Multiple Extranodal Involvements; Significant Risk Factor of Relapse In Peripheral T-Cell Lymphoma, Not Otherwise Specified

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4887-4887
Author(s):  
Kazuya Sato ◽  
Yoshihiro Torimoto ◽  
Yutaka Kohgo ◽  
Takashi Fukuhara
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Cell Lymphoma ◽  
Univariate Analysis ◽  
Risk Groups ◽  
Primary Treatment ◽  
Extranodal Involvement ◽  
Peripheral T Cell Lymphoma ◽  
Bulky Disease ◽  
Not Otherwise Specified

Abstract Abstract 4887 Background: Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) comprises clinically and histopathologically a heterogeneous group of predominantly nodal diseases which do not fit into definition of any other identified subtype of PTCLs. Most of cases are advanced diseases and characterized by aggressive behavior and very poor prognosis. Although several risk factors for response and survival in PTCL-NOS have been reported, little information is available for the incidence and risk factors of relapse after complete response (CR) achievement. Further analyses of the relapse will give valuable information for effective therapeutic strategies for PTCL-NOS. The aim of this study is to evaluate the incidence and risk factors of the relapse in PTCL-NOS patients. Methods: We retrospectively reviewed 107 patients with PTCL-NOS diagnosed by The 4th edition of the WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues in Hokkaido Hematology Study Group, which includes 30 hematology/oncology or pediatrics departments of 23 institutes, from January 2002 to December 2009. We further investigated the incidence, clinical backgrounds, and risk factors of relapse of the PTCL-NOS patients. Response to treatment was assessed by international workshop to standardize response criteria for non-Hodgkin's lymphomas (Cheson BD et al. J Clin Oncol. 1999). Overall survival (OS) curves were estimated using Kaplan-Meier method and compared by log-rank test. The association between clinical factors and relapse rate was evaluated in univariate analysis by the chi-squared test. Factors independently associated with relapse or OS were identified in multivariate analysis by logistic regression model or Cox proportional hazards model, respectively. Results: The median follow-up of the patients was 24 months (range 1–95). The sample population included 70 males and 37 females with a median age of 67 years (range 9–94). Chemotherapy (ChT) was selected in 90% (96/107) patients as the primary treatment. CHOP-lile regemens were chosen in 91% (86/96) patients as the primary ChT. The estimated 5 year-OS of all the patients was 35%. 48 (52%) patients achieved CR after primary treatment in the evaluable 92 patients, and were futher analyzed. Relapse was occured in 46% (22/48) patients with a median remission duration of 9 months (range 2–51). Multiple or diffuse extranodal relapses were presented in 64% (14/22) patients. Only 5 (24%) paitients achived 2nd CR in the 21 relapsed patients recived salvage ChT. Survaval of patients with relapse was significantly shorter than that without relapse (5 year-estimated OS 32% vs 100%, p<0.0001). Factors of high relapse rates at diagnosis were as follows; central nervous system involvement (100%), extranodal involvement sites>1 (87%), gastrointestinal involvement (80%), bulky disease (67%), bone marrow (BM) involvement (67%), high (H) and high-intermediate (HI) risk groups of International Prognositic Index (IPI) (63%). In addition, relapse rate of the patients showing FDG-uptake by PET after primary treatment was 100%. In univariate analysis, extranodal involvement sites at diagnosis >1 (p=0.022), H and HI risk groups of IPI at diagnosis (p=0.021), FDG-uptake by PET after primary treatment (p=0.043) were identified as risk factors of relapse. Age, clinical stage, B-sympton, perfomance status, BM imvolvement, bulky disease, high LDH level, risk groups of prognositic index for PTCL-U (PIT), and regemen or dose-reduction of primary treatment were not significant indicators for relapse in univariate analysis. In multivariate analysis, extranodal involvement sites at diagnosis >1 was identified as an independent risk factor not only for relapse (relative risk 26.0; 95% CI 1.115–605.9; p=0.043) but also for OS (relative risk 10.8; 95% CI 1.1466–80.13; p=0.02). Conclusions: Almost half of PTCL-NOS patients who achieved CR after primary treatment will relapse and the prognosis is poor. Multiple extranodal involvements at diagnosis will be a predictive factor of relapse and survival. These findings warrant further studies regarding specific treatment approaches for PTCL-NOS patients with multiple extranodal involvements to inhibit the relapse. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Baseline and interim functional imaging with PET effectively risk stratifies patients with peripheral T-cell lymphoma

2019 ◽  
Vol 3 (2) ◽  
pp. 187-197 ◽  
Author(s):  
Neha Mehta-Shah ◽  
Kimiteru Ito ◽  
Kurt Bantilan ◽  
Alison J. Moskowitz ◽  
Craig Sauter ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
T Cell ◽  
Confidence Interval ◽  
Cell Lymphoma ◽  
Univariate Analysis ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Standardized Uptake Value ◽  
T Cell Lymphoma ◽  
Peripheral T Cell Lymphoma

Abstract The prognosis of peripheral T-cell lymphoma (PTCL) is heterogenous. Baseline or interim imaging characteristics may inform risk-adapted treatment paradigms. We identified 112 patients with PTCL who were consecutively treated with cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP)/CHOP-like regimens with the intent to consolidate with an autologous transplant. Baseline (n = 93) and interim (after 4 cycles, n = 99) positron emission tomography (PET) images were reevaluated, and we calculated baseline total metabolic tumor volume (TMTV). Interim PET (iPET) responses were graded visually by 5-point score (i5PS) and by percentage change of standardized uptake value. By univariate analysis, predictors of event-free survival (EFS) included Prognostic Index for Peripheral TCL (PIT) higher than 1 (hazard ratio [HR], 1.83; P = .021), International Prognostic Index (IPI) higher than 3 (HR, 2.01; P = .021), high TMTV (&gt;125 cm3; HR, 3.92; P = .003), and positive iPET (HR, 3.57; P &lt; .001). By multivariate analysis, high baseline TMTV predicted worse overall survival (OS; HR, 6.025; P = .022) and EFS (HR, 3.861; P = .005). Patients with i5PS of 1 to 3 had a longer median OS and EFS (104 months, 64 months) than those with i5PS of 4 to 5 (19 months, 11 months; P &lt; .001). Four-year OS and EFS for patients with i5PS of 1 to 3 and PIT of 1 or less were 85% and 62%, respectively. However, 4-year OS and EFS for those with i5PS of 4 to 5 and PIT higher than 1 were both 0% (P &lt; .001). In multivariate analysis, after controlling for IPI and PIT, i5PS was independently prognostic for EFS (HR, 3.400 95% confidence interval, 1.750-6.750; P &lt; .001) and OS (HR, 10.243; 95% confidence interval, 4.052-25.891; P &lt; .001). In conjunction with clinical parameters, iPET helps risk stratify patients with PTCL and could inform risk-adapted treatment strategies. Prospective studies are needed to confirm these findings.

Allogeneic Stem Cell Transplantation (alloSCT) and Donor Lymphocyte Infusion (DLI) In Patients with Non-Hodgkin Lymphoma (NHL) Who Experienced Relapse or Progression After Autologous Stem Cell Transplantation (autoSCT): Retrospective Analysis From the Korean Society of Blood and Marrow Transplantation

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3536-3536 ◽  
Author(s):  
Ji-Won Kim ◽  
Byung-Su Kim ◽  
Soo-Mee Bang ◽  
Inho Kim ◽  
Dong Hwan Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Stem Cell ◽  
Serum Albumin ◽  
Cell Lymphoma ◽  
Univariate Analysis ◽  
Stage Iv ◽  
Grade 3 ◽  
Ecog Ps ◽  
Significant Factors

Abstract Abstract 3536 Prognosis of patients with NHL who underwent relapse or progression after autoSCT is generally dismal and treatment option is limited. AlloSCT has been performed to overcome this problem and long term survivors have been reported. However, substantial transplant-related mortality (TRM) is a significant problem. We report clinical outcomes of alloSCT in these patients and DLI after failure of alloSCT along with analysis of risk factors for treatment results and adverse events. This retrospective study was performed in 7 hospitals in Korea. Candidate risk factors were age, sex, histology, Ann Arbor stage at diagnosis, number of prior treatments, time to progression (TTP) after autoSCT, bone marrow involvement, Eastern Cooperative Oncology Group (ECOG) performance status (PS), donor type, stem cell source, conditioning regimens of alloSCT, serum lactate dehydrogenase (above 250 IU/L), serum albumin (above 3.0 g/dL), and acute graft-versus-host disease (aGvHD). Between August 1998 and March 2009, 38 patients received alloSCT. Median age was 37 (range, 17–54) years. Male to female ratio was 26:12. Eighteen patients (47.4%) had B-cell lymphoma and 20 patients (52.6%), T/NK-cell lymphoma. Before alloSCT, patients had received median 4 (range, 2–7) prior treatments including autoSCT. Median TTP after autoSCT was 5.9 (range, 0.8–35.8) months. Twenty four patients (63.2%) received stem cells from related donors and 14 patients (36.8%) from unrelated donors. Median number of CD34+ cells infused was 5.41 × 106 (range, 0.86 × 106-16.60 × 106) /kg. Eighteen patients (47.4%) underwent a myeloablative conditioning and 20 patients (52.6%), a reduced intensity conditioning. During a median follow-up of 45.2 (range, 1.3–137.1) months, 24 patients (63.2%) experienced treatment failure and 22 patients (57.9%) died. Median event-free survival (EFS) was 6.3 (95% confidence interval (CI), 4.3–8.4) months. Median overall survival (OS) was 19.0 (95% CI, 3.8–34.2) months. Estimated 5-year survival rate was 35.0% (Figure). Treatment response was evaluable in 30 patients. Response rate was 73.3%; complete remission (CR) was achieved in 20 patients (66.7%) and partial response in 2 patients (6.7%). Grade 3 or 4 renal toxicity developed in 6 patients (15.8%), grade 3 or 4 hepatic toxicity in 15 patients (39.5%) including veno-occlusive disease (VOD) in 6 patients (15.8%), aGvHD in 13 patients (34.2%), and neutropenic fever in 34 patients (89.5%) including documented sepsis in 11 patients (28.9%). TRM was reported in 8 patients (21.1%). Causes of TRM were infection in 7 patients and VOD in 1 patient. In univariate analysis, no significant association was found with treatment response. By contrast, EFS was related to stage (p=0.039), TTP after autoSCT (p=0.033), and PS (p<0.001). OS was associated with stage (p=0.037), number of prior treatments (p=0.049), TTP after autoSCT (p=0.032), PS (p<0.001), and serum albumin (p=0.016). On the other hand, aGvHD was not associated with EFS (p=0.545) and OS (p=0.476). Multivariate analysis demonstrated that stage IV (hazard ratio (HR) 2.85 (95% CI, 1.13–7.22); p=0.027) and ECOG PS 2 (HR 3.94 (95% CI, 2.08–7.47); p<0.001) were significant factors for EFS and that stage IV (HR 3.28 (95% CI, 1.19–9.04); p=0.022), ECOG PS 2 (HR 5.26 (95% CI, 2.22–12.48); p<0.001), and serum albumin above 3.0 g/dL (HR 0.15 (95% CI, 0.03–0.63); p=0.010) were significant factors for OS. TRM was associated with PS (p=0.010) and serum albumin (p=0.040) by univariate analysis. Multivariate analysis showed that ECOG PS 2 was the only significant factor for TRM (relative risk (RR) 11.77 (95% CI, 1.43–97.01); p=0.022). ECOG PS 2 was also a significant factor for documented sepsis (RR 7.14 (95% CI, 1.08–47.42); p=0.042). DLI was performed in 8 patients who failed alloSCT. After median 1.5 (range, 1–6) cycles of DLI, 2 patients achieved CR. Grade III or IV aGvHD developed in these patients. By contrast, among 6 patients who failed to achieve CR, aGvHD developed in 2 patients. In conclusion, alloSCT is a viable option for patients with NHL who failed autoSCT despite high TRM. Stage and PS were significant factors for EFS and OS. Serum albumin was a significant factor for OS. In patients with ECOG PS 2, alloSCT should be avoided and novel treatment approaches should be offered due to high risk of TRM. DLI after failure of alloSCT showed promising results, which supports the presence of graft-versus-lymphoma effect. Disclosures: No relevant conflicts of interest to declare.

Nuclear Area Predicts Outcome In Peripheral T-Cell Lymphoma, Not Otherwise Specified: Morphometric Image and Immunohistochemical Analyses of 78 Patients

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 5081-5081
Author(s):  
Daisuke Niino ◽  
Yoshizo Kimura ◽  
Junichi Kiyasu ◽  
Masanori Takeuchi ◽  
Tadashi Yoshino ◽  
...  
Keyword(s):  
Overall Survival ◽  
Image Analysis ◽  
Multivariate Analysis ◽  
Prognostic Factor ◽  
Cell Lymphoma ◽  
Nuclear Area ◽  
Lymphoma Cells ◽  
Peripheral T Cell Lymphoma ◽  
Not Otherwise Specified ◽  
Cytological Features

Abstract Abstract 5081 Background: Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) is an uncommon tumor with unfavorable prognosis. The purpose of this retrospective study was to investigate the cytological features and treatment outcomes in patients with PTCL-NOS and to obtain new information on the therapeutic implications of PTCL-NOS. Method: A total of 6 institutions in Japan and Asia submitted clinical and pathologic information on PTCL-NOS diagnosed and treated at their respective centers. Among these cases, 55 (71%) were from Japan, 8 (10%) were from Hong Kong, 8 (10%) were from Thailand, and 7 (9%) were from Korea. From 1992 to 2006, 78 cases of PTCL-NOS were examined for cytological features, focusing on morphometric image analysis. The average nuclear area of lymphoma cells, as well as the median, the minimum, the maximum and the standard deviation, was estimated in 50 cells for each case. In addition, we performed an immunohistochemical study of CCR4 expression in all cases. Univariate analyses were performed using Kaplan-Meier survival estimates, and data were compared using the log-rank test. Cox proportional-hazard regression test was used for multivariate analysis. P-values of less than 0.05 were considered significant. Results: Clinical information was available for review in 78 cases. There was a 1.52:1 male/female ratio, and median age was 62 years (range, 3 to 87 years). Sixty-two percent of patients had advanced clinical stages. Lactic dehydrogenase (LDH) was elevated in 53% of cases, and most patients were treated with combination chemotherapy. Median survival was 693 days. On the morphometric image analysis, median nuclear area was 41.7 μ m2 (range, 22 to 119 μ m2). Thirty-three of the cases (42%) showed positive CCR4 immunostaining. Statistical analysis confirmed that nuclear area of lymphoma cells in PTCL-NOS is correlated with overall survival, whereas immunohistochemical expression of CCR4 is not correlated with overall survival or nuclear area of lymphoma cells. Multivariate analysis confirmed that the nuclear area of lymphoma cells in PTCL-NOS is an independent prognostic factor. Conclusion: These results indicate that nuclear area of lymphoma cells in PTCL-NOS is an independent prognostic factor that may predict overall survival. Because PTCL-NOS is a heterogeneous disease with regard to histological type and pathological state, nuclear area of lymphoma cells could be used to stratify patients with PTCL-NOS for therapies, although we are continuing to accumulate data. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Peripheral T-cell lymphoma, not otherwise specified: a report of 340 cases from the International Peripheral T-cell Lymphoma Project

Blood ◽  
2011 ◽  
Vol 117 (12) ◽  
pp. 3402-3408 ◽  
Author(s):  
Dennis D. Weisenburger ◽  
Kerry J. Savage ◽  
Nancy Lee Harris ◽  
Randy D. Gascoyne ◽  
Elaine S. Jaffe ◽  
...  
Keyword(s):  
Overall Survival ◽  
T Cell ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
T Cell Lymphoma ◽  
Peripheral T Cell Lymphoma ◽  
Bulky Disease ◽  
Free Survival ◽  
Not Otherwise Specified ◽  
Pathologic Features

Abstract The International Peripheral T-cell Lymphoma Project is a collaborative effort to better understand peripheral T-cell lymphoma (PTCL). A total of 22 institutions submitted clinical and pathologic material on 1314 cases. One objective was to analyze the clinical and pathologic features of 340 cases of PTCL, not otherwise specified. The median age of the patients was 60 years, and the majority (69%) presented with advanced stage disease. Most patients (87%) presented with nodal disease, but extranodal disease was present in 62%. The 5-year overall survival was 32%, and the 5-year failure-free survival was only 20%. The majority of patients (80%) were treated with combination chemotherapy that included an anthracycline, but there was no survival advantage. The International Prognostic Index (IPI) was predictive of both overall survival and failure-free survival (P < .001). Multivariate analysis of clinical and pathologic prognostic factors, respectively, when controlling for the IPI, identified bulky disease (≥ 10 cm), thrombocytopenia (< 150 × 109/L), and a high number of transformed tumor cells (> 70%) as adverse predictors of survival, but only the latter was significant in final analysis. Thus, the IPI and a single pathologic feature could be used to stratify patients with PTCL-not otherwise specified for novel and risk-adapted therapies.

Serum Albumin and Peripheral Blood Neutrophils at Diagnosis May Provide Additional Prognostic Information in Primary Nodal Diffuse Large-B-Cell Lymphoma Patients Treated with R-CHOP

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5304-5304
Author(s):  
Branimir Spassov ◽  
Donka Vassileva ◽  
Georgi Mihaylov ◽  
Gueorgui Balatzenko ◽  
Margarita Guenova
Keyword(s):  
Multivariate Analysis ◽  
Cell Lymphoma ◽  
Univariate Analysis ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Risk Groups ◽  
Prognostic Impact ◽  
Prognostic Information ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Background and Aim: Diffuse large B-cell lymphoma (DLBCL) can present both as a primary nodal or extranodal neoplasm. Some studies claimed a separate origin for nodal and extranodal lymphomas and it has been even suggested that these could be regarded as separate nosological entities. However, the standard of care in DLBCL patients (pts) is rituximab-CHOP immunochemotherapy (R-CHOP), and the prognostic stratification is performed by the Enhanced Revised International Prognostic Index (NCCN-IPI), identifying 4 distinct [low (L), low-intermediate (LI), high-intermediate (HI) and high (H)] risk groups (RGs). A lot of new prognostic markers such as serum albumin (SA), serum β2-microglobulin (B2M), hemoglobin level (Hb), absolute neutrophil (ANC), lymphocyte (ALC), monocyte (AMC) and platelet counts etc. have been introduced into the clinical practice to perform better pts' stratification. However, data on the importance of these factors particularly in primary nodal (PN) DLBCL pts are still limited. Therefore, we aimed to access the prognostic impact of these markers regarding overallsurvival (OS) across the different NCCN-IPI RG of R-CHOP treated PN-DLBCL pts. Patients and Methods: We retrospectively reviewed the clinical outcome of 174 R-CHOP treated PN-DLBCL pts at a median age 58.4 years. Pts were stratified using NCCN-IPI into L (24.1%), LI (43.1%), HI (24.7%) and H (8.1%) RGs. Laboratory levels of SA, B2M, Hb, ANC, ALC, AMC and PC were recorded, and LMR and NLR - calculated. A receiver operating characteristic (ROC) curve analysis was used to illustrate in our data set the best cut off values of SA, B2M, Hb, ANC, ALC, AMC, PC, LMR and NLR to predict OS by Kaplan-Meier method. Univariate analysis to evaluate differences between variables was performed by the log rank. A multivariate analysis was performed by Cox proportional-hazards models. Results: The estimated 5-year OS was 79.4%, 51.5%, 20.1% and 16.2% for NCCN-IPI L, LI, HI and H-risk pts, respectively (p<0.001). Univariate analysis showed that inferior OS was associated significantly with decreased SA (≤39.4 g/L), elevated B2M (>3.2 mg/L), elevated ANC (>5.19 x 109), reduced ALC (≤1.38 x 109), elevated AMC (>0.515 x 109), decreased LMR (≤1.77), increased NLR (>2.97), lower Hb level (≤134 g/L), presented as dichotomized variables. Multivariate analysis confirmed the independent prognostic impact only for SA (p<0.001) and ANC (p=0.011). Based on the dichotomized SA and ANC values a SA/ANC prognostic index (PI) was created stratifying pts into 3 RG: favorable (F) [SA >39.4 g/L and ANC ≤5.19 x 109], intermediate (I) [SA ≤39.4 g/L or ANC >5.19 x 109] and poor (P) - risk [SA ≤39.4 g/L and ANC ≤5.19 x 109] populations. The estimated 5-year OS differed significantly in SA/ANC PI RG, as follows: 92.8% in F-RG, 48.4% in I-RG, and 0% in P-RG (p<0.001). Median OS for I- and P- SA/ANC PI RG was 2.54 and 1.13 years, respectively and not reached for the F-risk pts. We sought to determine whether the SA/ANC PI may provide additional prognostic information within the NCCN-IPI RG. No statistics could be calculated within the L-RG due to the low number of deaths - 9.5% (4/42), and in the H-RG due to the low number of patients (n=14), respectively. However, within the LI-RG the SA/ANC PI allowed us to discriminate 3 subgroups, characterized by significant differences in the OS (p<0.001): no patient within the P-RG was alive at 5years and the median OS was only 1.13 years; while 5-years OS was 77% and 87.7% in the I-RG and F-RG, respectively, and the median was not reached in both RG. Similarly, within the NCCN-IPI HI-RG the application of SA/ANC PI allowed us to discriminate 3 subgroups, characterized by significant differences in OS: no patient within the P-RG was alive at 5 years and the median OS was 1.29 years; while 5-years OS was 30.6% (median OS - 1.66 yrs) in the I-RG and 100% (median OS not reached) in the F-RG. The introduction of the SA/ANC PI allowed for defining favorable subgroups within the IPI LI- and HI RGs with 5-yrs OS comparable to IPI L-RG. Conclusion: The present study provided evidence for the independent prognostic significance ofSA and ANC in regard to survival in patients with PN-DLBCL. Adding these variables to prognostic models such as the NCCN-IPI score might improve the predictive ability, particularly within the NCCN-IPI LI and HI risk groups, where the introduction of SA/LMR PI allowed for identifying favorable subgroups comparable to the NCCN-IPI L-RG in terms of OS. Disclosures No relevant conflicts of interest to declare.

scholarly journals TARC before ASCT Is Highly Predictive of Outcome in Patients with Relapsed or Refractory (R/R) Classical Hodgkin Lymphoma (cHL) after First-Line Therapy

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3009-3009 ◽  
Author(s):  
Simonetta Viviani ◽  
Francesco Spina ◽  
Arabella Mazzocchi ◽  
Maria Galbiati ◽  
Flavio Crippa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Conflicts Of Interest ◽  
Cox Model ◽  
Univariate Analysis ◽  
Salvage Chemotherapy ◽  
New Drugs ◽  
Rank Test ◽  
High Dose ◽  
Bulky Disease

Abstract Background: Second-line salvage chemotherapy(CT) followed by high-dose (HD) CT and autologous stem cells reinfusion (ASCT) is standard treatment forR/R HL patients, although long-term cure can be achieved in only half of them, depending on risk factors. Chemosensitivity to salvage CT before ASCT, mainly represented by a negative PET scan, is highly predictive of a favorable outcome. The availability of new markers of prognosis, like the measurement of the serum chemokineTARC, could help identifying those patients who may require further treatment, i.e. new drugs like Brentuximab Vedotin or Nivolumab or Pembrolizumab, before ASCT, in order to achieve a durable remission.Therefore we planned to prospectively evaluate the prognostic role of serum TARC levels collected at different time points in cHL R/R patients. Methods: Serum TARC levels were measured by commercially available ELISA test kits (R & D Systems, Minneapolis, USA) in 41 patients treated with IGEV (ifosfamide, gemcitabine, vinorelbine, prednisone) salvage CT, followed by myeloablative B(F)EAM (carmustine, (fotemustine), etoposide, cytosine arabinoside, melphalan) + ASCT at Istituto Nazionale Tumori of Milan, Italy, from January 2007 to December 2013. The 99th centile of TARC distribution in a group of 156 independent healthy subjects corresponding to 800 pg/mL, was considered as cut-off value discriminating between normal and abnormal TARC values. TARC evaluation was performed before starting salvage CT(T0), after the first IGEV cycle (T1) and before ASCT (T-preASCT). The Wilcoxon Mann Whitney test was used to analyze TARC as a function of patient and disease characteristics and PET results. Kaplan-Meyer curves and log-rank test were used to assess differences in PFS according to TARC levels. Cox model was used for multivariate analysis. Results: Main patient characteristics at relapse/progression were as follows: males/females: 19/22, median age: 31 years (range,19-69), B symptoms: 34%, bulky disease: 27%, stage III/IV: 39%, extra nodal involvement: 34%, refractory vs relapsed < 12 months vs relapsed ≥ 12 months: 49% vs 34% vs 17%. Median (IQ range) T0, T1 and T-preASCT were: 1856 (8801-9983) pg/mL, 1148 (544-2532) pg/mL and 829 (454-1725) pg/mL, respectively. Patients with bulky disease had higher median T0 than their counterpart (3241 vs 1462 pg/mL; p=.016). Median T-preASCT was significantly higher in patients with refractory disease compared to relapse < or ≥ 12 months (1100 vs 595, vs 548 pg/mL, p=.027). A positive PET was recorded in 57.5% of patients after 2 IGEV cycles and in 32% before ASCT. Forty-one percent of patients needed ≥ 2 salvage CT before ASCT and 63% had ≥ 2 risk factors. At each time point, median TARC values were significantly higher in PET-2 positive patients compared to their counterpart (T0: 3238 vs 1310; T1: 1866 vs 624; T-preASCT: 908 vs 544; pg/mL). Median (IQ range)T-preASCT levels were significantly higher in patients with a positive PET before ASCT:1091 (596-10578) pg/mL compared to those with a negative one: 651 (447-964) pg/mL. After a median follow-up of 65 months, 5-year PFS and OS (95% CI) were 70 (57-88)% and 84 (72-98)%, respectively. In univariate analysis T-preASCT > 2000 pg/mL, PET-2, PET-preASCT, ≥ 2 risk factors and ≥ 2 salvage CT lines significantly affected PFS. In multivariate analysis only T-preASCT > 2000 pg/mL was significantly associated with a poor PFS (HR 6.65, CI95% 1.12-39.35, p=0.036) as shown in Figure 1. Conclusions: Results of this single institution prospective study suggest that a cheap and easy to perform test, like serum TARC levels measurement before ASCT, may help to ameliorate the identification of those patients at risk of failing ASCT, for whom anticipated use of new active drugs, like anti-CD30 immunoconjugates and/or anti-PD1 blockers, should be explored, in order to improve the cure rate of ASCT. Figure 1 PFS according to TARC levels Figure 1. PFS according to TARC levels Disclosures No relevant conflicts of interest to declare.

Primary T-Cell Lymphoma of The Testis Presenting In A Young Adult

2020 ◽  
Vol 2020 ◽  
Author(s):  
MOUNIA BENDARI ◽  
Wafaa Matrane ◽  
Maryam Qachouh ◽  
Asmaa Quessar ◽  
Nisrine Khoubila
Keyword(s):  
T Cell ◽  
Cell Lymphoma ◽  
Clinical Stage ◽  
T Cell Lymphoma ◽  
Second Line ◽  
Peripheral T Cell Lymphoma ◽  
Not Otherwise Specified ◽  
Ann Arbor ◽  
Prophylactic Chemotherapy ◽  
Line Chemotherapy

We report the case of a 40-year-old male presented with a painless right testicular swelling. Right radical orchidectomy was performed. The pathological diagnosis was peripheral T-Cell lymphoma-not otherwise specified (PTCL-NOS). According to Ann Arbor staging, the initial clinical stage was IEa. Treating him with four courses of the CHOEP protocol and intrathecal prophylactic chemotherapy was unsuccessful; with the appearance of orbital infiltration and a loco-regional extension. Although the patient started a second line chemotherapy, he unfortunately succumbed to death.

scholarly journals Fusion transcripts FYN-TRAF3IP2 and KHDRBS1-LCK hijack T cell receptor signaling in peripheral T-cell lymphoma, not otherwise specified

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Koen Debackere ◽  
Lukas Marcelis ◽  
Sofie Demeyer ◽  
Marlies Vanden Bempt ◽  
Nicole Mentens ◽  
...  
Keyword(s):  
T Cell ◽  
T Cell Receptor ◽  
Cell Lymphoma ◽  
Ex Vivo ◽  
Cell Receptor ◽  
T Cell Lymphoma ◽  
Peripheral T Cell Lymphoma ◽  
Fusion Transcripts ◽  
Not Otherwise Specified

AbstractPeripheral T-cell lymphoma (PTCL) is a heterogeneous group of non-Hodgkin lymphomas with poor prognosis. Up to 30% of PTCL lack distinctive features and are classified as PTCL, not otherwise specified (PTCL-NOS). To further improve our understanding of the genetic landscape and biology of PTCL-NOS, we perform RNA-sequencing of 18 cases and validate results in an independent cohort of 37 PTCL cases. We identify FYN-TRAF3IP2, KHDRBS1-LCK and SIN3A-FOXO1 as new in-frame fusion transcripts, with FYN-TRAF3IP2 as a recurrent fusion detected in 8 of 55 cases. Using ex vivo and in vivo experiments, we demonstrate that FYN-TRAF3IP2 and KHDRBS1-LCK activate signaling pathways downstream of the T cell receptor (TCR) complex and confer therapeutic vulnerability to clinically available drugs.

scholarly journals Risk Factor Analysis for Infection after Medial Open Wedge High Tibial Osteotomy

2021 ◽  
Vol 10 (8) ◽  
pp. 1727
Author(s):  
Ta-Wei Liu ◽  
Chih-Hao Chiu ◽  
Alvin Chao-Yu Chen ◽  
Shih-Sheng Chang ◽  
Yi-Sheng Chan
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Multivariate Analysis ◽  
High Tibial Osteotomy ◽  
Univariate Analysis ◽  
Arthroscopic Surgery ◽  
Underlying Disease ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Wedge High Tibial Osteotomy

Background: Medial open wedge high tibial osteotomy (MOWHTO) is a well-established treatment for osteoarthritis of the medial tibiofemoral compartment. Surgical site infection (SSI) after MOWHTO is a devastating complication that may require further surgery. In this study, we aimed to identify the risk factors for infection after MOWHTO over 1 to 4 years of follow-up. Methods: Fifty-nine patients who underwent MOWHTO combined with knee arthroscopic surgery were included in this prospective study. Artificial bone grafts were used in all cases. Possible risk factors, including sex, age, body mass index (BMI), underlying disease, hospitalization length, correction angle, and surgery time, were recorded. Both univariate and multivariate analysis were used. Results: A total of 59 patients who underwent 61 operations were included. Eleven patients (18.0%) were reported to have SSI. Univariate analysis showed that smoking and diabetes mellitus were positively associated with SSI. Multivariate analysis showed that smoking and age were positively associated with SSI. Three patients (4.9%) were reported to suffer from deep SSI, requiring surgical debridement, all of whom were male smokers. Conclusion: Smoking, diabetes mellitus, and old age were identified to be possible risk factors of SSI after MOWHTO. These findings are common risk factors of SSI after orthopedic surgery according to the literature. Patient selection should be performed cautiously, and postoperative prognosis for MOWHTO should be carefully explained to patients who smoke.

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