interval (CI) of NHL per 1 standard deviation (SD) increase in RBC level of specific fatty acids using unconditional logistic regression adjusted for matching factors. We also analyzed three common B-NHL subtypes individually (chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma) and examined all B-NHLs in aggregate with and without CLL/SLL. Results: We observed no associations between specific fatty acids and NHL risk overall (data not shown). In subtype-specific analyses, RBC very long chain saturated fatty acid (VLCSFA) levels (including the 20:0, 22:0, 23:0 fatty acids) were inversely associated with the group of all B-NHLs except CLL/SLL, with ORs suggesting 18% to 19% decreases in risk per SD increase in concentration (Table 1). We observed suggestive inverse associations of similar magnitude for follicular lymphoma and DLBCL but no clear association with CLL/SLL for these 3 VLCSFAs (Table 1). These three VLCSFAs had moderate to strong pairwise correlations; Spearman correlations were 0.61 for 20:0 with 22:0, 0.42 for 20:0 with 23:0 and 0.64 for 22:0 with 23:0. PUFAs were also inversely associated with all B-NHL except CLL/SLL, a finding primarily driven by RBC arachidonic acid levels [OR (95%CI) per SD: 0.83 (0.71, 0.90)] and suggestive also for follicular lymphoma [OR, 95% CI per SD: 0.79 (0.61, 1.02)] and DLBCL [OR, 95% CI per SD: 0.82 (0.64, 1.06)]. The remaining RBC fatty acids, including trans fatty acids, had no clear association with any NHL endpoint (data not shown). We did not observe heterogeneity by follow-up interval or age, although we had limited statistical power to detect significant heterogeneity for specific NHL subtypes. Conclusion: RBC levels of VLCSFAs and PUFAs may be associated with lower risk of several types of B-NHL other than CLL/SLL. The specific fatty acids found to be related with NHL risk are not good biomarkers of diet, suggesting that the observed relations may instead be due to endogenous metabolic processes. Investigation is warranted into biologic mechanisms by which circulating fatty acids and their determinants may influence NHL risk, as is further examination of these associations in larger (ideally pooled) study populations. Disclosures No relevant conflicts of interest to declare.

Clinical characteristics and prognosis associated with multiple primary malignant tumors in non-Hodgkin lymphoma patients

2019 ◽  
Vol 105 (6) ◽  
pp. 474-482
Author(s):  
Yanan Jiang ◽  
Zhaoyi Miao ◽  
Jinhuan Wang ◽  
Jing Chen ◽  
Yangyang Lv ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Clinical Characteristics ◽  
Malignant Tumors ◽  
B Cell Lymphoma ◽  
Solid Cancer ◽  
Synchronous Tumor ◽  
Non Hodgkin Lymphoma ◽  
Tumor Group ◽  
Multiple Primary

Objective: Patients with non-Hodgkin lymphoma (NHL) occasionally present with multiple primary malignant tumors (MPMTs). This study aimed to determine the clinical characteristics, survival, and risk factors of these patients. Methods: The median follow-up of 92 patients was 13.5 months (range 0.3–72). Overall, 21 patients had synchronous MPMTs and 71 had metachronous MPMTs. We classified patients in the latter group into metachronous first group (n=27) and metachronous second group (n=44). Results: Diffuse large B-cell lymphoma was the most frequent histologic lymphoma type. The digestive system was the commonest site affected by the solid cancer. The 1- and 2-year survival rates were 86.5% and 70.5%, respectively. The overall survival (OS) rates were 67.9% and 36.2% at 2 and 3 years, respectively, in the metachronous first group; 73.8% and 73.8%, respectively, in the metachronous second group; and 68.1% and 56.7%, respectively, in the synchronous tumor group. There was no difference in the survival rate among the 3 groups before 2 years, but after 2 years, a shorter OS rate was observed in the metachronous first group than in the metachronous second group and synchronous tumor group. For all patients, age >60 years, male sex, and ⩾3 involved nodal sites were considered independent prognostic factors associated with survival. Conclusions: OS time was shorter in patients with NHL who developed a second tumor than in those who were diagnosed with solid cancer synchronously and second neoplasm after previous solid tumors. Long-term follow-up and effective treatment should be provided to these patients.

Subcutaneous epcoritamab in patients with relapsed/refractory B-cell non-Hodgkin lymphoma: Safety profile and antitumor activity.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 7518-7518
Author(s):  
Michael Roost Clausen ◽  
Pieternella Lugtenburg ◽  
Martin Hutchings ◽  
Peter W. M. Johnson ◽  
Kim M. Linton ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
B Cell ◽  
Hodgkin Lymphoma ◽  
Safety Profile ◽  
Cell Lymphoma ◽  
Single Agent ◽  
B Cell Lymphoma ◽  
Non Hodgkin Lymphoma ◽  
Grade 3

7518 Background: Epcoritamab is a CD20xCD3 bispecific antibody that induces T-cell–mediated killing of CD20–positive malignant B-cells. We present updated data, including progression-free survival (PFS) from the dose escalation part of the first-in-human phase 1/2 study of epcoritamab in pts with relapsed or refractory (R/R) B-cell non-Hodgkin lymphoma (B-NHL; NCT03625037). Methods: Adults with R/R CD20+ B-NHL received flat-dose 1 mL SC epcoritamab (step-up dosing approach) in 28-day cycles (q1w: cycles 1–2; q2w: cycles 3–6; q4w thereafter) until disease progression or unacceptable toxicity. Step-up dosing and standard prophylaxis were used to mitigate severity of cytokine release syndrome (CRS). Results: At data cut off (1/31/2021), 68 pts with B-NHL were enrolled across histologies including diffuse large B-cell lymphoma (DLBCL; n = 46 [67.6%]; de novo and transformed), follicular lymphoma (FL; 12 [17.6%]), mantle cell lymphoma (MCL; 4 [5.9%]), and others (6 [8.8%]). Majority were heavily pretreated (median [range] prior lines: DLBCL, 3 [1–6]; FL, 4.5 [1–18]); including prior CAR-T (n = 6) and prior ASCT (n = 10). At median follow-up of 14.1 mo (DLBCL, 10.2 mo; FL, 15.2 mo), treatment was ongoing in 15 (22%) pts. Most common treatment-emergent adverse events (AEs) were pyrexia (69%), CRS (59%), and injection site reaction (47%). CRS events were all grade 1 or 2 and most occurred in cycle 1; neurotoxicity was limited (6%; grade 1: 3%; grade 3: 3%; all transient). One case of tumor lysis syndrome was observed (1.5%; grade 3); there were no cases of febrile neutropenia or treatment-related death. Overall response is shown for DLBCL ≥12 mg and ≥48 mg and FL ≥12 mg, corresponding to the minimal efficacy threshold (Table). Responses deepened over time (PR converted to CR: DLBCL, 6 pts; FL, 3 pts). Median time to response was 1.4 mo (DLBCL) and 1.9 mo (FL). Among DLBCL pts achieving CR with ≥6 mg (n = 11), none relapsed while on treatment. The median PFS for pts with DLBCL ≥12 mg (n = 22) was 9.1 mo (95% CI: 1.6, NE; median follow-up 9.3 mo) and for pts with DLBCL ≥48 mg (n = 11) median PFS was not reached (median follow-up 8.8 mo). Updated analyses will be presented. Conclusions: With longer follow-up, SC epcoritamab demonstrated substantial single-agent activity, inducing deep and durable clinically meaningful responses, with a consistent safety profile. Notably no severe (grade ≥3) CRS events, no febrile neutropenia, and limited neurotoxicity was observed. Clinical trial information: NCT03625037. [Table: see text]

Gray Zone Lymphomas: Clinical and Histological Characteristics and Treatment with Dose-Adjusted-EPOCH-R

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3590-3590 ◽  
Author(s):  
Kieron Dunleavy ◽  
Stefania Pittaluga ◽  
Nicole Grant ◽  
Seth Steinberg ◽  
Margaret Shovlin ◽  
...  
Keyword(s):  
B Cell ◽  
Hodgkin Lymphoma ◽  
Cell Lymphoma ◽  
Treatment Strategies ◽  
B Cell Lymphoma ◽  
Large Cell ◽  
Gray Zone ◽  
Non Hodgkin Lymphoma ◽  
Histological Characteristics

Abstract Gray zone lymphomas (GZL) are diseases with transitional morphology and immunophenotypic features between Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Their pathological and clinical characteristics are not well studied and the best treatment strategy (using HL or DLBCL regimens) has not been defined. Small previous series of HL-like ALCL, which would include GZL, suggest they have a poor outcome with HL treatments. We present GZL’s treated on studies of DA-EPOCH-R at the National Cancer Institute and describe their clinical and histological features and outcome. Overall, 14 patients with GZL were identified. Characteristics included median (range) age 30 (12–51) years; male sex 10 (71%); stage III/IV 2 (14%) and; elevated LDH 7 (50%). These cases could be divided into three Gray zone groups: classical HL (cHL) and primary mediastinal B-cell lymphoma (PMBL) in 9 (64%) patients; cHL and DLBCL in 2 (14%) and; lymphocyte predominant HL (LPHL) and T-cell histiocyte-rich large cell lymphoma (TCRBCL) in 2 (14%). Pathological characteristics are shown below. All but one case was CD 10 negative. Markers of cHL included CD15 in 33–50% and CD30 in 66–100% of cases. Morphologically, Reed-Sternberg like cells were typically seen in GZL with cHL features. Thirteen newly diagnosed patients received DA-EPOCH-R. Of 11 patients evaluable for response (2TE), 10 (91%) achieved CR and 1 PR. At a median follow-up time of 4 years, OS and PFS are is 86% and 57%, respectively. Of 9 patients with GZL between cHL and PMBL, 4 (44%) also required radiation therapy compared to only 3/31 (10%) patients with PMBL to achieve durable remissions. Gray zone lymphomas represent a biological and clinical continuum between HL and B-cell lymphomas. Clinically, they appear to be more resistant to treatment than either HL or DLBCL and may require aggressive treatment strategies including radiation. Accrual continues. Gray Zone Total 14 CD 20 CD 15 CD 30 cHL- PMBL 9 8 (89%) 7 (50%) 9 (100%) cHL-DLBCL 2 2 (100%) 1 (50%) 2(100%) LPHL-TCRBCL 3 3 (100%) 1 (33%) 2 (66%)

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