Hodgkin's Lymphoma in the Elderly Patient: Impact of Age and Co-Morbidities On Outcomes.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4529-4529
Author(s):  
Samer Nakkar ◽  
Toni Pacioles ◽  
Gabriela Ballester ◽  
Maria Tirona ◽  
Oscar F Ballester
Keyword(s):  
Overall Survival ◽  
Clinical Trials ◽  
Older Patients ◽  
Hodgkin’S Lymphoma ◽  
Conflicts Of Interest ◽  
Prognostic Score ◽  
Hodgkin's Lymphoma ◽  
Younger Patients ◽  
Morbidity Score ◽  
Co Morbidity

Abstract Abstract 4529 Introduction Age older than 45 years is a recognized independent prognostic factor for patients with Hodgkin's Lymphoma (HL), and it is part of the International Prognostic Score (IPS) system. This score system was based on data derived from selected patients included in clinical trials. It is unclear from these studies if age affects primarily disease biology or the ability of older patients to tolerate therapy. Patients and Methods We retrospectively reviewed all consecutive patients with newly diagnosed HL at our institution. Data collected included their IPS and a co-morbidity score (CoM) which includes assessment of co-existing cardiac, hepatic, pulmonary, renal and other morbidities. Results Forty five patients were identified. Twenty nine patients (64%) were younger than 45 years and 16 (35%) were 45 years or older. Patients were treated wit ABVD (adriamycin, bleomycin, vinblastine and DTIC) chemotherapy, with or without radiotherapy, except for 4 patients who were accrued to clinical trials. An IPS of 2 or more was documented in 17% of younger patients as compared to 71% of those older. There was a significant association between age and IPS score (p= 0.001). Similarly, there was a significant association between age and CoM score (p= 0.01). A CoM score of 4 or higher was seen in only 7.6% of the younger population but in 46.6% of the older patients. With a median follow up of 62 months, overall survival is 86 % for the entire population. Overall survival for the younger patients is 93% and for the older 71% (p= 0.01). Five of the six documented deaths occurred in patients 45 years or older, and 4 of these 5 were seen in patients over 60 years of age. Crude death rates for patients <45 (n= 29), 45 to 59 (n= 9) and 60 or older (n= 7) are: 3.4%, 11% and 57% respectively. Conclusions Older patients are more likely to present with high IPS and CoM scores which explain at least in part their poor outcomes. A high mortality rate in patients >60 years underscores the need to explore new therapeutic approaches in the older population. Disclosures: No relevant conflicts of interest to declare.

The Role of Surveillance Imaging for the Detection of Relapsed Lymphoma.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4629-4629
Author(s):  
Neta Goldschmidt ◽  
Omer Or ◽  
Martine Klein ◽  
Bella Savitsky ◽  
Ora B. Paltiel
Keyword(s):  
Fdg Pet ◽  
Hodgkin’S Lymphoma ◽  
Clinical Symptoms ◽  
Conflicts Of Interest ◽  
Prognostic Score ◽  
Hodgkin's Lymphoma ◽  
Independent Effect ◽  
Image Detection ◽  
Risk Of Death ◽  
Major Mode

Abstract Abstract 4629 Introduction Up to 30% of patients with Hodgkin's lymphoma (HL) and 60% of patients with aggressive Non-Hodgkin's lymphoma (A-NHL) will relapse after first remission. Early detection of relapse, associated with a low tumor burden, may improve survival. The optimal follow up method - clinical versus imaging - for the detection of relapse has not been clarified. Methods We retrospectively reviewed the files of 125 patients with HL and A-NHL diagnosed between 1.1993 - 1.2009 who relapsed at least one month after the end of initial therapy. We assessed whether relapse was detected by clinical symptoms or by imaging and specifically queried whether recent imaging techniques i.e. [18F] fluorodeoxyglucose positron emission tomography (FDG-PET), have changed the pattern and outcomes of relapsed disease. Results Forty two (34%) patients had HL and 83 (66%) had A-NHL. Of the 125 patients, age was <30 years in 50% of HL and >60 years in 47% of A-NHL patients; 75 (60%) had advanced disease and 50 (40%) had early disease at diagnosis. Seventy patients (56%) relapsed in the first year following treatment, 20 (16%) in the second year and the rest (33, 26%) relapsed thereafter. In 75 (60%) patients, relapse was detected based on patient's symptoms or an abnormal physical finding (clinical detection of relapse, CDR) and in 50 (40%) patients relapse was detected by routine imaging (image detection of relapse, IDR). A significantly higher proportion of A-NHL patients had CDR as opposed to IDR (67% versus 33%), whereas in HL the opposite was found (45% CDR and 55% IDR) (p=0.022). In the years 2001-2009, when FDG-PET was available at our institution, 28% of HL patients had CDR and 72% were diagnosed by IDR (p=0.065). Multiple regression analysis confirmed the independent effect of histology (OR 2.6, 95% CI 1.19-5.69 for HL versus NHL) and period of relapse (OR 2.4, 95% CI 1.1-5.4 for ≥2001 versus '2000) on the probability of IDR. Characteristics at relapse including time to relapse, stage, presence of B symptoms, prognostic score, site of relapse, extranodal involvement and period of relapse did not influence the mode of diagnosing relapse. The overall survival after relapse of all 125 patients did not differ significantly whether they had CDR or IDR. However, in patients with HL (but not in patients with A-NHL), IDR was associated with improved survival (albeit non-significant) (Fig 1). The risk of death was more than twice for HL patients with CDR versus IDR (Hazard ratio (HR) 2.4, 95% CI 0.73-7.63) whereas in A-NHL patients the mode of detection of relapse was not associated with survival (HR 0.91, 95% CI 0.5-1.66). Conclusions These preliminary results show that the major mode of detecting relapses in lymphoma remains the clinical exam and not imaging. However, routine surveillance by imaging may be important in HL as opposed to A-NHL and the use of contemporary imaging modalities, i.e. FDG-PET, may be more sensitive for relapse detection. Although non significant, our findings suggest that image detection of relapse in patients with HL may be associated with improved survival. Disclosures: No relevant conflicts of interest to declare.

Macrophages and Mast Cells Infiltration Are Biomarkers of Primary Refractory Hodgkin's Lymphoma

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3881-3881
Author(s):  
Deau Benedicte ◽  
Bachy Emmanuel ◽  
Ribrag Vincent ◽  
Delarue Richard ◽  
Rubio Marie-Therese ◽  
...  
Keyword(s):  
Mast Cells ◽  
Hodgkin’S Lymphoma ◽  
Conflicts Of Interest ◽  
Prognostic Score ◽  
Hodgkin's Lymphoma ◽  
Control Group ◽  
Tumor Associated Macrophages ◽  
Term Survival ◽  
Early Relapse ◽  
Hodgkin's Lymphomas

Abstract Abstract 3881 Classical Hodgkin's lymphoma is a highly curable lymphoma and about 80% of patients can be cured with modern treatment strategies. In spite of great clinical progress, a significant minority of classical Hodgkin's lymphoma experiences treatment failure after primary chemotherapy including a first line of anthracyclin-based regimen. Patients with refractory Hodgkin's lymphoma represent 5 to 10% of classical Hodgkin's Lymphoma. Many of these patients have a poor overall survival estimated at 25% at 5 years. A better biological characterization of such primary refractory patients might allow the use of early therapeutic intervention including targeted therapy. It remains, however, a challenge to identify patients whose disease will not be eradicated by standard therapy. Current prognostic models predict the outcome of treatment with imperfect accuracy, and clinically relevant biomarkers have not yet been established to improve the International Prognostic Score. For these reasons, reliable biomarkers for predicting long term survival at diagnosis are needed for such patients. Steidl et al. (Nejm,2010) recently reported the prognostic value of tumor-associated macrophages in patients with classical Hodgkin's lymphoma, showing that higher infiltration is associated with a shortened survival. The value of tumor-associated macrophages in primary refractory Hodgkin's lymphomas has not been specifically assessed. In a retrospective study (Canioni et al., Plos one 2009), we previously evaluated 59 patients (18 with primary refractory or early relapse disease and 41 responders) collected from 1997 to 2004 in two hematology centres (Necker Hospital and Gustave Roussy Institute, Paris France) for c-kit expression by immunohistochemical analysis as a marker of mast cell infiltration and correlated the results with the response to treatment. All available poor prognosis patients were first identified (18 patients with primary refractory disease or early relapse (< 1year)) and the control group (47 responders) was randomly selected. Patients received conventional chemotherapy-based treatments [(MOPP (mechlorethamine, vincristine, procarbazine, and prednisone), ABVD (doxorubicine, bleomycine, vinblastine, and dacarbazine) or the combination of both or BEACOPP (bleomycine, etoposide, doxorubicine, cyclophosphamide, vincristine, procarbazine, prednisone)] and radiotherapy in stages I and II. Most patients presented a nodular sclerosis subtype of Hodgkin's lymphoma regardless whether they were refractory (17/18cases, 94.5%) or responders (37/41cases, 90%). In this cohort, 44 (75%) patients had a localized stage, whereas 19 (25%) had a disseminated disease. The results showed that refractory Hodgkin's lymphoma were associated with an excess of mast cells infiltration in the tumor cells microenvironment. The number of mast cells stained was significantly higher in refractory Hodgkin's lymphoma (c-kit+ mast cells > 6 per field) than in responders (c-kit+ mast cells ≤ 6) (p=0.001 and 0.0194 in univariate and multivariate analysis, respectively). In this cohort of patients, using CD68 staining we also found a statistically significant higher proportion of tumor-associated macrophages in refractory Hodgkin's lymphoma as compared to responders in univariate and multivariate analyses (p=0.0048 and p=0.0041, respectively). Therefore, we confirmed a strong correlation between the number of CD68 positive macrophages in the tumor stroma and clinical outcome. The use of such markers (CD68 and c-kit) in combination with well-established clinical risk factors could improve on the predictive value of a single biomarker used alone. Therefore, in addition to mast cells, macrophages are also important players in refractory Hodgkin's lymphoma that may confer drug resistance to Hodgkin Reed Sternberg cells. Taken together, these data strongly suggest that microenvironment should be targeted in Hodgkin's lymphomas. In this regard, the use of kinase inhibitors that target both c-kit and M-CSF receptors could restore chemotherapy sensitivity in refractory Hodgkin's lymphoma and should be evaluated in clinical trials. Disclosures: No relevant conflicts of interest to declare.

Acute Promyelocytic Leukemia In Canada: Poor Outcomes In Older Patients Remain

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1714-1714
Author(s):  
Matthew D. Seftel ◽  
Anna Serebrin ◽  
Pascal Lambert ◽  
Julie Bergeron ◽  
Janeve Everett ◽  
...  
Keyword(s):  
Overall Survival ◽  
Clinical Trials ◽  
Acute Promyelocytic Leukemia ◽  
Older Patients ◽  
Early Death ◽  
Promyelocytic Leukemia ◽  
Survival Outcomes ◽  
Younger Patients ◽  
One Year

Abstract Introduction Despite widespread use of all-trans retinoic acid (ATRA) in treatment of Acute Promyelocytic Leukemia (APL), recent studies in the US1 and Sweden2 have reported continuing high rates of early death. Patient age has appeared to be an important factor affecting outcomes. We studied the incidence and outcomes in the Canadian APL patients to determine which patients may be at higher risk, and to analyze the success of current management. Methods We used data from the Canadian Cancer Registry, which included all patients diagnosed between 1993-2007. We obtained incidence, Early Death (ED) (death within 30 days of diagnosis), and 1 and 5-year overall survival (OS). This was stratified by age, sex, and time period of diagnosis. Detailed information was obtained on a subset of patients managed at five Canadian leukemia referral centres from 1999 to 2010. Results There were 399 cases of APL diagnosed in Canada between 1993-2007.This accounted for 3.01% of Acute Myeloid Leukemia cases. Incidence (age-standardized to the 1991 Canadian census population) was 0.083/100000. The incidence was greater in the population aged 50 and over, with an incidence rate ratio (IRR) of 2.192 (95% C.I.1.80 - 2.67, p<0.001). ED was 21.8% overall, with a rate over three times higher in older patients as compared to younger patients. The ED rate was 10.6% in younger (<50 years) patients and 35.5% in older (≥50 years) patients. One-year overall survival was 84.1% in younger patients as compared to 52.3% in older adults. The rate of death at one year is nearly three times higher in the older patients. Five-year survival was 54.6%; this was 73.3% in the younger patients (<50), and 29.1% in the older group (≥50 years). There were 131 patients in the leukemia referral centre cohort, who predominantly received tretinoin (ATRA) based therapy. In this population, ED was 14.6%. Two-year OS was 76.5% (95% C.I. 68%-83%). Age over 60 predicted an inferior outcome at 2-years with a hazard ratio of 4.051 (95% CI 1.17-7.57). Conclusions To our knowledge, this is the largest nationwide epidemiologic study of APL. Despite widespread use of ATRA in Canada and low rates of ED reported in clinical trials (often 3-8%), we found that the real survival outcomes of APL were worse than anticipated. However they were similar to those reported recently from other developed counties1,2. The outcomes were much poorer for the older patients with APL. This included a higher rate of early death as well as poorer rates of survival at one, two and five year follow-up times. The ED rates of patients <50 more closely matched rates reported in clinical trials. We compared the survival outcomes of the entire population with APL to a sample of only patients treated at specialized referral centres. Despite receiving care in a specialized tertiary centre, the survival of older patients remained significantly poorer than the younger patients. The incidence of APL was also double in the older population as compared to the younger population. Overall the age-standardized incidence was lower in Canada than has been reported in other countries1,2. This emphasizes that, although APL is a type of AML that does affect younger patients, there is a large and important impact of this disease on older patients. Recent studies in the US and Sweden have also reported higher rates of APL in older populations and poorer rates of survival at various follow up times. Overall the patients with high-risk Sanz scores had the worst survival outcomes. The survival at most time points was slightly higher for patients scored as intermediate-risk compared to those who were in the low-risk category. When arsenic becomes widely available as a first line therapy it will be important to continue population-based analysis to see how this affects outcomes and whether the outcomes are difference in difference age groups or populations. Disclosures: No relevant conflicts of interest to declare.

DLBCL with CD30+ Has Not a Better Prognosis in a Brazilian Coorte Population

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5014-5014
Author(s):  
Talita Rocha ◽  
Carlos Sérgio Chiattone ◽  
Ana Beatriz Kinupe ◽  
Felipe Costa ◽  
Jose Vassalo ◽  
...  
Keyword(s):  
Overall Survival ◽  
Hodgkin’S Lymphoma ◽  
Conflicts Of Interest ◽  
Cell Lymphoma ◽  
Disease Free Survival ◽  
B Cell Lymphoma ◽  
Large Cell ◽  
Hodgkin's Lymphoma ◽  
Anatomic Site ◽  
Large Cell Lymphoma

Abstract Background: CD30 is a well-known diagnostic marker in both anaplastic large cell lymphoma (ALCL) and classical Hodgkin's lymphoma (CHL). The chimeric drug brentuximab vedotin that combines an anti-CD30 monoclonal antibody with the anti-tubulin agent monomethyl auristatin E demonstrated activity in patients with relapsed CHL, ALCL and other lymphomas that express CD30+. Previous observational studies have suggested that CD30 may be expressed in 10 to 20% of DLBCLs. It is possible that CD30+ DLBCLs may show different biologic behavior and be amenable to anti-CD30 therapy. The aim of this study was to determine the prevalence of CD30 expression in DLBCL by immunohistochemistry and explore possible relationships with important clinical and biologic variables of DLBCL. Methods: We retrospectively identified cases of DLBCL diagnosed between Jan 2007 and march 2014 at our institution. Eligible cases included patients with diagnosis of DLBCL irrespective of anatomic site or tumor stage. The diagnosis of DLBCL was based on the current WHO 2008 criteria. The following large B cell lymphoma subtypes were excluded from this analysis: post-transplant lymphoproliferative disorders with DLBCL morphology, Primary Mediastinal large cell lymphoma and the unclassifiable lymphomas with features intermediate between either DLBCL and Burkitt's lymphoma or between DLBCL and Hodgkin's lymphoma. Immunohistochemistry was performed with TMA (tissue microarray) in all the cases. We use a cut-off of 0%, 5% (expression between 0 and 10%), 10% and 20%. DLBCLs were classified into germinal center (GC) or non-GC subtypes applying the Hans algorithm. Logistic regression analysis was performed to assess association between selected variables and CD30 expression. Results: A total of 197 cases of DLBCL were eligible for this study and of these 152 cases (77.1%) had paraffin material available to analyse CD30. Clinical and laboratory characteristics of all coorte are shown bellow(table 1). Fifty one patients (33,5%) were positive for CD30, using cut-off>0% and 16 pacients (10,5%) were positives with a cut off ≥ 20%. Nine patients (5,9%) were EBV positives and excluded from the survival analyses. With a follow-up of 34,3 months, according disease free survival, with a cutt off CD30>0%, that was no difference between the groups (71,3% versus 71% p 0,974). According cell origen, no difference was found in the subgroup GC (75% versus 72% p 0,726) nor APC (68,8% versus 64,4% p 0,397). Using cut off CD30 ≥ 20% that was also no difference in DFS between groups (75% versus 70,5% p 0,945). Also ocurred when we analysed cell origen, GC with or without CD30 (75% versus 72,7% p 0,519) and for patients ABC with or without CD30 (75% versus 64,2% p 0,524) . Acoording overall survival, using cutt-off CD30% >0% there was no difference between the groups (86,9% versus 78,2% p 0,257). GC cell origen patients with CD30+ did not have better outcomes than patients CD30- (81,3% versus 77,1% p 0,792). For patients with ABC tumor, there was a slightly better survival for patients with CD30+ (92,3% versus 74,9% p 0,059). Using cut off CD30 ≥ 20% same results were found according CD30 expression. No difference in overall survival (87,1% versus 80,3% p 0,908). Even versus 78,7% p 0,292) nor ABC (90,9% versus 79,8% p 0,384). Conclusion: In this present study, DLBCL with CD30+, using cut-off of 0% or 20% did not shown any difference in DFS or overall survival. Disclosures No relevant conflicts of interest to declare.

Drug Shortage: The Impact of Substituting Mechlorethamine in Stanford V for Hodgkin's Lymphoma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1818-1818
Author(s):  
Luis P Monteiro ◽  
Catia L Gaspar ◽  
Margarida Fevereiro ◽  
Ana L Tome ◽  
Nuno Almeida ◽  
...  
Keyword(s):  
Combination Chemotherapy ◽  
Hodgkin’S Lymphoma ◽  
Conflicts Of Interest ◽  
Prognostic Score ◽  
Hodgkin's Lymphoma ◽  
Drug Shortage ◽  
Results Of Treatment ◽  
Pediatric Study ◽  
Pre Treatment ◽  
The Impact

Abstract Introduction: the shortage of some anticancer drugs has forced their substitution in established combination chemotherapy regimens, but the replacement may have critical effects on the results of treatment and need careful evaluation. Since 1996 we treat Hodgkin's lymphoma (HL) with the Stanford V (SV) regimen, which achieves the same results as the more widely employed ABVD regimen with the benefits of a shorter duration (12 weeks) and lower cumulative doses of bleomycin and doxorubicin. When mechlorethamine became unavailable in 2008, we substituted cyclophosphamide at a dose of 650 mg/m2 for mechlorethamine 6 mg/m2. In 2012 the Pediatric Hodgkin Lymphoma Consortium, which had adopted the same policy, suggested in a retrospective analysis that the modification could lead to an inferior event-free survival (EFS). To assess the impact of the substitution, we retrospectively compared our results with the original SV (SVo) and the modified SV (SVm). Methods: we evaluated the 265 patients consecutively treated in our center with SV between Nov/96 and Dec/14. We compared the pre-treatment characteristics, the complete remission (CR) rate, EFS and overall survival (OS) of the 184 patients who received SVo to those of the 81 patients treated with SVm. Radiotherapy indications and supportive measures were unchanged between the 2 periods. Results: median age of the 2 groups was identical: 31 (16-69) for SVo and 31 (15-72) for SVm. No differences were found in histologic subtypes (nodular sclerosis 76/74%), frequency of B symptoms (36/47%, p=0.09), proportion of advanced stages (32/33%) or International Prognostic Score (≥3 in 20/13%, p=0.22). The CR rate was 89% for SVo and 86% for SVm. With a median follow up of 9 years for the SVo group and 4.6 years for the SVm group, there were no significant differences in EFS (76/73%, p=0.66) and OS (89%/85%, p=0.63) at 5 years. Conclusion: the impact of forced substitutions in components of combination chemotherapy regimens due to drug shortage must be carefully scrutinized, notably in first line protocols for curable diseases. In the case of HL treated with the SV regimen, the present study is the first, to our knowledge, to evaluate the impact of replacing mechlorethamine by cyclophosphamide in adults. We found no difference in OS nor, unlike the pediatric study, in EFS. The substitution can be considered safe, since the modified version of SV achieves the same favorable results as the original SV. Disclosures No relevant conflicts of interest to declare.

Comparative effectiveness of treatment options in elderly patients with colon cancer receiving adjuvant chemotherapy.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 470-470
Author(s):  
Sacha Satram-Hoang ◽  
Devi Ramanan ◽  
Luen F. Lee ◽  
Shui Yu ◽  
Carolina M. Reyes ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Clinical Trials ◽  
Propensity Score ◽  
Elderly Patients ◽  
Older Patients ◽  
Randomized Clinical Trials ◽  
Cohort Analysis ◽  
Risk Of Death ◽  
Morbidity Score ◽  
Co Morbidity

470 Background: While colon cancer (CC) is predominantly a disease of the elderly, older patients are underrepresented in clinical trials. We sought to evaluate whether the treatment patterns and benefits realized by trial participants pertain to older patients in the real-world setting. Methods: Using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we conducted a retrospective cohort analysis of 3390 stage II and III CC patients diagnosed between 1/1/ 2004 to 12/31/2007, who were >66 years, enrolled in Medicare Parts A and B, and received adjuvant treatment with 5FU/LV (n=1368), FOLFOX (n=1398), CAP (capecitabine; n=507), and CAPOX (CAP + oxaliplatin; n=117) within 3 months after surgery. Date of last follow-up was 12/31/2007. Chi-square test and ANOVA or t-test assessed differences in patient and disease characteristics by treatment. Propensity score weighted Cox regression assessed the relative risk of death by treatment. Results: Patients treated with CAP were older (mean age 77 years; p<.0001), more likely female (61%; p<.05), more likely non-white (19%; p<.05) and had higher co-morbidity score (p<.0001) compared to the other treatment groups. The mean time to chemo initiation after surgery were similar between the groups (mean 46-49 days) while mean duration of treatment were longer for 5FU/LV (149 days) and FOLFOX (144 days), compared to CAP (121 days) and CAPOX (111 days); p<.0001. The incidence of adverse events (AEs) within 180 days after initiation of treatment were higher in patients treated with FOLFOX (82%) and 5FU/LV (78%) compared to CAP (74%) and CAPOX (71%); p=0.0002. Propensity score adjusted multivariate analysis demonstrated comparable survival for CAP-based regimens vs. 5-FU/LV- based regimens ( table ). Conclusions: Treatment outcomes for elderly patients observed in routine clinical practice were comparable between CAP-based and 5FU/LV-based regimens and consistent with results reported in randomized clinical trials. AEs associated with medical resource utilization were less frequent with CAP-based regimens. [Table: see text]

Impact Of Dialysis-Dependent Renal Failure At Time Of Myeloma Diagnosis On Overall Survival - a 15-Year Single Centre Analysis

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3230-3230
Author(s):  
Philip T Murphy ◽  
Cherisse Baldeo ◽  
Patrick O'Kelly ◽  
Jeremy Sargant ◽  
Patrick Thornton ◽  
...  
Keyword(s):  
Overall Survival ◽  
Renal Impairment ◽  
Patient Population ◽  
Older Patients ◽  
Conflicts Of Interest ◽  
Wilcoxon Test ◽  
High Dose ◽  
Term Survival ◽  
Old Patients ◽  
Younger Patients

Abstract In myeloma, the use of autologous stem cell transplantation in younger patients as well as the introduction of thalidomide, lenalidomide and bortezomib has resulted in improvement in long-term survival of both younger and older patients. Bortezomid and high dose dexamethasone is currently recommended to treat newly diagnosed myeloma patients presenting with renal impairment and may lead to varying degrees of improvement in renal function. We have assessed not only survival trends for all patients diagnosed at our centre over the past 18 years but also the survival of the subset of patients with severe renal impairment who required dialysis at diagnosis. All patients diagnosed with myeloma at our centre between January 1995 and December 2012 were included. We constructed Kaplan-Meier curves and used the Breslow generalised Wilcoxon test to evaluate overall survival (OS) patterns (diagnosed in three calendar periods: 1995-2000; 2001-2006; 2007-2012) for our total patient population as well as the subset of patients who required dialysis within 4 weeks of diagnostic bone marrow test. 262 patients (60.3% males) were diagnosed between 1995 and 2012. For all patients, median OS significantly increased from 13.2 months in period 1995-2000 to 27 months in period 2001-2006 with median OS not yet reached in period 2007-2012 (p=0.0001). In patients 70 years old or less, median OS significantly increased from 25.4 months in period 1995-2000 to 46.7 months in period 2001-2006 with median OS not yet reached in period 2007-2012 (p=0.0482). Improved median OS was also seen in patients > 70 years old: 4.4 months in period 1995-2000, 17.4 months in period 2001-2006 and 25.1 months in period 2007-2012 (p<0.0001). In contrast, patients requiring dialysis at diagnosis (n = 44) had much worse outcomes: median OS in the period 1995-2000 was 2.8 months and although there was a slight improvement in median OS in the period 2001-2006 (p=0.0318), there has been no further improvement in median OS in the period 2007-2012. In our overall myeloma patient population, median OS has continued to increase over the time periods 1995-2000, 2001-2006 and 2007-2012, both for younger patients 70 years old or less and older patients >70 years old. Patients requiring dialysis at diagnosis, however, continue to have much poorer median OS, despite the use of bortezomib and dexamethasone containing regimens in recent years. The possible benefit of improved supportive measures and the early use of other emerging novel agents in this poor prognostic subgroup should be explored in the clinical trial setting. Disclosures: No relevant conflicts of interest to declare.

Correlation of PET Scan Negativity and Higher Absolute Lymphocytes: Monocytes (ALC:AMC) Ratio As Prognostic Markers in Classical Hodgkin Lymphoma Patients Treated with ABVD Chemothearapy at a Single Center in Saudi Arabia

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5004-5004
Author(s):  
Ibraheem H Motabi ◽  
Syed Ziauddin A. Zaidi ◽  
Shahid Iqbal ◽  
Atta Munawar Gill ◽  
Imran Khan Tailor ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Conflicts Of Interest ◽  
Prognostic Score ◽  
Pet Scan ◽  
Hodgkin's Lymphoma ◽  
Monocyte Count ◽  
Advanced Stage ◽  
Bulky Disease ◽  
Number Of Patients ◽  
International Prognostic Score

Abstract The International Prognostic Score (IPS) is the standard stratification system for survival in patients with classical Hodgkin's lymphoma (cHL). However, the IPS only applies to patients with advanced stage disease and it does not offer risk stratification for classical Hodgkin's lymphoma patients diagnosed with limited disease [i.e., stages I and IIA, without constitutional symptoms and no bulky disease. Furthermore, early interim positron emission tomography (PET) has been shown to have a prognostic value superior to that of the IPS in patients with advanced-stage cHL in an analysis (Gallamini et al). Lymphopenia (<600/ul), monocytosis >750 per ul (Tadmore et al) and high tumor-associated macrophages (TAM) are reported to be negative prognostic factors for survival in classical Hodgkin's lymphoma (Koh et al). More recent studies suggested a prognostic role for the peripheral blood absolute lymphocyte count/absolute monocyte count (ALC/AMC) ratio at diagnosis in cHL patients treated with multitude of chemotherapies (Porrata et al, Tadmor et al). It is intriguing to investigate the significance of the ALC/AMC ratio in relation to PET negativity after treatment. Out of 164 cases of cHL treated at our center with ABVD +/- radiation therapy, we identified 70 patients who were evaluated by PET Scan. Median age was 26 years (range 14-80), 33 (47%) were stage IV, Median IPS was 3 (range1-6). We tested correlation of a high ALC/AMC ratio (>2.1) with achievement of a negative PET scan after ABVD chemotherapy. We arbitrarily chose cut-off value of >2.1 (Tadmore et al) from the multiple values reported recently, as this multicenter study had the largest number of patients. A total of 45 patients achieved a negative PET scan. Mean ALC/AMC ratio was 2.39 (range0.19-14.6). ALC/AMC ratio of >2.1 did show a trend for better OS in addition to a negative PET scan. A Spearman correlation test of a negative PET result showed a positive correlation with ALC/AMC ratio of >2.1 though it was weak. This study suggests that the ALC/AMC ratio may be a simple, inexpensive, and independent prognostic factor in cHL outcome and may have a role in the stratification of cHL patients in addition to the International Prognostic Score, TAM content and acheivement of a negative PET scan early post chemotherapy. However we plan to define our own best cut off value for ALC/AMC ratio by ROC and AUC analysis as ALC/AMC Ratio of ≥2.1 did not discriminate survival advantage very well and it may be a reason for weaker correlation with likelihood of a negative PET. Further larger studies are needed to confirm our findings. Disclosures No relevant conflicts of interest to declare.

PROGNOSTIC SIGNIFICANCE of CD68 EXPRESSION for Korean PATIENTS with HODGKIN'S LYMPHOMA

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3888-3888
Author(s):  
Dok Hyun Yoon ◽  
Young Wha Koh ◽  
Shin Kim ◽  
Chan-Sik Park ◽  
Dae Ho Lee ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Clinical Outcome ◽  
Hodgkin’S Lymphoma ◽  
Conflicts Of Interest ◽  
Prognostic Score ◽  
Prognostic Significance ◽  
Hodgkin's Lymphoma ◽  
Significant Prognostic Factor ◽  
Primary Therapy ◽  
Localized Disease

Abstract Abstract 3888 Background: A lower incidence of Hodgkin's lymphoma (HL) in Asians has been recognized and the incidence of HL in Korea was reported to be 5.3%. This low incidence of HL in Asian population has hindered the evaluation of pathogenesis and prognostic factors of the disease. Although international prognostic score (IPS) has been largely utilized as prognostic stratification tool, there has been unmet need to further clarify those with poor prognosis until an increased number of tumor-associated macrophages was identified as a predictor of poor clinical outcome. Hence, we evaluated the prognostic significance of CD68, a marker of macrophages, in Korean HL patients. Methods: We performed immunohistochemical analysis of CD68 in 144 classic HL patients treated with ABVD (n=113, 78.5%), MOPP (n=10, 6.9%), ABVD/MOPP hybrid (n=15, 10.4%) or BEACOPP (n=6, 4.2%) chemotherapy with or without radiotherapy between November 1990 and December 2009 in the Asan Medical Center. The relative percentage of CD68+ cells in relation to overall cellularity was calculated and the results were correlated with clinical outcome. Results: We examined various cutoff points of CD68 expression from 10 to 90 percentile with a rising gradient constructed using 5% steps (5%, 10%, 15%, 20%, 25%, 30%, 35% and 40%). The most significant statistical difference in disease-specific survival (DSS) was observed at a cutoff value of 20%, employing the log-rank test. The high (>=20%, n=78) CD68 group included more patients with older patients (Age 45 yr, 45.5% vs. 28.2%, p=0.032) and higher IPS (>=4, 37.9% vs. 21.8%, p=0.034) compared with the low (<20%, n=66) CD68 group. In total, 18 patients in the low CD68 group and 20 patients in the high CD68 group experienced relapse or progression. Nine patients in the low CD68 group (6 patients of progressive disease [PD], 1 of treatment-related infection during salvage treatment, 1 of moyamoya disease and 1 of unknown cause) and 15 patients in the high CD68 group (8 of PD, 5 of treatment-related infection, 1 of intraventricular hemorrhage during primary therapy, 1 of unknown cause) died by the time of data cutoff. Treatment-related mortality (TRM) was significantly higher in the high CD68 group (n=1 vs. n=6, p=0.048). The 5-year EFS rates were 74.7% and 49.5% in the low and high CD68 expression groups, respectively (P=0.009) with a median follow-up period of 5.4 years (range, 0.6–19.0 years) in surviving patients. The 5-year DSS rates were 95.7% in the low CD68 expression group and 76.5% in the high CD68 expression group (P=0.011). In the multivariate analysis with clinical variables significantly correlating with EFS/DSS in univariate analyses including IPS (>=4), age (>=45 years) and presence of B symptoms, CD68 expression was found to be an independent prognostic factor for EFS (Hazard ratio [HR] =1.846; 95% confidence interval [CI] 1.106–3.354; P=0.044) and DSS (HR = 2.955; 95% CI, 1.148–7.607; p=0.025). However, the prognostic significance of CD68 seems to be more prominent in patients with localized disease (n=48) in a subgroup analysis. While 5-year EFS (85.8% vs. 25.7%, p=0.001) and DSS (95.7% vs. 78.8%, p=0.007) for patients with localized disease were significantly higher in the low CD68 group, both EFS (66.5% vs. 56.5%, p=0.144) and DSS (92.7% vs. 75.7%, p=0.144) were not significantly different between the high and low CD68 groups. Conclusion: The number of CD68+ macrophages is a significant prognostic factor in Korean HL patients. Disclosures: No relevant conflicts of interest to declare.

Sign in / Sign up

Export Citation Format

Share Document