Underreporting of Myelotoxicity with Emerging Regimens for Selected Hematologic Malignancies

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1501-1501
Author(s):  
Stephanie A. Gregory ◽  
Steve Abella ◽  
Timothy Moore
Keyword(s):  
Hodgkin Lymphoma ◽  
Research Funding ◽  
English Language ◽  
Antibiotic Use ◽  
Hematologic Malignancies ◽  
Lymphocytic Leukemia ◽  
Phase 3 ◽  
Non Hodgkin Lymphoma ◽  
Prophylactic Use ◽  
Clinically Significant

Abstract Abstract 1501 Background: Clinical data guiding colony-stimulating factor (CSF) use with emerging regimens that incorporate targeted agents for treating hematologic malignancies are not readily available, even though many of these regimens can produce increased myelosuppressive side-effects. This review assessed the diligence of reporting around neutropenia, febrile neutropenia (FN), and neutropenic complications as well as the use of CSF and antibiotics in published clinical trials evaluating emerging regimens for the treatment of non-Hodgkin lymphoma (NHL), Hodgkin lymphoma, multiple myeloma (MM), or chronic lymphocytic leukemia (CLL). Methods: English-language reports of randomized controlled phase 3 studies of the selected hematologic malignancies published between January 2005 and June 2009 were identified by searching Medline, EMBASE, and Cochrane databases. Publications that met the inclusion criteria were retrieved and data on the incidence of neutropenia and its complications and CSF/antibiotic use were extracted. The percentage of publications that reported each outcome was then calculated. Results: Fifty seven trials that met the criteria were included in this analysis. Overall, 68% of trials reported on the incidence of grade 3/4 neutropenia (80%, MM; 71% CLL; 63% NHL, and 50%, Hodgkin lymphoma). However, fewer trials (18%) reported on the incidence of FN (57%, CLL; 20%, MM; 8%, NHL; and 0%, Hodgkin lymphoma). Similarly, only a few trials (4%) reported neutropenia-related hospitalizations (8%, NHL; 0% each for Hodgkin lymphoma, MM, and CLL). Primary prophylactic use of CSF was defined in the methods section of 19% of trials and CSF use was reported in the results section of 25% of trials. Use of antibiotics for FN treatment was defined in the methods section of 2% of trials and was reported in the results section of 9% of trials. Conclusion: In the published phase 3 studies evaluated in this analysis, clinically significant neutropenia and neutropenia-related events (including FN) were poorly or generally not described. Furthermore, the use of CSF and antibiotics was infrequently and inconsistently reported in the published literature of emerging regimens. A standardized approach to reporting neutropenic outcomes and the related use of supportive care measures can assist clinicians to prospectively manage the relevant toxicities associated with emerging regimens for hematologic malignancies. This is essential for the safe and effective transition of these regimens into broad clinical practice. Disclosures: Gregory: Amgen Inc.: Consultancy; Astellas: Research Funding; Celgene: Research Funding; Cephalon: Research Funding, Speakers Bureau; Genentech (Roche): Consultancy, Research Funding, Speakers Bureau; GlaxoSmithKline: Research Funding; Immunomedics: Research Funding; NCIC CTG: Research Funding; Novartis: Consultancy, Research Funding; Onyx: Research Funding; Spectrum Pharmaceuticals: Consultancy. Abella:Amgen Inc.: Employment, Equity Ownership. Moore:Amgen Inc.: Consultancy, Honoraria.

Pooled safety summary for patients treated with the CD22-directed cytotoxin moxetumomab pasudotox-tdfk.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 7014-7014
Author(s):  
Robert J. Kreitman ◽  
Steven Coutre ◽  
Cynthia Elesinmogun ◽  
Nataliya Kuptsova-Clarkson ◽  
Xia Li ◽  
...  
Keyword(s):  
Treatment Interruption ◽  
Hematologic Malignancies ◽  
Underlying Disease ◽  
Lymphocytic Leukemia ◽  
Adult Patients ◽  
Open Label ◽  
Phase 3 ◽  
Pivotal Phase ◽  
Peripheral Edema ◽  
Non Hodgkin Lymphoma

7014 Background: Moxetumomab pasudotox-tdfk was FDA-approved in 2018 for the treatment of adults with relapsed/refractory hairy cell leukemia (HCL) who have received ≥2 prior therapies, including a purine nucleoside analog. Methods: The pooled integrated safety summary included all adult patients (N=165) treated with ≥1 dose of moxetumomab across 5 open-label, single-arm clinical trials. Two trials included patients with HCL (N=129, with N=80 in the pivotal phase 3 trial) and 3 trials included patients with non-Hodgkin lymphoma (N=15) or chronic lymphocytic leukemia/small lymphocytic lymphoma (N=21). Overall, 81% were male, median age was 60 years (range 34–84) and 94% had an ECOG ≤1. Results: The most common adverse events (AEs) with moxetumomab were peripheral edema (41%), hypoalbuminemia (35%), and nausea (35%). Serious AEs occurred in 47 (28.5%) patients and were considered treatment-related in 21 (12.7%) patients. Treatment-related AEs were mainly grade 1/2; the most common were peripheral edema (32%), hypoalbuminemia (32%), increased ALT (29%), increased AST (28%), nausea (26%), headache (24%), pyrexia (23%), fatigue (22%), and myalgia (20%). In total, 19 deaths (11.5% of patients) occurred (including 3 in the pivotal trial), with most (13) due to underlying disease and 6 due to AEs (none were assessed as treatment-related by the investigators, however, 1 fatal AE in a non-HCL patient was re-assessed by the Sponsor as possibly related to moxetumomab). In 16 patients (9.7%), a treatment-related AE led to treatment discontinuation, with hemolytic uremic syndrome HUS; 3.6%) and capillary leak syndrome (CLS; 2.4%) the most common. Treatment-related AEs resulted in dose delay, omission or treatment interruption in 11 patients (6.7%). Conclusions: Moxetumomab had an acceptable safety profile based on pooled data from 165 adult patients with hematologic malignancies, with few treatment-related discontinuations. Proactive monitoring of patients is important to manage AEs. These results are consistent with results from the pivotal phase 3 trial in patients with HCL. Clinical trial information: NCT01829711, NCT00586924, NCT00587457, NCT00587015, NCT01030536.

Treatment With The Potent PI3K-δ,γ Inhibitor IPI-145 Is Associated With Rapid Decreases In Specific Cytokines, Chemokines and Matrix Metalloproteinases In The Serum Of Patients With Chronic Lymphocytic Leukemia and Indolent Non-Hodgkin Lymphoma

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1633-1633 ◽  
Author(s):  
Mark Douglas ◽  
Ken Allison ◽  
Synder Ted ◽  
Kerstin Allen ◽  
Brad S. Kahl ◽  
...  
Keyword(s):  
B Cells ◽  
Chronic Lymphocytic Leukemia ◽  
Matrix Metalloproteinases ◽  
Hodgkin Lymphoma ◽  
Research Funding ◽  
B Cell Lymphoma ◽  
Serum Levels ◽  
Lymphocytic Leukemia ◽  
Non Hodgkin Lymphoma ◽  
Median Serum

Abstract Phosphoinositide-3 kinases (PI3Ks) are key cellular signaling proteins that act as a central node, relaying signals from cell surface receptors to downstream mediators such as AKT. The PI3K-δ and PI3K-γ isoforms are preferentially expressed in normal and malignant leukocytes where they play critical roles in cell differentiation, migration, and proliferation. IPI-145 is a potent, oral PI3K-δ,γ inhibitor that has shown clinical activity in the Phase 1 trial (IPI-145-02) in patients with advanced hematologic malignancies (ClinicalTrials.gov NCT01476657). Cytokines, chemokines, and matrix metalloproteinases (MMPs) play key roles in the homing, migration and activation of normal immune cells, and can have similar effects on malignant leukocytes. To further explore the biological effects of IPI-145, a panel of cytokines, chemokines, and MMPs were evaluated at several time points in the serum of patients enrolled in the IPI-145-02 trial. Serum was collected from consenting subjects at baseline, Cycle 1 Day 8 (C1D8), and Cycle 2 Day 1 (C2D1). Serum was frozen and stored at -80°C prior to analysis. Serum proteins were analyzed using Luminex xMAP(®) technology in which analytes are captured on uniquely labeled fluorescent beads, and the amount of analyte is quantified using an LED CCD camera contained in Millipore's MagPix(®) instrument. Multiplex panels of cytokines, chemokines and MMPs covering 72 analytes were evaluated in 30 chronic lymphocytic leukemia (CLL) and 19 indolent non-Hodgkin lymphoma (iNHL) subjects. Each sample was tested in duplicate, and duplicate measurements were averaged. Measurements were excluded from further analysis if duplicate readings exhibited a coefficient of variation of greater than 20% or if all values for a specific analyte and subject were below the limit of detection. Each analyte was evaluated for evidence of a consistent change (reduction or increase) in serum levels at C1D8 and/or C2D1 compared to baseline. When data were compared between CLL subjects treated with IPI-145 at 25 mg twice daily (BID) and those treated at 75 mg BID, no clear differences in serum analyte levels were observed, although the population subgroups were relatively small. For the purposes of this analysis, all doses were pooled together (n=1 at 8 mg BID, 2 at 15 mg BID, 15 at 25 mg BID, and 13 at 75 mg BID). Likewise, the iNHL dose groups were also pooled (n=1 at 15 mg BID, 12 at 25 mg BID, 1 at 50 mg BID, and 5 at 75 mg BID). In CLL subjects, 9 of 72 analytes decreased after IPI-145 treatment compared to baseline, whereas none increased significantly. Analytes that decreased after IPI-145 treatment include CXCL13, CCL3, CCL4, IL-10, TNFα, IL-12p40, MMP-9, CCL17 and CCL22. Median serum levels of these analytes decreased by C1D8, ranging from 16% to 59% of baseline. In iNHL subjects, median serum levels of 7 analytes decreased by C1D8 (ranging from 32% to 70% of baseline), whereas none increased significantly. Of the 7 analytes that decreased in iNHL subjects, 5 also decreased in CLL subjects (CXCL13, MMP-9, TNFα, CCL17 and CCL22) and 2 were distinct (CCL1 and MMP-12). Interestingly, many of the analytes that decreased with IPI-145 treatment are involved in the communication between malignant B-cells and the microenvironment. CCL3, CCL4, CCL17 and CCL22 are expressed by malignant B-cells and may play a role in recruiting T-cells to interact with the malignant B-cells. CXCL13 is secreted by stromal cells and recruits malignant B-cells to the lymph nodes. In addition, IL-10 is produced by many normal immune cell types as well as by neoplastic B-cells. IL-10 is known to be an autocrine growth factor for B-cell lymphoma cell lines. These pharmacodynamic data provide further evidence for biological activity of IPI-145 in patients with CLL and iNHL and suggest both similarities and differences in how these two malignancies respond to IPI-145. The association of many of these pharmacodynamic factors with the tumor microenvironment suggests a mechanistic basis for the clinical observation of lymphocytosis and nodal reduction with IPI-145 treatment of CLL subjects. Cytokine, chemokine and MMP levels from patients in IPI-145-02 are being evaluated further for associations with multiple clinical parameters to determine if there is evidence for biomarkers predictive of efficacy and tolerability. Disclosures: Douglas: Infinity Pharmaceuticals, Inc.: Employment. Allison:Infinity Pharmaceuticals, Inc.: Employment. Ted:Infinity Pharmaceuticals, Inc.: Employment. Allen:Infinity Pharmaceuticals, Inc.: Employment. Kahl:Infinity Pharmaceuticals, Inc.: Consultancy, Research Funding. Horwitz:Celgene, Allos, Seattle Genetics, Bristol-Myers Squibb, Genzyme, Kyowa, Janssen, Johnson & Johnson, Millenium: Consultancy; Celgene, Allos, Seattle Genetics, Kyowa, Infinty, Millenium: Research Funding. Flinn:Infinity Pharmaceuticals, Inc.: Consultancy, Research Funding. Kelly:Infinity Pharmaceuticals, Inc.: Employment. Stern:Infinity Pharmaceuticals, Inc.: Employment.

scholarly journals Racial and ethnic disparities in hematologic malignancies

Blood ◽  
2017 ◽  
Vol 130 (15) ◽  
pp. 1699-1705 ◽  
Author(s):  
Kedar Kirtane ◽  
Stephanie J. Lee
Keyword(s):  
Hodgkin Lymphoma ◽  
Myeloid Leukemia ◽  
Myeloproliferative Neoplasms ◽  
Ethnic Disparities ◽  
Hematologic Malignancies ◽  
Lymphocytic Leukemia ◽  
Racial And Ethnic Disparities ◽  
Future Directions ◽  
Non Hodgkin Lymphoma ◽  
Solid Malignancies

Abstract Racial and ethnic disparities in patients with solid malignancies have been well documented. Less is known about these disparities in patients with hematologic malignancies. With the advent of novel chemotherapeutics and targeted molecular, cellular, and immunologic therapies, it is important to identify differences in care that may lead to disparate outcomes. This review provides a critical appraisal of the empirical research on racial and ethnic disparities in incidence, survival, and outcomes in patients with hematologic malignancies. The review focuses on patients with acute myeloid leukemia, acute lymphocytic leukemia, multiple myeloma, non-Hodgkin lymphoma, Hodgkin lymphoma, myeloproliferative neoplasms, and myelodysplastic syndrome. The review discusses possible causes of racial and ethnic disparities and also considers future directions for studies to help decrease disparities.

scholarly journals Results of a Phase 3 Randomised Multicenter Study Comparing Pixantrone + Rituximab with Gemcitabine + Rituximab in Patients with Relapsed Aggressive B-Cell Non-Hodgkin Lymphoma Not Eligible for Stem Cell Transplantation

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4189-4189
Author(s):  
Gilles Andre Salles ◽  
Wojciech Jurczak ◽  
David J. Andorsky ◽  
Donald P. Quick ◽  
Jack W. Singer ◽  
...  
Keyword(s):  
Stem Cell ◽  
B Cell ◽  
Hodgkin Lymphoma ◽  
Stock Options ◽  
Research Funding ◽  
De Novo ◽  
Phase 3 ◽  
Non Hodgkin Lymphoma ◽  
Grade 3 ◽  
To Receive

Abstract Introduction: There are limited treatment options for patients with relapsed aggressive B-cell non-Hodgkin lymphoma (NHL) who are not candidates for high-dose therapy and stem-cell transplant (SCT). Reasons for ineligibility for intensive treatment include advanced age and overall condition, comorbidities, failure to respond to standard salvage treatment regimens, progressive disease following previous SCT, and presence of other adverse risk factors. The PIX306 study evaluated the efficacy of pixantrone + rituximab (PIX+R) compared with gemcitabine + rituximab (GEM+R) in patients with relapsed aggressive B-cell NHL in this particular clinical setting. We present the primary results of the core analysis of the PIX306 trial. Methods: PIX306 was a phase 3, multicentre, open-label, randomized trial in patients aged ≥18 years diagnosed with de novo diffuse large B-cell lymphoma (DLBCL), DLBCL transformed from indolent lymphoma, or grade 3 follicular lymphoma (FL) who relapsed after at least one standard rituximab-containing multi-agent regimen. Primary refractory de novo DLBCL and grade 3 FL, defined as progression within 12 weeks of the last cycle of the first-line treatment regimen, was an exclusion criterion. Patients were randomly allocated 1:1 to receive PIX 50 mg/m2 or GEM 1000 mg/m2 on days 1, 8 and 15 of a 28-day cycle, each in combination with R 375 mg/m2 on day 1, for up to 6 cycles, with follow-up for progression up to 96 weeks. The primary endpoint was progression-free survival (PFS) as determined by the Independent Radiology Committee (IRC). Disease response was assessed according to the Modified IWG 2007 Revised Response Criteria. The current analysis is based on 197 PFS events (IRC). Overall survival (OS), complete response (CR), overall response rate (ORR), and safety were secondary endpoints. Results: The ITT population included 312 patients; 155 and 157 patients were randomly allocated to receive PIX+R and GEM+R, respectively. Groups were well balanced; no statistically significant differences in baseline demographics were shown (Table). Median age was 73 years (range: 26-91 years). Overall, 193 (61.9%) patients had received only one line of prior chemotherapy. Most patients (n=242; 77.6%) had de novo DLBCL, 43 (13.8%) had DLBCL transformed from indolent NHL and 27 (8.7%) had grade 3 FL. The majority of patients had Ann Arbor stage III/IV (n=230; 73.7%) disease, 166 (53.2%) patients had an IPI score of ≥3, and in 195 (62.5%) patients extranodal disease was diagnosed at baseline. In total, 116 (37.2%) patients had their first disease relapse within 1 year following the initiation of the front-line therapy for DLBCL or FL. Thirty-three (10.6%) patients had undergone a previous SCT. The study did not meet its primary objective of efficacy, as measured by PFS, of PIX+R vs GEM+R [P= 0.28; HR=0.85 (95% CI: 0.64, 1.14)]. The median PFS (95% CI) in the PIX+R and the GEM+R groups were 7.3 months (5.2; 8.4) and 6.3 months (4.4; 8.1), respectively. Median OS was 13.3 vs 19.6 months [HR=1.13 (95% CI: 0.83, 1.53), P=0.43], CR was observed in 35.5% vs 21.7% of patients, and ORR was 61.9% vs 43.9% in the PIX-R and GEM-R groups, respectively. Both regimens were reasonably tolerated and no new safety signals were reported. Cardiac failure was reported as a serious adverse event in 3 and 2 patients (2.0% and 1.3%) receiving PIX-R and GEM-R, respectively. Conclusions: This is the first study to investigate the efficacy of PIX+R vs GEM+R as second-line or later therapy in patients with relapsed aggressive B-cell NHL who are not eligible for SCT and who have few therapeutic options. Even though the present study did not meet its primary endpoint, the PFS observed in both the PIX+R and GEM+R groups were longer than the study outcomes previously reported in similar patient populations. Disclosures Salles: Merck: Honoraria; Servier: Honoraria; Pfizer: Honoraria; Gilead: Honoraria; Acerta: Honoraria; AbbVie: Honoraria; Celgene: Honoraria, Research Funding; Roche: Honoraria, Research Funding; Novartis: Consultancy, Honoraria; Takeda: Honoraria; Janssen: Honoraria; Amgen: Honoraria; Epizyme: Honoraria; Morphosys: Honoraria. Jurczak:Epizyme: Research Funding; Celgene: Research Funding; Beigene: Research Funding; Bayer: Research Funding; Afimed: Research Funding; Gilead: Consultancy, Research Funding; Janssen: Consultancy, Research Funding; Sandoz-Novartis: Consultancy; Acerta: Consultancy, Research Funding; AstraZeneca: Consultancy; European Medicines Agency: Consultancy; Servier: Consultancy, Honoraria, Research Funding; Nordic Nanovector: Research Funding; Merck: Research Funding; Morphosys: Research Funding; Pharmacyclics: Research Funding; Roche: Research Funding; TG therapeutics: Research Funding. Andorsky:AstraZeneca: Consultancy; CTI BioPharma: Consultancy, Research Funding; Celgene: Research Funding; Genentech: Consultancy. Quick:CTI BioPharma: Research Funding. Singer:CTI BioPharma: Employment, Other: Stock options. Bedi Singh:CTI BioPharma: Employment, Other: Stock options. Wang:CTI BioPharma: Employment, Equity Ownership. Egorov:Servier: Employment. Gabarroca:Servier: Employment. Pettengell:CTI: Honoraria; Pfizer: Honoraria; Roche: Honoraria; Servier: Honoraria; Takeda: Honoraria.

scholarly journals Malignant (Diffuse) Mesothelioma in Patients With Hematologic Malignancies: A Clinicopathologic Study of 45 Cases

2015 ◽  
Vol 139 (9) ◽  
pp. 1129-1136 ◽  
Author(s):  
Xin Li ◽  
Noel A. Brownlee ◽  
Thomas A. Sporn ◽  
Annabelle Mahar ◽  
Victor L. Roggli
Keyword(s):  
Hodgkin Lymphoma ◽  
Malignant Mesothelioma ◽  
Hematologic Malignancy ◽  
Hematologic Malignancies ◽  
Lymphocytic Leukemia ◽  
Myelogenous Leukemia ◽  
Survival Period ◽  
Clinicopathologic Characteristics ◽  
Non Hodgkin Lymphoma ◽  
History Of

Context Ionizing radiation has a role in the development of malignant mesothelioma, in several epidemiologic studies, including patients with hematologic malignancies. Objective To study the clinicopathologic characteristics of patients with malignant mesothelioma and hematologic malignancies with and without a history of radiotherapy. Design From a database of approximately 3600 patients with malignant mesothelioma, we identified 45 patients (1%) who also had hematologic malignancies. We examined clinicopathologic features and noted whether the patient had received radiotherapy for malignancy, comparing those with and those without such exposure. Results Among the 45 cases, 18 (40%) had Hodgkin lymphoma, 15 (33%) had non-Hodgkin lymphoma, 10 (4%) had chronic lymphocytic leukemia, and 2 (22%) had chronic myelogenous leukemia; 20 patients (44%) had a history of radiotherapy, and 23 (51%) did not. Most patients with Hodgkin lymphoma (16 of 18; 90.0%) received radiation, whereas none of the patients with leukemia (0 of 12) and only 20% (3 of 15) of the patients with non-Hodgkin lymphoma did so. Patients without radiation were older than patients who received radiotherapy (median, 73 versus 54 years, respectively; P < .001), had a shorter interval from diagnosis of hematologic malignancy to that of mesothelioma (median, 2 versus 24 years, respectively; P < .001), and had a shorter survival period (median, 6.0 versus 14.0 months, respectively; P = .02). Epithelial mesotheliomas were proportionately more common in patients with a history of radiotherapy. Conclusions Patients with mesothelioma and hematologic malignancies with a history of radiation tended to be younger, had a longer interval from diagnosis of hematologic malignancy to that of mesothelioma, had a longer survival period, and were more likely to have the epithelial variant compared with patients without radiotherapy.

scholarly journals Stem Cell Mobilization and Harvesting Failure in Case of Heavily Pretreated Patients

2017 ◽  
Vol 2 (s4) ◽  
pp. 39-41
Author(s):  
Eszter Mild ◽  
Erzsébet Lázár ◽  
Judit-Beáta Köpeczi ◽  
Enikő Kakucs ◽  
Marius Găzdac ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hodgkin Lymphoma ◽  
Hematologic Malignancies ◽  
High Dose Chemotherapy ◽  
Lymphocytic Leukemia ◽  
High Dose ◽  
Hematopoietic Stem ◽  
Non Hodgkin Lymphoma ◽  
Cell Harvesting ◽  
Cell Mobilization

AbstractBackground:High-dose chemotherapy and autologous stem cell transplantation have become a standard curative treatment in various hematologic malignancies. Many factors can affect the success of mobilization and hematopoietic stem cell harvesting.Aim:The aim of this study was to analyze factors that lead to mobilization failure.Material and Methods:We conducted a retrospective study on 19 patients with failure of stem cell harvesting. All patients were administered high doses of GCS-F (filgrastim, 15 μg/kg/day) and 0.24 mg/kg of plerixafor on day +5 or +10 of harvesting.Results:The median age of the study population was 51 years (range 35–67) and 52.6% (n = 10) were males. The study group included 4 (21%) subjects with multiple myeloma, 6 (31.5%) with Hodgkin lymphoma, 8 cases (42.1%) with non-Hodgkin lymphoma and 1 patient with chronic lymphocytic leukemia. Each patient received 2.78 (range 1–5) lines of chemotherapy, administered in 11.57 (range 2 to over 20) cycles of treatment.Conclusion:In hematologic malignancies it is very important to collect stem cells in time, in order to reduce mobilization failure. As we have shown in our studied cases, multiple lines of polychemotherapy with or without radiotherapy lead to mobilization failure.

scholarly journals Deep Learning for the Classification of Non-Hodgkin Lymphoma on Histopathological Images

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2419
Author(s):  
Georg Steinbuss ◽  
Mark Kriegsmann ◽  
Christiane Zgorzelski ◽  
Alexander Brobeil ◽  
Benjamin Goeppert ◽  
...  
Keyword(s):  
Deep Learning ◽  
Hodgkin Lymphoma ◽  
Expert Knowledge ◽  
B Cell Lymphoma ◽  
High Accuracy ◽  
Lymphocytic Leukemia ◽  
Non Hodgkin Lymphoma ◽  
Image Patches ◽  
Histopathological Images

The diagnosis and the subtyping of non-Hodgkin lymphoma (NHL) are challenging and require expert knowledge, great experience, thorough morphological analysis, and often additional expensive immunohistological and molecular methods. As these requirements are not always available, supplemental methods supporting morphological-based decision making and potentially entity subtyping are required. Deep learning methods have been shown to classify histopathological images with high accuracy, but data on NHL subtyping are limited. After annotation of histopathological whole-slide images and image patch extraction, we trained and optimized an EfficientNet convolutional neuronal network algorithm on 84,139 image patches from 629 patients and evaluated its potential to classify tumor-free reference lymph nodes, nodal small lymphocytic lymphoma/chronic lymphocytic leukemia, and nodal diffuse large B-cell lymphoma. The optimized algorithm achieved an accuracy of 95.56% on an independent test set including 16,960 image patches from 125 patients after the application of quality controls. Automatic classification of NHL is possible with high accuracy using deep learning on histopathological images and routine diagnostic applications should be pursued.

Thrombotic complications in adult patients with lymphoma: a meta-analysis of 29 independent cohorts including 18 018 patients and 1149 events

Blood ◽  
2010 ◽  
Vol 115 (26) ◽  
pp. 5322-5328 ◽  
Author(s):  
Vanesa Caruso ◽  
Augusto Di Castelnuovo ◽  
Susana Meschengieser ◽  
Maria A. Lazzari ◽  
Giovanni de Gaetano ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Meta Analysis ◽  
Hematologic Malignancies ◽  
Incidence Rates ◽  
Clinical Implications ◽  
Low Grade ◽  
Thrombotic Risk ◽  
Non Hodgkin Lymphoma ◽  
Thrombotic Complications ◽  
Exact Maximum Likelihood

AbstractThrombotic complications in hematologic malignancies have important clinical implications. In this meta-analysis we sought to obtain accurate estimates of the thrombotic risk in lymphoma patients. Articles were searched in electronic databases and references. Eighteen articles were identified (29 cohorts, 18 018 patients and 1149 events). Pooled incidence rates (IRs) were calculated by the use of a method based on the exact maximum likelihood binomial distribution. The global IR of thrombosis was 6.4% (95% confidence interval [CI] 6.0%-6.8%). The global IRs of venous or arterial events were 5.3% (95% CI, 5.0%-5.7%) and 1.1% (95% CI, 0.9%-1.2%), respectively. The IR of thrombosis observed in subjects with non-Hodgkin lymphoma (NHL) was 6.5% (95% CI, 6.1%-6.9%), significantly greater than that observed for patients with Hodgkin lymphoma (4.7%; 95% CI, 3.9%-5.6%). Within NHL, patients with high-grade disease had a greater risk of events (IR 8.3%; 95% CI, 7.0%-9.9%) than low-grade disease (IR 6.3%; 95% CI, 4.5%-8.9%). This meta-analysis shows that the IR of thrombosis in lymphoma patients is quite high, especially in those with NHL at an advanced stage of the disease. These results may help better defining lymphoma populations at high thrombotic risk, to whom prophylactic approaches could be preferentially applied.

Sign in / Sign up

Export Citation Format

Share Document