Final Results of a Multicenter Phase II Trial Assessing the Activity and Efficacy of Helicobacter Pylori-Eradicating Antibiotic Therapy As Exclusive Treatment for Patients with Stage I-II1 Diffuse Large B-Cell Lymphoma of the Stomach (the HGL-1 Trial)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 958-958 ◽  
Author(s):  
Silvia Govi ◽  
Caterina Patti ◽  
Markus Raderer ◽  
Alessandro Andriani ◽  
Daniele Caracciolo ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
B Cell ◽  
De Novo ◽  
Phase Ii Trial ◽  
Objective Response ◽  
B Cell Lymphoma ◽  
Stage I ◽  
Experimental Therapy

Abstract Abstract 958 BACKGROUND: Helicobacter pylori (Hp) infection is associated with the pathogenesis of marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT)-type of the stomach, and Hp-eradicating antibiotic therapy is the standard treatment for this lymphoma, with complete remission rates of 60–80%. Hp is also detected in 35% of diffuse large B-cell lymphomas (DLBCL) of the stomach, being more common in cases with concomitant MALT areas with respect to de novo cases (65% vs. 15%). However, the role of Hp-eradicating antibiotic therapy in gastric DLBCL remains to be elucidated, since only rare and small, monoinstitutional retrospective studies are available. Herein, we report the final results of a multicentre phase II trial, the first one in Western countries, addressing the role of Hp-eradicating therapy as exclusive treatment in patients with gastric DLBCL. AIMS: To assess feasibility, activity and efficacy of Hp-eradicating therapy as exclusive treatment for limited-stage DLBCL of the stomach. METHODS: Inclusion criteria were histopathologic diagnosis of DLBCL, with or without concomitant MALT-type areas; Hp-infection assessed by multiple gastric biopsies and/or breath test; stage I-II1 of disease according to Musshoff staging system; perigastric lymph nodes diameter <1.5 cm; normal lactate dehydrogenase (LDH) serum level; age ≥18 years old; ECOG-Performance Status <3; absence of HIV-infection or history of previous cancer; absence of bleeding lesions (hemoglobin >9 g/dl). Registered patients received clarithromycin 500 mg bid, tinidazole 500 mg bid and omeprazole 20 mg bid, orally, for 7 consecutive days. Objective response and bacterial eradication were assessed at 30 and 60 days from antibiotics by gastric endoscopy-ultrasonography, biopsies and breath test. Patients who did not achieve Hp eradication received a second-line antibiotic therapy according to local guidelines. Eradicated patients who achieved complete lymphoma remission (CR) were referred to follow-up; patients with partial response (PR) received rituximab as complementary therapy; patients with stable (SD) or progressive (PD) disease received conventional treatment (R-CHOP ± radiotherapy). RESULTS: From 2003 to 2010, 16 patients (median age 70; range 38–87; 11 males) were enrolled. Eleven patients had de novo DLBCL, while 5 patients presented concomitant MALT areas. Ten patients had stage II1 disease, 5 had stage IE. Five patients presented anemia; two patients had concomitant HCV infection. None presented systemic symptoms. Eradicating therapy was completed in all patients with excellent tolerability. Eradication was documented at one month in 15 patients and after second-line antibiotic-therapy in the remainder patient. Lymphoma regression was complete in 8 (50%) patients and partial in 3 (ORR= 69%; 95% CI= 47%–91%). Two of the three PRs achieved CR after rituximab, with a CRR after experimental therapy of 63% (95% CI= 39%–87%). Objective response was not associated with stage or concomitant MALT areas. At a median follow-up of 53 months, 9 of the 10 patients who achieved CR after experimental therapy remain relapse-free, the remainder experienced relapse at 10 months, with a median DFS of 68+ months. Treatment failure was observed in 7 patients: 5 patients with SD/PD after antibiotics, one patient in PR who did not receive rituximab and the single patient with relapsing disease; they were referred to conventional chemoradiation treatment, achieving CR in all cases, and none of them experienced relapse after 13–128 months (median 41+). No patient died of lymphoma; two patients died of cardiac failure and gallbladder cancer, respectively; the remaining 14 patients are alive (13 disease-free), with a 5-yr OS of 94%. CONCLUSIONS: Patients with stage I-II1 Hp-associated DLBCL of the stomach can be safely managed with antibiotics alone. Half of treated patients will achieve long-term remission without chemotherapy, a critical issue considering that two-thirds of patients are >65 years old. Importantly, unresponsive patients can be safely salvaged with conventional treatment. Registered cases of Hp-associated DLBCL of the stomach will be characterized under pathologic and molecular perspectives to identify parameters useful to distinguish the best candidates for eradicating therapy. Disclosures: No relevant conflicts of interest to declare.

Chlamydia Psittaci-Eradicating Antibiotic Therapy as a Potential Therapeutic Strategy Against Marginal Zone B-Cell Lymphoma of the Ocular Adnexa.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3274-3274 ◽  
Author(s):  
Andres J. Ferreri ◽  
Maurilio Ponzoni ◽  
Massimo Guidoboni ◽  
Antonia A. Lettini ◽  
Laura Caggiari ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
B Cell ◽  
Marginal Zone ◽  
Mononuclear Cells ◽  
Cell Lymphoma ◽  
Objective Response ◽  
B Cell Lymphoma ◽  
Chlamydia Psittaci ◽  
Ocular Adnexa

Abstract Background: Chlamydia psittaci (Ch.ps.) DNA has been detected in tumor tissue of 80% of patients with ocular adnexal lymphoma (OAL) and in peripheral blood mononuclear cells (PBMCs) of 40% of them [Ferreri AJM, et al. J Natl Cancer Inst 96:586, 2004]. Chronic antigenic stimulation provided by Ch.ps. persistent infection may favor the development and sustaining of OAL. Removal of this stimulation with antibiotic therapy could result in lymphoma regression. Aim: To assess the rate of Ch.ps. eradication and anti-lymphoma activity of antibiotic therapy in OAL patients. Methods: Twelve patients with Ch.ps.-positive marginal zone B-cell lymphoma of the ocular adnexa, at diagnosis (n=5) or relapse, were treated with doxycycline 100 mg, bid orally, for three weeks. The presence of Ch.ps. DNA in lymphoma samples was assessed by multiplex touchdown PCR. Specificity of the amplified PCR fragments was confirmed by direct sequencing of both sense and anti-sense strands. The presence of Ch.ps. DNA in PBMCs collected before and one and 12 months after antibiotic therapy was evaluated in 11 cases. Six of these patients had Ch.ps.-positive PBMCs and were assessable for bacterial eradication rate. Nine patients had measurable disease at the time of therapy and were evaluable for objective response; a lymphomatous lesion of ocular adnexa was detected in all 9 evaluable patients: unilateral in three, bilateral in three, associated with regional lymphadenopathies in two, and with multiple subcutaneous nodules in one. Objective response was assessed one, three and six months after therapy conclusion and every six months during follow-up. Observation period after doxycycline ranged from 1 to 29 months (median 25). Results: All patients but one completed antibiotic therapy, with excellent tolerability. At one month from doxycycline assumption, Ch.ps. DNA was no longer detectable in PBMC of the six positive patients; these results were confirmed at one year of fw-up in all the three assessable cases. Objective response was complete in two patients (26+ and 9+ months), partial in two (29+ and 6+ m.) and lower than 50% in two (3+ and 5+ m.), whereas one patient had stable disease at one month of fw-up. Two patients experienced progression and received salvage treatment. Importantly, two patients showed lymphoma regression in previously irradiated orbit, and the two patients with regional lymphadenopathies achieved complete response; doxycycline was the 4th-line treatment in one of them. Time to the best response ranged from 3 to 24 months. All patients are alive and well (median fw-up: 54 m.). Conclusions: Ch.ps.-eradicating antibiotic therapy is followed by tumor regression in OAL patients, even after multiple relapses. Estimation of response rate requires a longer follow-up. A large phase II trial is warranted to confirm whether this fast, cheap and well-tolerated therapy may be a valid alternative to conventional, more aggressive strategies against OAL.

Population Outcomes Of Primary Mediastinal Large B-Cell Lymphoma In The Rituximab Era

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1743-1743
Author(s):  
Karen Ortiz Cruz ◽  
Luciano J. Costa
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Puget Sound ◽  
B Cell Lymphoma ◽  
Population Level ◽  
Stage I ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Background Primary Mediastinal Large B-cell Lymphoma (PMLBCL) is a rare entity corresponding to approximately 10% of all diffuse large B-cell lymphomas (DLBCL), but molecular and clinically distinct. In the pre rituximab (R) era, cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) chemotherapy, produced inferior results compared to more intense chemotherapy regimens, but improved outcomes were seen with the addition of consolidative radiotherapy (RT). Since the availability of R, there has been a substantial improvement in outcomes, but optimal upfront management, including the role of RT remains undefined. It is unknown if the favorable outcome seen in case series and clinical trials are achievable at the population level. Therefore, we performed a retrospective analysis of a large cohort of non-selected PMBCL patients diagnosed in the pos R era to assess the long-term outcomes and the possible impact of use of RT. Methods We utilized the National Cancer Institute's Surveillance Epidemiology and End Results (SEER-18) program to identify cases of PMLBCL (International Classification of Diseases-Oncology, Third Edition, ICD-O-3 code 9679/3) diagnosed as first malignant neoplasm. The SEER-18 register includes Atlanta, Connecticut, Detroit, Hawaii, Iowa, New Mexico, San Francisco-Oakland, Seattle-Puget Sound, Utah, Los Angeles, San Jose-Monterey, Rural Georgia, Alaska Native Tumor Registry, Greater California, Kentucky, Louisiana, New Jersey and Greater Georgia. We included all cases reported from 2001 to 2010 and follow up was current up to the end of 2012. Characteristics surveyed included age, sex, stage, race, use of RT, duration of follow up and vital status. Results We identified a total of 315 cases of PMBCL. Nine cases were subsequently excluded due to absence of stage information, resulting in 306 patients for analysis with median follow up was 29.5 months (IQR 14.2-60.7). Median age at diagnosis was 36 years (IQR 27-44.7), 183 patients (59.8%) were female, 241 (78.8%) were white and 235 patients (76.8%) had stage I or stage II disease. Overall 3-year survival was 86.4 % (95% C.I. 80.7%-92.1%) for stages I/ II and 71.7% (95% C.I. 57.9% - 85.6%) for stages III/ IV, P=0.002 (Figure, panel a).Of the 298 patients with RT information available, 159 patients (53.3%) received RT as part of their treatment. Among patients with stage I/II disease 122 of the 210 (58%) with information available received RT. There was a trend for higher utilization of RT among male patients with stage I/II disease (65% vs. 54%, P=0.1). There was no significant difference between RT and non-RT patients in terms of age, year of diagnosis and race. Overall 3-year survival was 90.6% (95% C.I. 84.3%-96.9%) for stages I/II patients treated with RT and 83.4 % (95% C.I. 73.1%-93.7%) for the patients who did not receive radiation (Figure, panel b, P=0.2). When adjusted for age, year of diagnosis, race and sex, there was no association between RT and mortality in patients with stage I/II disease. Conclusion The high cure rates of PMBCL reported in the R era are reproducible at the population level. We found no evidence that with contemporary systemic treatment the addition of RT produces a positive impact on survival. Prospective trials are necessary to assess the best systemic therapy for PMBCL in the R era and to reevaluate the role of RT in this disease. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Real-World Outcome of Dose-Adjusted EPOCH-R, a Single-Centre Experience

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 27-28
Author(s):  
Rachel Wong ◽  
Roopesh R. Kansara
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Time Interval ◽  
Cns Involvement ◽  
Free Survival ◽  
Aggressive B Cell Lymphoma

Introduction Dose adjusted (DA) EPOCH-R is an intensive outpatient infusional regimen, that incorporates intrathecal (IT) methotrexate to treat patients with aggressive B-cell lymphoma including HIV associated aggressive B-cell lymphoma, double-hit lymphoma (DHL), primary mediastinal B-cell lymphoma (PMBCL), Burkitt's lymphoma (BL) ineligible for intensive therapy, and gray zone lymphoma (GZL) with features in between BL and diffuse large B-cell lymphoma (DLBCL). We aimed to evaluate non-trial, progression-free survival (PFS) and overall survival (OS) of Manitoba patients treated with DA-EPOCH-R, assess the role of prophylactic IT chemotherapy and toxicities. Methods Patients in MB approved to receive DA-EPOCH-R were identified through the CCMB Provincial Oncology Drug Program (PODP) database. Patients were included if they were older than 17 years, received at least 1 cycle of DA-EPOCH-R and with a diagnosis of HIV associated aggressive B-cell lymphoma, DHL, PMBCL, BL ineligible for more aggressive therapy, or GZL. All other diagnoses were excluded. Baseline demographic data, treatment characteristics, treatment responses, and treatment toxicity were collected. The primary endpoints of the study were progression free survival (PFS) and overall survival (OS). PFS was the time interval between the date of diagnosis to date of progression, last follow-up, or death from any cause. OS was the time interval between date of diagnosis to date of death by any cause, or last follow-up. The study was approved by the University of Manitoba Research Ethics Board and the CancerCare Manitoba Research Resource Impact Committee. Results A total of 40 patients were approved for DA-EPOCH-R between 2013 and 2019. 10 of these patients were excluded. 4 patients never received the therapy, 4 patients were treated in the relapsed setting, and 2 patients had histologies outside the inclusion criteria. Of the 30 patients included, 19 (63%) were male, 11 (37%) were female. The median age at diagnosis was 55 years (range 20-88). Our cohort was composed of DHL (n=9), triple hit lymphoma (THL, n=5), BL (n=4), GZL (n=3), and HIV-associated DLBCL (n=2). 87% (n=26) had advanced stage disease. By revised-IPI, 19 (63.3%) had poor prognosis (R-IPI ≥ 3). Response rate was 90%; CR 53.3% (n=16) and PR 37% (n=11). At a median follow-up of 25.3 months, the median PFS was 33.3 months and median OS was not reached. By histological subtype, median PFS was not reached in DHL, however THL, BL and PMBCL had worse median PFS (6.1, 8.4, and 5.6 months, respectively). Only 1 patient had CNS involvement at time of diagnosis. Of the patients with no documented CNS disease at presentation (n=29), none developed CNS involvement, including those who did not receive IT methotrexate. Median chemotherapy cycles per patient was 6 (range 1-6) and median IT treatment was 3 (range 0-6). 3 patients did not receive IT prophylaxis, and 2 stopped after 1 cycle due to intolerance. 56.7% (n=17) were able to undergo dose escalation beyond dose level 1, and 40% (n=T12) tolerated maximum dose level 3 or higher.77% of patients (n=23) experienced at least one adverse event of grade 3 or higher. 17 (57%) patients required blood transfusion at least once. 10 (33%) experienced neuropathy, 4 requiring vincristine dose reduction. 9 (30%) patients had febrile neutropenia complicating a total of 22 treatment cycles. 8 patients had grade 2-3 infectious complications. Conclusions While the real-world survival data for patients with DHL and HIV-associated lymphoma treated with DA-EPOCH-R are encouraging, those with THL, BL, and PMBCL did not attain durable response. Considering no patients (including those who did not receive IT chemotherapy) experienced CNS relapse, the role of IT chemotherapy needs to be further clarified. Disclosures No relevant conflicts of interest to declare.

scholarly journals Impact of Interim FDG-PET (iPET) in the Outcomes of Patients with Aggressive B-Cell Lymphomas Receiving DA-EPOCH-R

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2898-2898
Author(s):  
Vania Phuoc ◽  
Leidy Isenalumhe ◽  
Hayder Saeed ◽  
Celeste Bello ◽  
Bijal Shah ◽  
...  
Keyword(s):  
B Cell ◽  
Board Of Directors ◽  
Fdg Pet ◽  
Research Funding ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Advisory Committees ◽  
End Of Treatment

Introduction: 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) remains the standard of care for baseline and end of treatment scans for aggressive non-Hodgkin lymphomas (NHLs). However, the role of interim FDG-PET remains not as well defined across aggressive NHLs, especially in the era of high-intensity chemoimmunotherapy. Interim FDG-PET (iPET) can serve as an early prognostic tool, and prior studies evaluating the utility of iPET-guided treatment strategies primarily focused on diffuse large B-cell lymphomas (DLBCL) and frontline R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Classification criteria systems assessing response also differ between studies with no clear consensus between use of Deauville criteria (DC), International Harmonization Project (IHP), and the ΔSUVmax method. Methods: This study evaluates our institutional experience with iPET during treatment with DA-EPOCH ± R (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin with or without Rituximab) in aggressive NHLs. We retrospectively evaluated 70 patients at Moffitt Cancer Center who started on DA-EPOCH ± R between 1/1/2014 to 12/31/2018 for aggressive NHLs. Response on interim and end-of-treatment (EOT) scans were graded per DC, IHP, and ΔSUVmax methods, and progression free survival (PFS) probability estimates were calculated with chi-square testing and Kaplan Meier method. PFS outcomes were compared between interim negative and positive scans based on each scoring method. Outcomes were also compared between groups based on interim versus EOT positive or negative scans. Results: We identified 70 patients with aggressive NHLs who received DA-EPOCH ± R at our institute. The most common diagnoses were DLBCL (61%) followed by Burkitt's lymphoma (10%), primary mediastinal B-cell lymphoma (9%), plasmablastic lymphoma (7%), gray zone lymphoma (6%), primary cutaneous large B-cell lymphoma (1%), primary effusion lymphoma (1%), and other high-grade NHL not otherwise specified (3%). Of the 43 patients with DLBCL, 21/43 (49%) had double hit lymphoma (DHL) while 7/43 (16%) had triple hit lymphoma (THL), and 3/43 (7%) had MYC-rearranged DLBCL while 2/43 (5%) had double expressor DLBCL. Thirty nine out of 70 (56%) were female, and median age at diagnosis was 58.39 years (range 22.99 - 86.86 years). Most patients had stage IV disease (49/70, 70%), and 43/70 (61%) had more than one extranodal site while 45/70 (64%) had IPI score ≥ 3. Forty-six out of 70 (66%) received central nervous system prophylaxis, most with intrathecal chemotherapy (44/70, 63%). Fifty-five out of 70 (79%) had iPET available while 6/70 (9%) had interim computerized tomography (CT) scans. Fifty-six out of 70 (80%) had EOT PET, and 4/70 (6%) had EOT CT scans. Sustained complete remission occurred in 46/70 (66%) after frontline DA-EPOCH ± R (CR1), and 12/70 (17%) were primary refractory while 5/70 (7%) had relapse after CR1. Four of 70 (6%) died before cycle 3, and 3/70 (4%) did not have long-term follow-up due to transition of care elsewhere. Median follow-up was 15.29 months (range 0.85 - 60.09 months). There was significantly better PFS observed if iPET showed DC 1-3 compared to DC 4-5 (Χ2=5.707, p=0.0169), and PFS was better if iPET was negative by IHP criteria (Χ2=4.254, p=0.0392) or ΔSUVmax method (Χ2=6.411, p=0.0113). Comparing iPET to EOT PET, there was significantly better PFS if iPET was negative with EOT PET negative (iPET-/EOT-) compared to iPET positive with EOT negative (iPET+/EOT-), and iPET+/EOT+ and iPET-/EOT+ had worse PFS after iPET-/EOT- and iPET+/EOT- respectively. This pattern in iPET/EOT PFS probability remained consistent when comparing DC (Χ2=30.041, p<0.0001), IHP (Χ2=49.078, p<0.0001), and ΔSUVmax method (Χ2=9.126, p=0.0104). These findings fit clinical expectations with positive EOT scans indicating primary refractory disease. There was no significant difference in PFS when comparing DLBCL versus non-DLBCL (Χ2=3.461, p=0.0628) or DHL/THL versus non-DHL/THL diagnoses (Χ2=2.850, p=0.0914). Conclusion: Our findings indicate a prognostic role of iPET during treatment with DA-EPOCH ± R for aggressive NHLs. Significant differences in PFS were seen when graded by DC, IHP, and ΔSUVmax methods used in prior studies and when comparing interim versus EOT response. Larger studies are needed to confirm these findings. Disclosures Bello: Celgene: Speakers Bureau. Shah:Novartis: Honoraria; AstraZeneca: Honoraria; Spectrum/Astrotech: Honoraria; Adaptive Biotechnologies: Honoraria; Pharmacyclics: Honoraria; Jazz Pharmaceuticals: Research Funding; Incyte: Research Funding; Kite/Gilead: Honoraria; Celgene/Juno: Honoraria. Sokol:EUSA: Consultancy. Chavez:Janssen Pharmaceuticals, Inc.: Speakers Bureau; Genentech: Speakers Bureau; Kite Pharmaceuticals, Inc.: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees.

Addition of Rituximab (R) to CHOP Improves Survival in the Non-GCB Subtype of Diffuse Large B Cell Lymphoma (DLBCL).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 816-816 ◽  
Author(s):  
Pedro Farinha ◽  
Laurie Sehn ◽  
Brian Skinnider ◽  
Joseph M. Connors ◽  
Randy D. Gascoyne
Keyword(s):  
Overall Survival ◽  
B Cell ◽  
De Novo ◽  
Univariate Analysis ◽  
B Cell Lymphoma ◽  
Cell Of Origin ◽  
Chop Chemotherapy ◽  
Entire Study ◽  
Survival Difference

Abstract Background: The cell of origin (COO) distinction provides a prognostic and biologically relevant subclassification of DLBCL. Germinal center B cell (GCB) and non-GCB subtypes were originally characterized by gene expression studies and subsequently validated at the protein level by Hans et al., Blood 193: 275–82 (2004). The addition of R to CHOP chemotherapy has been shown to improve the outcome of patients with DLBCL. The underlying mechanism(s) responsible for this effect is largely unknown. However, it is known that R may preferentially prevent chemotherapy failure in DLBCLs that express Bcl-2 protein or fail to express Bcl-6 (Mounier et al., Blood101: 4279–84 2003, Winter et al., Blood107: 4207–13 2006). Bcl-2 over-expression and absence of Bcl-6 is more common in the non-GCB subtype. Thus, R may benefit mostly non-GCB lymphomas. To test this hypothesis we assessed the clinical impact of CHOP-R vs CHOP in DLBCL distinguished by COO subtypes. Method: We identified 163 patients with DLBCL treated with either CHOP or CHOP-R with available paraffin blocks and interpretable immuno-staining. All were de novo DLBCL cases diagnosed between 1999 and 2002 at the BCCA. The two treatment cohorts represent consecutive eras of therapy (Sehn et al., JCO2005; 23: 5027–33), and thus the median follow-up of living patients was 5.1 and 4.0 y for CHOP and CHOP-R, respectively. HIV+ patients or those with active secondary malignancies were excluded. Tissue microarrays (TMA) were built using duplicate 0.6mm cores from paraffin embedded formalin fixed (FFPE) tissues and stained with antibodies against CD10, Bcl-6, MUM1, and Bcl-2. The COO distinction was determined using the method of Hans. Results: Patients were treated with either CHOP (81) or CHOP-R (82). Their clinical characteristics, including the IPI, were evenly matched. The median follow-up of living patients was 4.4 y. The IPI was predictive of overall survival (OS) (p&lt;0.0001) for the entire study population. Six cases had uninterpretable immunostains resulting in 74 cases with a GCB phenotype and 83 with a non-GCB phenotype (n = 157). Overall, 71% and 75% of the cases over-expressed Bcl-2 and Bcl-6, respectively. Bcl-2 protein was expressed in 70% GCB cases and 73% non-GCB (p= 0.72). Bcl-6 was expressed in 96% GCB cases and 63% non-GCB cases (p&lt;0.0001). In univariate analysis, the addition of R was associated with a better prognosis in the non-GCB cases (p=0.02), but not in the GCB cases (p=0.3). This survival difference was not solely explained by either Bcl-2 or Bcl-6 expression. The addition of R to CHOP chemotherapy and IPI were independent predictors of OS in non-GCB DLBCL (p=0.02; p=0.016, respectively). The addition of R was also of prognostic importance in the lymphomas over-expressing Bcl-2 (p=0.0081). Conclusion: Immuno-chemotherapy using CHOP-R is associated with better OS in DLBCL, due largely to its effect on the non-GCB subgroup. Although Bcl-2 expression does not contribute to the determination of COO distinctions, the OS of Bcl-2-positive DLBCL patients is significantly improved by the addition of R. These results provide insight into the possible mechanisms by which R exerts its beneficial therapeutic effect. Overall Survival for 157 DLBCL Based on Cell of Origin Overall Survival for 157 DLBCL Based on Cell of Origin

Array-CGH Identifies Regions, Including the FOXP1 Locus, Associated with Different Clinical Outcome in Diffuse Large B-Cell Lymphomas (DLBCL) Treated with R-CHOP

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 478-478
Author(s):  
Marta Scandurra ◽  
Paola M.V. Rancoita ◽  
Timothy C. Greiner ◽  
Wing C. Chan ◽  
Julie M. Vose ◽  
...  
Keyword(s):  
Complete Remission ◽  
B Cell ◽  
De Novo ◽  
B Cell Lymphoma ◽  
Response To Therapy ◽  
Poor Responders ◽  
Score Distribution ◽  
Genomic Aberrations ◽  
Large B Cell

Abstract Background. Diffuse large B-cell lymphoma (DLBCL) consists of a heterogeneous group of tumors. More than 30% of cases are not cured with R-CHOP chemotherapy. Aim. To identify genomic aberrations that could affect the response to therapy, we performed an arrayCGH study on uniformly treated DLBCL patients. Materials and Methods. Tumor samples were analyzed with Affymetrix Human Mapping 250K SNP arrays. Eligibility criteria were diagnosis of de novo DLBCL, first line treatment with R-CHOP or R-CHOP-like regimens, availability of frozen biopsy and of clinical baseline and follow-up data. Exclusion criteria were: primary mediastinal DLBCL, primary central nervous system DLBCL, HIV-positivity. Material has been collected according to the local IRB guidelines. Results. Genomic tumor profiles have been obtained in 163 samples from 10 Institutions; 23/163 cases were excluded from this analysis because the information on response was not available; 140/163 cases fulfilled the study requirements. The clinical parameters of the patients reflected the normal DLBLC population, as shown by the IPI score distribution (0–1 in 30%, 2 in 37%, 3 in 23% and 4–5 in 10%). The median follow-up was 23 months (range 1–1251). Complete remission was observed in 108/140 (77%) patients, partial response in 21 (15%), stable disease in 6 (4%) and progression in 5 (2%). Genomic differences were observed between complete responders (108 cases) and the remaining patients, grouped together as poor responders (32 cases). The latter group had more gains of 3p14.1 (FOXP1 locus), 3q29, 11q24.3, and losses of 2p11.2-p13.3, 8p23.1- pter, 10p12.31-p13, 15q11.2-q14, 15q21.1 and copy neutral LOH of chromosome 9p. On the converse, 1q gains were more common among patients achieving complete remission. No differences were observed for other common region of gains (7, 12, 18q/BCL2) or losses (1p, 6q, 17p/TP53). Conclusions. Specific genomic aberrations are associated with the response to R-CHOP in patients with DLBCL. In particular, the gain of the 3p14.1 (FOXP1 locus), which is associated with a lack of response to R-CHOP, suggests that the role of FOXP1 should be further investigated in DLBCL.

Outcomes of Nodular Lymphocyte Predominant Hodgkin's Lymphoma (NLPHL) Patients Treated with R-CHOP.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2812-2812 ◽  
Author(s):  
Michelle A. Fanale ◽  
Chao-Ming Lai ◽  
Peter McLaughlin ◽  
Jorge Romaguera ◽  
Luis Fayad ◽  
...  
Keyword(s):  
B Cell ◽  
Research Funding ◽  
Hodgkin’S Lymphoma ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Stage I ◽  
Hodgkin's Lymphoma ◽  
Stage Iii ◽  
Field Radiation

Abstract Abstract 2812 Introduction: Nodular lymphocyte predominant Hodgkin's lymphoma (NLPHL) constitutes 5% of Hodgkin's lymphoma (HL) diagnoses. Recently gene expression profiling has shown significant overlap between NLPHL, T-cell-rich B cell lymphoma (TCRBCL), and classical HL (Brune, V et al, J Exp Med, 2008). NLPHL patients also have an approximate 7% risk of transformation at 10 years to diffuse large B-cell lymphoma (DLBCL) and TCRBCL (Al-Mansour, M et al, JCO, 2010). Data from multiple groups (Nogova, L et al, Ann Onc, 2005, Chen, RC et al, JCO, 2010, Wirth, A et al, Cancer, 2005) support extended progression-free survivals (PFS) for stage IA/IIA patients treated with radiation alone. While chemotherapy is generally recommended for patients with stage IB/IIB or III/IV disease, there is lack of guidelines on whether classical HL-directed regimens, such as ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine), or B-cell lymphoma-directed regimens, such as R-CHOP (rituximab, cychlophosphamide, doxorubicin, vincristine, prednisone) should be used. Given the similarities between NLPHL and indolent CD20+ B-cell non-Hodgkin's lymphoma (NHL), our group started using the R-CHOP regimen for patients with NLPHL requiring systemic therapy. In order to examine the potential efficacy of this approach, we conducted a retrospective analysis of treatment outcomes in patients who received R-CHOP versus other regimens treated at UT MDACC from 1995 to 2010. Results: 83 patients were referred. 6 patients were found to have NLPHL with transformation to DLBCL or TCRBCL. 3 had alternative diagnoses. 11 lacked full immunophenotyping to confirm diagnosis. 63 patients had confirmed diagnoses of NLPHL (39 stage I/II and 24 stage III/IV). 52 NLPHL patients were evaluable (10 did not complete full treatment planning or were lost to follow-up and 1 is currently completing therapy). 7 patients had extranodal disease (thyroid, breast, lung, liver, bone marrow/cortex) and 8 had spleen involvement. Overall their median age at diagnosis was 40, male:female ratio was 2.5, and median follow-up is 46 months (range 8–149 months). 6 patients had relapse of NLPHL, 2 patients had transformation at a median of 39 months (1 to DLBCL, 1 to TCRBCL), 4 patients died (1 from acute myelogenous leukemia with deletion 7, 1 from DLBCL, 2 from unrelated causes while in remission), and 2 patients underwent autologous stem cell transplant (1 for relapsed NLPHL in 3rd complete remission and 1 for transformation to TCRBCL). Therapies for stage I/II NLPHL included: surgical excision alone (2 patients with stage IA disease declined radiation treatment), subtotal nodal irradiation (STNI), mantle field radiation, involved field radiation (IFRT), rituximab (R) alone and plus IFRT, ABVD plus STNI, R-ABVD, COPP (cyclophosphamide, vincristine, procarbazine, prednisone) plus IFRT, and R-CHOP alone and plus IFRT. Therapies for stage III/IV included: mantle field radiation (1 patient who declined chemotherapy), NOVP (mitoxantrone, vincristine, vinblastine, prednisone) plus mantle field radiation, ABVD, R-ABVD, R-CHOP alone and plus IFRT. A total of 15 patients received R-CHOP alone (4 stage I/II, 11 stage III/IV) and 5 patients received R-CHOP plus IFRT (4 stage I/II, 1 stage III/IV). Response to R-CHOP as assessed by CT scan criteria was 100% overall response rate (ORR) with 90% complete remissions (CR). No R-CHOP patients have had relapses or transformation with a median follow-up of 42 months (range 8–111 months). One patient treated with R-CHOP died of unrelated causes while in remission. However, with other therapies 19% have relapsed after median remissions of 38 months (range 4 to 72 months). R-CHOP when compared to other treatments has a trend towards improved PFS (Figures 1, 2, and 3). Survival rates for NLPHL patients at 5 years with 95% confidence intervals are: R-CHOP: PFS 0.95 (0.86, 1), OS (overall survival) 0.95 (0.86, 1) and other therapies: PFS 0.71 (0.55, 0.92), OS 0.91 (0.8, 1). Conclusions: Our data demonstrates that RCHOP is an effective regimen for the treatment of patients with NLPHL. A prospective evaluation of R-CHOP as a front-line treatment of NLPHL is under consideration. Disclosures: Fanale: Seattle Genetics: Research Funding; Novartis: Honoraria, Research Funding; Millenium: Research Funding; Genentech: Research Funding. Off Label Use: Given the CD20 positivity of nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) rituximab has been evaluated previously for relapsed NLPHL and was shown to be efficacious. Rituximab however is not FDA approved for NLPHL. This is a retrospective study that evaluates the use of R-CHOP and other therapies for NLPHL. Current NCCN guidelines support consideration of R-CHOP for NLPHL treatment, and given the rarity of the disease there is no one defined preferred chemotherapy regimen. This information will be disclosed to the audience. Fayad:Genentech: Research Funding. Rodriguez:Genentech: Research Funding. Shah:Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Millenium: Research Funding; Novartis: Research Funding. Younes:Genentech: Honoraria, Research Funding; SBIO: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Seattle Genetics: Honoraria, Research Funding.

Long Term Follow-Up Of De Novo Or Minimally Treated Burkitt Lymphoma/Leukemia (BL/B-ALL) After Frontline Therapy Per The Hyper-CVAD Regimen With Or Without Rituximab: 20-Year Cumulative Experience

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3917-3917 ◽  
Author(s):  
Preetesh Jain ◽  
Hagop M Kantarjian ◽  
Jorge E. Cortes ◽  
Elias J. Jabbour ◽  
Stefan H. Faderl ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
B Cell ◽  
De Novo ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Historical Experience ◽  
Frontline Therapy ◽  
Anti Cd20

Abstract Background Incorporation of the anti-CD20 monoclonal antibody rituximab into intensive, multi-agent chemotherapy regimens has been widely applied as frontline therapy of BL/B-ALL. We previously reported significant improvements in disease-free (DFS) and overall survival (OS) rates with the addition of rituximab to hyper-CVAD compared with the historical experience. We now report a cumulative update of the findings over a 20-year period. Methods 52 patients (pts) with newly diagnosed non-HIV BL (n=12) or B-ALL (n=40) were treated with hyper-CVAD and rituximab from February 2000 to June 2013. Chemoimmunotherapy was administered as previously described (Thomas DA et al, Cancer 2006:106; 1569-80). A separate cohort (n=9) with bcl-2 expression was excluded since they represented the category of B-cell lymphoma, unclassifiable, with intermediate features between diffuse large B-cell lymphoma and BL as per the 2008 revision of the WHO classification. Median age was 41 yrs (range, 17–77); 11 (21%) were aged 60 yrs or older. Six of the 52 pts were inevaluable for response: 3 were enrolled in complete remission (CR) after pretreatment with one cycle of chemotherapy and 3 had surgical resection of the tumor mass without evidence of residual disease. Seven (13%) had CNS involvement at presentation. Lactate dehydrogenase (LDH) level (ULN > 618 U/L) was elevated in 40 (77%). Outcome of the chemoimmunotherapy group was compared to historical experience with 44 pts treated with hyper-CVAD without rituximab from August 1992 to January 2000. Results All evaluable pts responded; 42 of 44 (95%) achieved CR and 2 achieved partial response. All 11 pts aged 60 yrs or older achieved CR. After a median follow up of 90 months, 10 (19%) pts relapsed with only one survivor (late relapse after 7 yrs successfully salvaged with DA-EPOCH-R). Twelve (29%) pts died in CR from infections (n=4), other malignancies (n=4), other preexisting comorbid medical conditions (n=2), or unknown causes (n=2). Overall 5-yr DFS and OS rates were 70% and 70% respectively, improved compared with corresponding historical cohort rates of 60% and 51%. Six pts developed secondary dyscrasias (1 with acute myelogenous leukemia [AML] at 7 yrs, 1 with t(8;21) AML at 3 yrs, 1 with monosomy 7 AML at 3 yrs, 3 with myelodysplastic syndrome (range 1-8 yrs). Toxicity profile was similar to hyper-CVAD alone. In the cohort (n=9) of bcl-2 positive dual hit lymphoma/leukemia (DHL) typically associated with poor prognosis, the 5-yr DFS and OS rates were 71% and 56% respectively; 4 were long-term survivors beyond 5 years without disease recurrence. Conclusions The incorporation of rituximab into the hyper-CVAD regimen has improved outcomes for de novo BL/B-ALL, with achievement of respectable cure rates. Bortezomib has been incorporated for the DHL subset in an effort to improve the results. Later generation anti-CD20 monoclonal antibodies such as ofatumumab have supplanted rituximab. Investigation of other novel monoclonal antibodies such as blinatumomab or inotuzumab for BL/B-ALL is clearly warranted. Disclosures: No relevant conflicts of interest to declare.

Diffuse Large B-Cell Lymphoma (DLBCL) Patients with Composite Histology Have Improved Early Outcome Compared to De Novo DLBCL When Treated with R-CHOP

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2819-2819
Author(s):  
Matthew J. Maurer ◽  
Thomas E. Witzig ◽  
William R. Macon ◽  
Sergei I. Syrbu ◽  
James R. Cerhan ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Follicular Lymphoma ◽  
B Cell ◽  
De Novo ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Indolent Lymphoma ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Background: A significant percentage of DLBCL patients present with a composite histology, often seen as a node containing both follicular lymphoma and DLBCL or DLBCL in the node and discordant indolent lymphoma in the bone marrow. Literature from the pre-rituximab era suggests DLBCL patients with transformed lymphoma or composite histology have worse outcome than de novo DLBCL. Here we report on early events in a cohort of R-CHOP treated patients. Goal: To determine whether patients with composite lymphoma have an inferior event free survival (EFS) and overall survival (OS) compared to de novo diffuse large B-cell lymphoma when treated with R-CHOP. Methods: Newly diagnosed patients treated with an R-CHOP containing regimen were prospectively enrolled in our Lymphoma SPORE registry from 9/2002 through 6/2007. Pathology was centrally reviewed. All patients were followed for retreatment, disease progression, and death. Results: 401 DLBCL patients were enrolled; 14% (57/401) had a composite histology. 33 patients had DLBCL and another histology, predominantly follicular lymphoma (n=29), in the same node. 20 patients had a non-DLBCL histology in a distinct location from the DLBCL; this was primarily indolent lymphoma in the bone marrow (n=15). 4 patients had both. 19% (75/401) of patients died during follow-up and 30% (121/401) had an event (death due to any cause, progression, or retreatment). Median follow-up for living patients was 34 months (range, 5–73). Composite DLBCL patients had higher event-free (3 year EFS = 79%) and overall (3 year OS = 93%) survival then de novo DLBCL (3 year OS = 66%, 3 year EFS 79%), p=0.05 and p=0.005 respectively. These differences remained statistically significant after adjusting for the International Prognostic Index (IPI): EFS HR = 0.53, 95% CI: 0.29–0.97, p=0.02; OS HR=0.28, 95% CI: 0.10–0.76, p=0.002. OS and EFS for composite DLBCL more closely resembled R-CHOP treated grade III follicular lymphoma (A,B) from the same cohort (3 year EFS = 81%, 3 year OS = 93%). Improved outcome for composite DLBCL was consistent whether the additional histology was in the same node or distinct from the DLBCL. Conclusions: R-CHOP treated DLBCL patients with indolent discordant bone marrow involvement or other composite histology have improved early OS and EFS compared to de novo DLBCL. Further follow-up is needed to assess the long-term prognosis of composite DLBCL in the rituximab era. Histology N Age &gt; 60 Stage III/IV LDH &gt; ULN PS &gt; 1 &gt;2 EN Sites 3 YR EFS 3 YR OS * Denotes statistically significant difference at p=0.05 de novo DLBCL 344 58% 56% 56% 17% 22% 66% 78% Composite DLBCL 57 65% 77%* 34%* 18% 32% 79%* 93%* Figure Figure

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