Prognostic Value of 18F-FDG Positron Emission Tomography Used for Assessment of the First Line Therapy in 410 Diffuse Large B-Cell Lymphoma Patients: A Daily Practice Evaluation Before and After the Prescription of This Metabolic Imaging Technique,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3686-3686
Author(s):  
Herve Ghesquieres ◽  
Céline Ferlay ◽  
Emilie Lavergne ◽  
Emmanuelle Nicolas Virelizier ◽  
Izabela-Irina Domnisoru ◽  
...  
Keyword(s):  
Induction Therapy ◽  
B Cell Lymphoma ◽  
Daily Practice ◽  
First Line ◽  
Interim Pet ◽  
First Line Therapy ◽  
Line Therapy ◽  
Positron Emission ◽  
End Of Treatment ◽  
Initial Staging

Abstract Abstract 3686 Background: 18F-FDG Positron Emission Tomography (PET) had improved initial staging and response assessment after first line therapy of Diffuse Large B-cell Lymphoma (DLBCL). While the prognostic role of PET after induction therapy (interim PET) remains controversial, the outcome of patients with positive PET at the end of initial treatment is clearly worse as compared with negative ones. In clinical practice, many PET are performed before, during and after first line therapy for patients with DLBCL. A hypothetical effect of therapeutic decisions, guided by PET results, on DLBCL patients' outcome remained questionable. We evaluated our daily practice about PET prescription during first line therapy to explore how a complete PET could influence the DLBCL prognosis. Patients and Methods: From 1996 to 2008, 410 patients with DLBCL received first-line therapy in our institution. No selection was made on initial therapeutic intent (curative/palliative), medical history, patient's age or initial type of chemotherapy (CT) to be in accordance with daily practice setting. Study population was described and Overall Survival (OS) and Time To Progression (TTP) analysis was performed using the Kaplan Meier method. OS and TTP were compared between patients with or without PET, using the Log-Rank test. We first focused on interim PET considering patients who performed at least 3 months of the induction therapy (n=380). PET at the end of treatment were studied on patients who achieved a major part of their consolidation treatment (at least 6 months, n=354). As it was a practical study, the PET interpretation methods were not taken into account. Results: Median age at diagnosis was 65 years (range: 19–97). Most patients received CHOP-like CT (53%) or high-dose CHOP CT (31%). Rituximab was associated to CT for 269 patients (66%). PET was performed at initial staging, after induction therapy and at the end of initial treatment respectively on 77, 72 and 94 patients. We first observed that patients who had a pre-treatment PET presented a significantly higher rate of III-IV Ann Arbor stage than patients evaluated by conventional methods (71% vs. 57%, p =.021). Patients who had an interim PET were younger (median age: 55 vs. 67 years, p <.001), presented a higher age-adjusted IPI score (2–3, 66% vs. 47%, p =.004) and were more frequently treated by rituximab (96% vs. 61%, p <.001) than patients who did not have a PET, that is in accordance with the date of approval of rituximab for DLBCL in 2002. The same observation was done for patients who had a PET at the end of the treatment. No difference in TTP was observed between patients who had an interim PET and patients evaluated by conventional methods (p =.543), with 5-year TTP rates of 65.6% (CI95% [51.0–76.8]) and 70.3% (CI95% [64.5–75.3]) respectively. Similarly, no difference in OS was observed between these groups. Neither OS nor TTP were found to be statistically different between patients evaluated at the end of treatment with a 5-year TTP rates of 72.4% (CI95% [61.5–80.7]) for patients who performed a TEP at the end of the treatment and 73.8% (CI95% [67.6–78.9]) (p =.653) for the others. Preliminary results showed a worse prognosis for patients who had a positive PET at completion of first line therapy with a 5-year OS rate of 50.0% (CI95% [22.9–72.2]) compared with 84.4% (CI95% [70.4–92.1]) for patients with negative PET (p =. 001). However, no observe a prognostic value of positivity of interim PET performed at mid-treatment was observed. Conclusions: Results of this retrospective clinical practice study are consistent with the usefulness of PET for initial staging of DLBCL patients and a poor prognosis of positive PET at the end of first line therapy. Using PET for evaluation of treatment response after induction therapy or after treatment completion was not found to be significantly associated with patient's prognosis. Modification of therapeutic decision based on PET results need to be more accurately explored with a prospective clinical trial. Disclosures: No relevant conflicts of interest to declare.

Influence of Baseline Positron Emission Tomography in Metastatic Gastroesophageal Cancer on Survival and Response to Therapy

Oncology ◽  
2021 ◽  
pp. 1-6
Author(s):  
Ahmed Abdelhakeem ◽  
Madhavi Patnana ◽  
Xuemei Wang ◽  
Jane E. Rogers ◽  
Mariela Blum Murphy ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Response To Therapy ◽  
Emission Tomography ◽  
Gastroesophageal Cancer ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Positron Emission ◽  
Pet Ct ◽  
Metastatic Burden

<b><i>Background:</i></b> The value of baseline fluorodeoxyglucose-positron emission tomography-computed tomography (PET-CT) remains uncertain once gastroesophageal cancer is metastatic. We hypothesized that assessment of detailed PET-CT parameters (maximum standardized uptake value [SUVmax] and/or total lesion glycolysis [TLG]), and the extent of metastatic burden could aid prediction of probability of response or prognosticate. <b><i>Methods:</i></b> We retrospectively analyzed treatment-naive patients with stage 4 gastroesophageal cancer (December 2002–August 2017) who had initial PET-CT for cancer staging at MD Anderson Cancer Center. SUVmax and TLG were compared with treatment outcomes for the full cohort and subgroups based on metastatic burden (≤2 or &#x3e;2 metastatic sites). <b><i>Results:</i></b> We identified 129 patients with metastatic gastroesophageal cancer who underwent PET-CT before first-line therapy. The median follow-up time was 61 months. The median overall survival (OS) was 18.5 months; the first progression-free survival (PFS) was 5.5 months. SUVmax or TLG of the primary tumor or of all metastases combined had no influence on OS or PFS, whether the number of metastases was ≤2 or &#x3e;2. Overall response rates (ORRs) to first-line therapy were 48% and 45% for patients with ≤2 and &#x3e;2 metastases, respectively (nonsignificant). ORR did not differ based on low or high values of SUVmax or TLG. <b><i>Conclusions:</i></b> This is the first assessment of a unique set of PET-CT data and its association with outcomes in metastatic gastroesophageal cancer. In our large cohort of patients, detailed analyses of PET-CT (by SUVmax and/or TLG) did not discriminate any parameters examined. Thus, baseline PET-CT in untreated metastatic gastroesophageal cancer patients has limited or no utility.

scholarly journals Cytotoxic Chemotherapy as First-Line Therapy for Advanced Non-Small-Cell Lung Cancer in Taiwan: Daily Practice

2016 ◽  
Vol 7 (11) ◽  
pp. 1515-1523 ◽  
Author(s):  
Yi-Hsin Liang ◽  
Yu-Yun Shao ◽  
Bin-Chi Liao ◽  
Ho-Sheng Lee ◽  
James Chih-Hsin Yang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Daily Practice ◽  
Cytotoxic Chemotherapy ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy

scholarly journals Valproate in combination with rituximab and CHOP as first-line therapy in diffuse large B-cell lymphoma (VALFRID)

2018 ◽  
Vol 2 (12) ◽  
pp. 1386-1392 ◽  
Author(s):  
Kristina Drott ◽  
Hans Hagberg ◽  
Karin Papworth ◽  
Thomas Relander ◽  
Mats Jerkeman
Keyword(s):  
Histone Deacetylase Inhibitor ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
First Line ◽  
First Line Therapy ◽  
Large B Cell Lymphoma ◽  
Promising Strategy ◽  
Line Therapy ◽  
Deacetylase Inhibitor ◽  
Key Points

Key Points This trial evaluates addition of the histone deacetylase inhibitor valproate to standard R-CHOP therapy in DLBCL. Addition of valproate to R-CHOP is a promising strategy in DLBCL, but auditory side effects warrant monitoring.

Efficacy of Mitoxantrone and Etoposide in Patients with Acute Myeloid Leukemia Refractory to Initial Standard Induction Therapy.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4385-4385 ◽  
Author(s):  
Rajesh Sehgal ◽  
Wassim McHayleh ◽  
James Natale ◽  
Anastasios Raptis ◽  
Mounzer Agha ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Induction Therapy ◽  
Myeloid Leukemia ◽  
Infectious Complications ◽  
High Dose ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Grade 3 ◽  
Acute Myeloid

Abstract The most effective reinduction regimen for acute myeloid leukemia (AML) patients who do not achieve complete remission (CR) after one cycle of cytarabine combined with an anthracycline is not well established. In an effort to search for new synergistic and non-cross resistant antileukemic regimens different chemotherapeutic combinations have been investigated in refractory AML patients. Multiple regimens including high dose cytarabine, anthracyclines, fludarabine and etoposide have been used with CR rates up to 40%. Mitoxantrone and etoposide have activity in AML as induction agents but their role in reinduction in patients not responding to first line therapy has not been fully established. In the current retrospective study we evaluated the efficacy and toxicity of mitoxantrone and etoposide in AML patients treated at our institution who did not respond to first induction therapy with cytarabine and an anthracycline. A total of fifty seven AML patients were treated with mitoxantrone and etoposide (mean age 55 years, range 18–75 years). Twenty four patients were treated with mitoxantrone 10 mg/m2/d and etoposide 100 mg/m2/d both administered intravenously, days 1 to 5 (regimen 5+5) and thirty three patients were treated with mitoxantrone 10 mg/m2/d administered intravenously days 1 to 3 and etoposide 100 mg/m2/d administered intravenously, days 1 to 5 (regimen 3+5). Twenty six of fifty seven patients (46%) achieved CR. CR was achieved in 38% of patients (9/24) treated with the 5+5 regimen and 52% of patients (17/33) treated with the 3+5 regimen. Mean blast percentage before treatment with mitoxantrone and etoposide was 25% in patients who achieved CR vs 40% in patients who did not achieve CR (p < 0.03). Grade 3/4 hepatic toxicities were seen in 5% (3/57) of patients and there were no grade 3 or 4 renal toxicities. The median duration of neutropenia in patients achieving CR was 29 days after reinduction. 10% (6/57) of the patients died from infectious complications. Cytogenetic analyses were performed prior to first-line therapy in all patients. Patients with favorable cytogenetics treated with etoposide and mitoxantorne had 100% CR (3/3), patients with standard cytogenetics had 58% CR (19/33) and patients with unfavorable cytogenetics had 19% CR (4/21). Overall CR was achieved in 61% (22/36) of patients with favorable and standard cytogenetics. Our data suggest that the combination of etoposide and mitoxantorne is an active and well tolerated regimen, especially in patients with favorable and standard cytogenetics, and warrants further studies in prospective trials.

CPOP-R Versus CHOP-R As First-Line Therapy for Diffuse Large B-Cell Lymphoma (DLBCL): A Phase 2, Randomized, Open-Label, Multicenter Study

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1605-1605
Author(s):  
Raoul Herbrecht ◽  
David MacDonald ◽  
Florian Weissinger ◽  
Martin Wilhelm ◽  
Charles Holladay ◽  
...  
Keyword(s):  
B Cell ◽  
Troponin T ◽  
Survival Rates ◽  
B Cell Lymphoma ◽  
Comparable Efficacy ◽  
High Survival ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Grade 3

Abstract Abstract 1605 Introduction: CHOP-R is standard therapy for patients with untreated DLBCL. Pixantrone dimaleate (P) is a novel aza-anthracenedione that, unlike doxorubicin (D), forms stable DNA adducts and has enhanced efficacy compared to D in preclinical lymphoma models. Due to its inability to bind iron or form alcohol metabolites, P has substantially less cardiotoxicity than D or mitoxantrone in preclinical studies. In a Phase I-II study in 65 patients with relapsed aggressive B cell NHL after CHOP (±R), patients treated with CPOP (P replaced D in CHOP) had CR/CRu rate of 52% and an overall response rate (ORR) of 77% with median progression-free survival (PFS) of 8.2 months and overall survival (OS) of 17.9 months (Leuk Lymph 2011;52: 620–8). The present Phase II study evaluated efficacy and safety, particularly cardiotoxicity, of CPOP-R vs CHOP-R as first-line therapy in patients with DLBCL. Patients and Methods: Patients with untreated DLBCL (CD20+, stage II-IV disease) were randomized to CPOP-R or CHOP-R (1: 1). CHOP-R was administered at standard doses; in CPOP-R, P (150 mg/m2) was substituted for D. After 4 cycles, patients with a partial response (PR) received 4 more cycles of treatment; those with CR received 2 more cycles. Follow-up after treatment was 36 months. Response was assessed by an independent assessment panel. A primary objective to evaluate non-inferiority of CPOP-R to CHOP-R, measured by CR/CRu rates, required 280 patients. Secondary endpoints included ORR, PFS, OS, and time to progression (TTP) and safety. Enrollment was stopped after 124 patients because of resource constraints; the study was no longer powered to detect non-inferiority. Results: Of the 124 patients enrolled, 61 were randomized to CPOP-R and 63 to CHOP-R. Treatments were administered to 122 patients (98%). Demographics and baseline disease characteristics were balanced between arms. Median age was 68 years in both arms, 79% of patients in CPOP-R vs 78% in CHOP-R were Ann Arbor stage 3–4, 48% vs 54% had IPI ≥3, and 20% vs 11% had ≥3 comorbid conditions. Median number of cycles delivered was 8 for CPOP-R vs 6 for CHOP-R. CR/CRu rate in the ITT population was 72.1% for CPOP-R vs 79.4% for CHOP-R (95% CI for the difference = −7.8%, 22.3%) and ORR (CR+CRu+PR) was 82.0% vs 87.3%. PFS appeared similar for CPOP-R and CHOP-R (HR=1.08). TTP was also similar (median not reached in either arm). Median OS was not reached in either arm (HR=2.34, 95% CI=1.05, 5.22, P =.032). The 3-year survival rates were 66% in CPOP-R vs 85% in CHOP-R. Three-year survival for patients with IPI ≤2 was 82% for CPOP-R vs 86% for CHOP-R; IPI ≥3, survival was 50% vs 84%. It was unusual that in the CHOP-R arm, patients with the modal IPI score=3 (n=25) had a better survival than patients with IPI ≤2 with only 8% mortality at 3 years. This historically high survival rate for CHOP-R patients with IPI=3 appeared responsible for the disparate survival rates between CPOP-R and CHOP-R. Eight patients in CPOP-R and 2 in CHOP-R had a history of coronary artery disease, congestive heart failure (CHF), or myocardial infarction. Overall, adverse events (AEs) were similar between arms; grade 3/4 AEs occurred in about 85% of patients in both arms. Incidence of grade 3/4 AEs was similar for neutropenia (61.0% vs 60.3%), febrile neutropenia (15.3% vs 15.9%), thrombocytopenia (5.1% vs 6.3%), and infections (16.9% vs 17.5%). Stomatitis was less common in CPOP-R (6.8% vs 17.5%). LVEF was measured prospectively at intervals through 24 months. LVEF values were generally stable in CPOP-R, but declined significantly from baseline in CHOP-R (P <.05). One patient in CPOP-R vs 8 in CHOP-R had LVEF declines ≥20% (P<.05). In CPOP-R, 6.7% of patients vs 35.2% in CHOP-R developed elevated troponin T levels (P<.05). No patients in CPOP-R vs 4 in CHOP-R developed CHF. Three deaths occurred within 30 days of last dose in CPOP-R vs none in CHOP-R. Most deaths after treatment in both arms were related to progressive disease. Conclusions: This study compared CPOP-R, a pixantrone-containing regimen, with CHOP-R as first-line therapy for DLBCL and showed comparable efficacy as measured by response, PFS, and TTP. Hematopoietic toxicities were similar; however, CPOP-R had reduced cardiotoxicity as determined by overall and serious declines in LVEF, elevations in troponin T, and CHF occurrence. Non-inferiority of CPOP-R to CHOP-R could not be established. Disclosures: Herbrecht: Cell Therapeutics, Inc: Consultancy, Membership on an entity's Board of Directors or advisory committees. Cernohous:Cell Therapeutics, Inc: Employment. Singer:Cell Therapeutics, Inc: Employment. van der Jagt:Cell Therapeutics, Inc: Consultancy, Research Funding.

Differences in Cell of Origin (COO) Affect Outcomes in Caucasian(C) but Not in African American(AA) Patients with Diffuse Large B-Cell Lymphoma(DLBCL)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1460-1460 ◽  
Author(s):  
Uma Borate ◽  
Deniz Peker ◽  
James M. Foran ◽  
Luciano J Costa
Keyword(s):  
B Cell ◽  
B Cell Lymphoma ◽  
Disease Stage ◽  
Rank Test ◽  
Advanced Stage ◽  
Cell Of Origin ◽  
First Line ◽  
First Line Therapy ◽  
Log Rank Test ◽  
Line Therapy

Abstract Introduction: DLBCL is an aggressive mature B-cell neoplasm with a low incidence in African Americans and other minority groups. The differences in outcomes based on DLBCL Cell of Origin(COO) immunophenotypic subtypes as defined by the Hans algorithm using CD10, Bcl-6, and MUM1 namely germinal center B-cell (GCB) and non-GCB have been based on predominantly Caucasian patients (pts) and their impact on outcomes in AA patients have not been well studied. Material and Methods: A retrospective review of clinicopathologic data from patients diagnosed and treated for DLBCL at UAB between 2002-2011 was conducted following IRB approval .The data collected included patient demographics (age, sex, self identified race), DLBCL subtype (GCB vs. non-GCB based on the Hans algorithm), disease stage, first line therapy regimens and patient outcomes. We analyzed group differences in both C and AA pts with GCB and non-GCB subtypes of DLBCL in all the parameters mentioned above using the chi square test for categorical variables,. In addition, OS was examined using Kaplan Meier curves and the log rank test. We performed univariate and multivariate analyses to examine the effects of variables of interest on OS. All results were considered statistically significant at α=0.05 level. Results: We included a total of 259 pts in our analysis after excluding patients with missing demographics, disease related data, primary mediastianal DLBCL, missing first line therapy data and outcomes data as well as race identified as other than C or AA. 45 patients (17.4%) of patients self identified as AA and 214 (82.6%) self identified as Caucasian. The mean age of presentation for AA pts was 52 yrs compared to 58 years for C patients (p=0.045) and 28 (62.2%) AA patients presented with advanced Stage III and IV disease compared to 89 (44.6%) of C patients (P=0.04) both being statistically significant. Based on COO characterization using immunophenotype by Hans algorithm, 27 AA pts (60%) and 145(67%) of C pts were GCB by immunophenotype(p=0.317). 95% of all patients received R-CHOP as first line therapy , 3.5% received R-CVP and the remaining received a combination of Rituximab alone, FCR or radiation therapy .On analyzing OS based on COO, AA patients did not demonstrate a significant difference in OS based on COO with both GCB and non-GCB groups having a median OS of 84 months ( p=0.74)( 95% CI 72-121 months). However, the median OS for C pts with GCB phenotype was 104 months compared to 25 months for the non-GCB phenotype and the median OS was 55 months +/-12.6 months for the C pt group as a whole( p<0.001 by log rank test )which was highly statistically significant.Multivariate analyses of different factors affecting OS showed only COO (p<0.001), age(p=0.07) and stage of DLBCL at presentation(p=0.027) to affect OS significantly.Race,Gender and IPI score did not appear to impact OS significantly. Conclusion: Our study aimed to study the impact of COO and Race on OS in DLBCL especially in AA pts where this has not been well characterized. Our results show that as expected the incidence of DLBCL is lower in AA patients compared to C pts. However, DLBCL presents at younger age and with more advanced stage in AA than in C patients. Although distribution of COO is similar in AA and C patients, our findings suggest that COO may not have the same effect on prognosis among AA pts as it does among the C pt population where we see non-GCB patients do significantly worse than their GCB counterparts. This may reflect a different disease biology in AA patients that has yet to be understood. Our study limitations include not taking into account disease relapse, second line therapy and effect of autologous bone marrow transplantation on overall survival. Figure 1. Figure 1. Figure 2. Figure 2. Figure 3. Figure 3. Disclosures No relevant conflicts of interest to declare.

Risk-adapted maintenance therapy (MaintRx) after ASCT in first-line therapy for multiple myeloma (MM).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 8607-8607
Author(s):  
Jonathan L. Kaufman ◽  
Joanne Willey ◽  
Michael E. Williams ◽  
Brynn Tiscione ◽  
Arden Buettner ◽  
...  
Keyword(s):  
Induction Therapy ◽  
Plasma Cells ◽  
Autologous Stem Cell Transplant ◽  
Phase Iii ◽  
Cell Transplant ◽  
First Line ◽  
Case Scenario ◽  
First Line Therapy ◽  
Line Therapy ◽  
Best Response

8607 Background: Maintenance lenalidomide improves survival in patients who have undergone induction therapy and then autologous stem cell transplant (ASCT) as first line management for MM. We studied how the extent of cytoreduction after induction therapy à ASCT (as measured by CR, VGPR, or PR as best response) influences MAINTRX prescribing preferences among American Hematology-Oncology physicians (AHOP). Methods: We studied 284 individual AHOPs using a proprietary, live, case-based market research tool to assess prescribing preferences. A core case scenario and variations based on extent of response to induction à ASCT was constructed. Preference data were acquired using blinded audience response technology. All responses for each scenario were obtained contemporaneously prior to any display of respondent selections. All sources of research support were double blinded. The core scenario involved a 59-year-old patient (42% plasma cells in BM, no cytogenetic abnormalities, CrCl 65ml/min, B2M 5.8, PS 1) treated with induction therapy of choice à ASCT. The same query was then posed in each of 3 settings: Following CR (or following VGPR or following PR) as best response, what, if any, further therapy would you recommend now? Results: See Table. Conclusions: Among patients with myeloma getting first-line therapy, MaintRx is almost uniformly preferred by AHOPs. Specific single or doublet therapy preferences are dependent upon best response to induction à ASCT treatment. Compared to the CR setting, preferences for 2 drug MaintRx are significantly increased in patients with VGPR (p <.0.001) or with PR (p < 0.001)] as best overall response. The potential for benefit from intensified MaintRx in these response subsets needs prospective phase III testing. [Table: see text]

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