A Phase II Trial of Alemtuzumab (Campath) with DA-EPOCH-R in Relapsed or Refractory Diffuse Large B-Cell Lymphoma and Hodgkin Lymphoma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3709-3709 ◽  
Author(s):  
Cliona Grant ◽  
Kieron Dunleavy ◽  
Julieanne Hessler ◽  
Seth M. Steinberg ◽  
Stefania Pittaluga ◽  
...  
Keyword(s):  
B Cell ◽  
Hodgkin Lymphoma ◽  
Mononuclear Cells ◽  
Conflicts Of Interest ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Large B Cell Lymphoma ◽  
Age Range ◽  
Large B Cell

Abstract Abstract 3709 Background: In diffuse large B-cell lymphoma (DLBCL), stromal signatures are predictive of outcome in newly diagnosed patients treated with R-CHOP. These signatures, termed 'stromal 1' and 'stromal 2' are associated with genes expressed by infiltrating mononuclear cells. The stromal 2 signature includes genes associated with angiogenesis and is associated with a poor outcome. Hence, targeting reactive cells in the microenvironment is a rational therapeutic strategy in DLBCL. In Hodgkin lymphoma (HL), the reactive macrophages surrounding Hodgkin Reed Sternberg (HRS) cells are associated with an adverse outcome and may provide survival signals. CD52 is highly expressed in many of these cells in the microenvironment and in most cases of DLBCL. Methods: We combined alemtuzumab (a monoclonal antibody against CD52) with DA-EPOCH-R to target reactive cells in the microenvironment and positive tumor cells. Alemtuzumab (30 mgs on day 1) was administered intravenously before DA-EPOCH-R (as previously described) and responding patients received up to 6 cycles of therapy. Results: Characteristics of 28 patients accrued: median age (range) 44 (22–72); male sex 15 (54%); stage III or IV disease 20 (71%); median prior regimens (range) 2 (1–6); and prior autologous transplant 7 (25%). Enrolled histologies were HL 12 (43%); DLBCL 10 (36%); and primary mediastinal B-cell lymphoma 6 (21%). Responses by histological subtype are shown in the attached table. The regimen was particularly effective in patients with HL with a CR rate of 73%. At 12 months (with 21 months median potential follow-up), the OS and PFS probabilities for all patients were 68% and 18% respectively. Toxicities included: treatment related mortality (sepsis) in 1 patient; febrile neutropenia in 16%; and grade 4 thrombocytopenia 15% of cycles. CMV reactivation was observed in 52% of patients in the setting of anti-viral prophylaxis. Conclusions: Combining alemtuzumab with DA-EPOCH-R is feasible. Patients with a diagnosis of HL had a very high complete response rate. Accrual continues. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Doublet Versus Triplet PET: Is END of Therapy PET Needed IF Interim PET Is Negative in Hodgkin'S or Diffuse Large B CELL Lymphoma?

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5354-5354
Author(s):  
Imran K Tailor ◽  
Bilal Btoosh ◽  
Shaimaa Hamdy ◽  
Shanker Raja ◽  
Mohammed O Alharbi ◽  
...  
Keyword(s):  
B Cell ◽  
Conflicts Of Interest ◽  
Cell Lymphoma ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Standard Of Care ◽  
Complete Response ◽  
Interim Pet ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Introduction: Baseline (PETb) and end of therapy (PETe) FDG PET is standard of care in the management of hodgkin's lymphoma (HL) and diffuse large B cell lymphoma (DLBCL). The role of interim PET (PETi) in HL is well established while its role in DLBCL is not well defined. We evaluated the utility of triPET (PETb, PETi and PETe ) in management of these two lymphomas. Methods: Retrospective review of PET archives revealed a total of 37 pts (HL=22, DLBCL=15). TriPET were acquired per accepted protocol. SUVmax and Deauville scores (DSc) were obtained from five target lesions, the average i.e. composite SUVmax & DSc were computed for each pt. Statistical analyses were performed with the composite maxSUV (cSUV) and Deauville scores (cDSc) (using EXCEL). Following statistics were performed (separately and combined in HL and DLBCL); mean+SD, PPV and NPV for complete response (CR) Vs. progressive disease (PD) on PETi using the following variables 1. cSUV and 2. cDSc and 3. delta change (DELT). Median progression free survival (PFS) was the clinical endpoint for response. Results: The mean PFS in our group was 17 and 15 months in HL and DLBCL respectively. Using cut off thresholds for intP to predict CR at cSUV<=2.0, , cDSC<=2.0 and DELT >=80%,. In HL: for cSUV- PPV 67%, NPV 95%; for DELT of cSUV PPV 100%, NPV 95%; for cDSC-PPV 30%, NPV 100%. In DLBCL: for cSUV- PPV 25%, NPV 100%; for DELT of cSUV PPV 33%, NPV 100%; for cDSC- PPV 50%, NPV 100%. Conclusion: The results from our series suggest that PETi has a role not only in HL but in DLBCL as well. Our modest cohort suggests that a negative PETi in DLBCL had a NPV of 100% across cSUV, cDSc and DELT, with regards to CR. Our data also suggests that PETe is not needed if PETi is -ve. While in HL subset, our results concur with results from other groups, this needs to be validated in a larger series. Disclosures No relevant conflicts of interest to declare.

Anaplastic Variant of Diffuse Large B-Cell Lymphoma: Re-Apprasial As Extra-Mediastinal Grey Zone Lymphoma Intermediate Between Diffuse Large B-Cell Lymphoma and Classical Hodgkin Lymphoma,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3660-3660 ◽  
Author(s):  
Nirmeen Ali Megahed ◽  
Seiichi Kato ◽  
Naoko Asano ◽  
Shigeo Nakamura
Keyword(s):  
B Cell ◽  
Hodgkin Lymphoma ◽  
Conflicts Of Interest ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Aggressive Lymphoma ◽  
Grey Zone ◽  
Female Ratio ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Abstract 3660 Background: Recently more light has been shed on the overlap in biologic and morphologic features between classic Hodgkin lymphoma (cHL) and B-cell non-Hodgkin lymphoma. This overlap was further substantiated by analyzing the neoplastic nature of the malignant cell of cHL, which was proven to be of B-cell origin in nearly all cases. In addition, the growing recognition of composite and metachronous Hodgkin and non-Hodgkin lymphomas provided a further evidence of such claim. This advocated the term Grey zone lymphoma, which was first introduced in 1998 in the ÔÔWorkshop on HodgkinÕs disease and related diseasesÕÕ. According to WHO classification 2008, the term Ògrey zone lymphomaÓ designates anterior mediatsinal involvement with lymphoma intermediate between DLBCL and cHL. This type of lymphoma is claimed to have a more aggressive course than either cHL or DLBCL. Although the optimum treatment regimen in such cases is not yet well established most authors go for administration of therapy appropriate for DLBCL with the addition of Rituximab. We present a reappraisal of anaplastic variant of diffuse large B-cell lymphoma as an extramediastinal grey zone lymphoma showing morphologic and phenotypic features intermediate between DLBCL and cHL. Methods and results: Clinical and pathological data of 13 cases were retrieved over 8-year period. The age of the patients ranged from 57 to 86 years old (mean= 75 yeas). Eight of our cases were males and 5 were females with slight male predominance (male: female ratio= 1.6:1). This runs in contradiction with cases of mediastinal grey zone lymphoma which show striking female predominance. All the cases were presented with extramediastinal lymphadenopathy. Six patients showed associated extranodal involvement (e.g. liver, stomach, forearm, bone). None of the cases was associated with EBV activity. Four cases were presented with stage IV disease, 3 cases with stage III and 4 cases with stage II. B symptoms were reported in 6 cases. Histopathologically, tumors showed sheet like growth of pleomorphic cells, some of them are Reed Sternberg like cells, admixed with inflammatory background formed of mature lymphocytes eosinophils and plasma cells. Fibrous strands and geographic necrosis were seen in all cases. B-cell immunophenotyping of the tumor cells was evidenced by positivity for CD20, CD79a and Pax 5 in all cases. On the other hand, Hodgkin-like immunophenotyping was evidenced by positivity for CD30 in 10 cases, positivity for CD15 in 2 cases, positivity for Mum1 in one case and positivity for fascin in 6 cases. All the cases were negative for ALK1, CD10, CD3, κ□Aλ and CD45 RO. Worth to be noted that 69% of the cases (9/13) showed positivity for p53 and 23% (3/13) showed positivity for BCL-6 which are both an unusual finding in cHL. Forty six percent of the cases (6/13) died within the first year of the disease course (mean=8.3 months). Six patients are still alive (46%), 5 of which showed complete remission and one patient showed partial remission. Conclusion: Anaplastic variant of diffuse large cell lymphoma shows phenotypic and immunotypic features intermediate between cHL and DLBCL. We here propose the term (Extramediastinal grey zone lymphoma) for such cases which represent a distinctive subgroup of aggressive lymphoma. Further future studies of this group could contribute more to unmasking the link between Hodgkin and Non-Hodgkin lymphomas. Disclosures: No relevant conflicts of interest to declare.

Concomitant Radiochemotherapy In The Treatment Of Refractory Or Locally Relapsed Diffuse Large B-Cell Lymphoma: A Single Center Retrospective Study

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5114-5114
Author(s):  
Emmanuel Gyan ◽  
Alban Villate ◽  
Severine Lissandre ◽  
Lotfi Benboubker ◽  
Martine Delain ◽  
...  
Keyword(s):  
B Cell ◽  
Conflicts Of Interest ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Hematological Toxicity ◽  
Severe Toxicity ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Introduction Primary refractory Diffuse Large B-Cell Lymphoma (DLBCL) as well as relapse after salvage therapy displays a poor prognosis. Salvage radiation therapy alone does not provide sufficient disease control on locally chemoresistant DLBCL. Autologous stem cell transplantation (ASCT) provides the best progression-free survival when salvaged patients are transplanted in Complete Response (CR). The objective of this study was to assess the effectiveness of CCR in locally relapsed or refractory DLBCL, followed by ASCT in responding patients. Material and methods We report the outcome of consecutive patients with locally relapsed or refractory lymphoma for which a decision of CRC was taken in a single institution. Each patient has been assessed by CT or PET-scan. The CRC regimen consisted in 3 cycles of Rituximab (375 mg/m² day 1), CDDP (30 mg/m² 3 days 1-3) and VP16 (120 mg/m² days 1-3) at 21 days intervals, with concomitant radiotherapy delivered to the residual disease sites, administrated in 2 Gy fractions per day to a total dose of 30 Gy, starting on day 1 of the second cycle. Responding patients received ASCT with a BEAM conditioning at the end of the procedure. Extra-hematological toxicity was ranked according to the Common Terminology Criteria for Adverse Events. Tumor response was evaluated according to IWG 1999 at 1 month after the last cycle of CRC, three months after ASCT if performed and during a quarterly follow-up. Results We identified 13 patients with localized chemoresistant DLBCL from January 2002 to April 2011 including 12 primary refractory forms. The median age was 56 years (20-76), 12 of 13 patients had received at least two lines of chemotherapy before inclusion with anthracycline and cisplatin. 11 patients achieved a partial response (85%) and 4 of them (31%) a complete response after the CRC. 8 (61.5%) patients were transplanted 1 month after the last cycle of CRC. 7 patients have relapsed within 6 months after the end of treatment. After a median follow-up of 37 months (range 21-125) for the surviving patients, 7 patients are alive and free of disease. The overall survival is 54%, and all surviving patients had been transplanted. No severe toxicity was reported. Conclusion CRC should be considered as an option in the therapeutic arsenal in refractory or locally relapsed DLBCL, especially in patients eligible for ASCT. Further research on CRC is warranted. Disclosures: No relevant conflicts of interest to declare.

An Interesting Case Report of A Concurrent Classic Hodgkin Lymphoma and Gray Zone Lymphoma in the Mediastinum

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S110-S110
Author(s):  
B Mai ◽  
J Huddin ◽  
Z Hu
Keyword(s):  
B Cell ◽  
Hodgkin Lymphoma ◽  
Mediastinal Mass ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Gray Zone ◽  
Large B Cell Lymphoma ◽  
Classic Hodgkin Lymphoma ◽  
Atypical Cells ◽  
Large B Cell

Abstract Casestudy A 52-year-old female presented with night sweats, chills, anorexia, and weight loss. Computed tomography and positron emission tomography showed a soft tissue infiltration in the anterior mediastinum and hypermetabolic bilateral supraclavicular, mediastinal, right hilar, and left internal mammary lymph nodes. An anterior mediastinal mass resection and thymectomy was subsequently performed. Results Sections of the mediastinal mass showed Hodgkin/Reed-Sternberg cells (HRS) admixed with small lymphocytes, histiocytes, plasma cells, and eosinophils. The HRS cells are positive for CD30, CD15, and MUM1, faintly positive for PAX5, and negative for CD20, CD45, CD79a, and BCL6. The morphology and immunophenotype is diagnostic of nodular sclerosis classic Hodgkin lymphoma (CHL). Sections of the thymectomy specimen showed similar morphology, however, in an area that represents 10-20% of the specimen, there are nodular and diffuse lymphoid infiltrates consisting of small lymphocytes, histiocytes, and large atypical cells. The large atypical cells are positive for CD20, CD23, CD30, CD45, CD79a, BCL2, BCL6, MUM-1, and PAX5, and negative for CD1a, CD3, CD57, and Cyclin D1. The background small CD3-positive lymphocytes form a rosette around most of the large atypical cells. CD21 and CD23 stains highlight residual follicular structures. In situ hybridization for EBV-encoded RNA (EBER) is negative. The presence of residual follicular meshwork with an immunophenotype of large B cell lymphoma supports a diagnosis of a gray zone lymphoma (GZL). Overall, CHL is involving 80-90% and GZL is involving 10-20% of the thymic tissue. The patient was subsequently placed on ABVD chemotherapy and achieved remission. Conclusion An accurate diagnosis of GZL is challenging. GZL is a rare type of lymphoma with morphological features between CHL and diffuse large B-cell lymphoma (DLBCL). It is even rarer to encounter a CHL concurrently present with a GZL. The optimal therapeutic approach for cases with concurrent lymphoma diagnosed with CHL and GZL needs further investigation.

scholarly journals Correlations between baseline 18F-FDG PET tumour parameters and circulating DNA in diffuse large B cell lymphoma and Hodgkin lymphoma

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Pierre Decazes ◽  
Vincent Camus ◽  
Elodie Bohers ◽  
Pierre-Julien Viailly ◽  
Hervé Tilly ◽  
...  
Keyword(s):  
B Cell ◽  
Hodgkin Lymphoma ◽  
Fdg Pet ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Circulating Dna ◽  
Tumour Burden ◽  
B Cell Malignancies ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Background 18F-FDG PET/CT is a standard for many B cell malignancies, while blood DNA measurements are emerging tools. Our objective was to evaluate the correlations between baseline PET parameters and circulating DNA in diffuse large B cell lymphoma (DLBCL) and classical Hodgkin lymphoma (cHL). Methods Twenty-seven DLBCL and forty-eight cHL were prospectively included. Twelve PET parameters were analysed. Spearman’s correlations were used to compare PET parameters each other and to circulating cell-free DNA ([cfDNA]) and circulating tumour DNA ([ctDNA]). p values were controlled by Benjamini–Hochberg correction. Results Among the PET parameters, three different clusters for tumour burden, fragmentation/massiveness and dispersion parameters were observed. Some PET parameters were significantly correlated with blood DNA parameters, including the total metabolic tumour surface (TMTS) describing the tumour–host interface (e.g. ρ = 0.81 p < 0.001 for [ctDNA] of DLBLC), the tumour median distance between the periphery and the centroid (medPCD) describing the tumour’s massiveness (e.g. ρ = 0.81 p < 0.001 for [ctDNA] of DLBLC) and the volume of the bounding box including tumours (TumBB) describing the disease’s dispersion (e.g. ρ = 0.83 p < 0.001 for [ctDNA] of DLBLC). Conclusions Some PET parameters describing tumour burden, fragmentation/massiveness and dispersion are significantly correlated with circulating DNA parameters of DLBCL and cHL patients. These results could help to understand the pathophysiology of B cell malignancies.

scholarly journals Large B-Cell Lymphoma with T-Cell–Rich Background and Nodules Lacking Follicular Dendritic Cell Meshworks: A Case Report with Complete Response to Chemotherapy and a Review of the Literature

2020 ◽  
Vol 5 (11) ◽  
pp. 561-565
Author(s):  
Walid Shalata ◽  
Ismaell Massalha ◽  
Kayed Al-Athamen
Keyword(s):  
T Cell ◽  
Dendritic Cell ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Follicular Dendritic Cell ◽  
Large B Cell Lymphoma ◽  
Follicular Dendritic ◽  
Large B Cell

In this report, we describe a 38-year-old male with a very rare type of lymphoma, large B cell lymphoma with T cell-rich background and nodules lacking follicular dendritic cell meshworks (THRLBCL). In 2016 the patient presented hot flashes and night sweats (B-symptoms) and peripheral edema. He was treated with R-CHOP (doxorubicin, vincristine, cyclophosphamide, rituximab and Prednisone) chemotherapy, a Positron emission tomography–computed tomography (PET-CT) scan was performed after four cycles of treatment which showed radiologic complete response and blood test (complete blood count (CBC)) results showed normal ranges. As of September, 2020 he patient remains in complete remission. We searched the literature for descriptions of cases spanning the diagnostic spectrum of THRLBCL and we identified only five cases worldwide. The last reported case was in 2014 with distinctive features that were difficult to classify according to the World Health Organization criteria or previously described variants. Our patient is the sixth case of THRLBCL to be reported. He is the youngest of the reported cases and the first from Israel and the Middle East.

scholarly journals Relative Frequencies and Patterns of Malignant Lymphoma in a Reference Centre in Khartoum, Sudan: A Descriptive Study Based on the WHO Classification of Lymphoid Neoplasms

2020 ◽  
Vol 5 (2) ◽  
pp. 107-112
Author(s):  
Ezeldine K Abdalhabib
Keyword(s):  
B Cell ◽  
Malignant Lymphoma ◽  
Complete Blood Count ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Reference Centre ◽  
Large B Cell Lymphoma ◽  
Appropriate Treatment ◽  
Age Range ◽  
Large B Cell

Background: The effective management and choice of appropriate treatment of lymphoma subtypes depend on an accurate diagnosis and differentiation, which require comprehensive haematology and pathology work. Methods: A total of 134 cases of malignant lymphoma, newly diagnosed between January 2017 to January 2020, were selected. For each patient’s samples, complete blood count, immunohistochemistry, and morphological evaluation were done. Results: Clinical data showed that 81 patients (60.4%) were males and 53 (39.6%) females. The age range was 4 to 80 years. NHL lymphoma comprised 87.3% of cases, while HL comprised 12.7% of cases. Diffuse large B cell lymphoma was the most prevalent NHL subtype, representing 39.3% of cases. Among HL subtypes, mixed cellularity was present in 41.2% of cases. B cell lymphoma constituted 93.2% of cases. All HL patients and 74.4% of NHL patients had anaemia. Conclusion: This is the first statistical report of malignant lymphoma patterns in Sudanese patients. These data suggest that malignant lymphoma in Sudanese patients is more frequent in males than females; its incidence increases with age. Further, B cell lymphoma is more common than T cell lymphoma. Diffuse large B cell lymphoma was the most frequent NHL subtype.

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