Bendamustine + Rituximab-Combinations and R-CHOP Achieve a Major Survival Improvement Of Patients With Follicular Lymphoma In Routine Care

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5584-5584
Author(s):  
Rudolf Weide ◽  
Stefan Feiten ◽  
Vera Friesenhahn ◽  
Jochen Heymanns ◽  
Kristina Kleboth ◽  
...  

Abstract Introduction Progress has been made in diagnosis and treatment of patients with follicular lymphoma who receive their treatment within prospective clinical trials. Due to necessary inclusion and exclusion criteria only a very limited number of patients are treated in studies. Therefore results from clinical trials can't be transferred into routine care. Little practice data are available how patients with follicular lymphoma are diagnosed and treated in routine care and whether improvements in survival are achieved. Methods A retrospective analysis of all patients with follicular lymphoma who were treated in an oncology group practice in Germany between 1995-2012. Relevant clinical data concerning diagnosis, treatment and survival were transferred from clinical files into a database and analyzed statistically using SPSS and SURVSOFT. Results 174 patients with a median age of 60 (27-87) were identified. 43.7% were male and 56.3% female. Stage distribution at initial diagnosis was as follows: Stage I 45 patients (25.9%), stage II 23 patients (13.2%), stage III 32 patients (18.4%), stage IV 62 patients (35.6%), in 12 patients (6.9%) initial stage could not be retrieved. 90.8% needed therapy with a median of 2 different therapies (1-12). Regimens most frequently applied were: Rituximab-containing (67.1%), Bendamustine-containig (41.8%), Bendamustine+Rituximab-combinations (39.9%) and R-CHOP (27.8%). 15 patients (9.5%) received radiotherapy only. 13.3% of patients were treated within a clinical trial. 5 and 10 year absolute overall survival was 88.9% and 73.9%. Relative survival after 5 and 10 years was 94.4% and 86.6%. Median overall survival according to stage was 28 years for stage I, median not reached for stage II, 21 years for stage III and 16 years for stage IV. Median relative survival was 17.4 years for stage IV and has not been reached for stages I-III. Conclusions Systemic treatment of patients with follicular lymphoma in routine care consisted mainly of Bendamustine+Rituximab-combinations and R-CHOP. Employment of the most active chemoimmunotherapies leads to a marked prolongation of survival compared to historical controls and registry data. Disclosures: No relevant conflicts of interest to declare.

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5613-5613
Author(s):  
Rudolf Weide ◽  
Stefan Feiten ◽  
Vera Friesenhahn ◽  
Jochen Heymanns ◽  
Kristina Kleboth ◽  
...  

Abstract Introduction Progress has been made in diagnosis and treatment of patients with CLL who receive their treatment within prospective clinical trials. Due to necessary inclusion and exclusion criteria only a very limited number of patients are treated in studies. Therefore results from clinical trials can't be transferred into routine care. No clinical practice data are available how patients with CLL are diagnosed and treated in routine care and whether improvements in survival are achieved. Methods A retrospective analysis of all patients with CLL who were treated in an oncology group practice in Germany between 1995-2012. Relevant clinical data concerning diagnosis, treatment and survival were transferred from clinical files into a database and analyzed statistically using SPSS and SURVSOFT. Results 580 CLL patients with a median age of 67 (35-92) were identified. At initial diagnosis 446 patients (76.9 %) were in Binet stage A, 69 (11.9%) Binet stage B and 31 (5.3%) Binet stage C. Due to external diagnosis of 34 patients (5.9%) the stage at initial diagnosis couldn't be retrieved. 323 patients (55.7 %) never received any treatment. 257 patients (44.3%) needed therapy with a median of 2 therapy lines (1-11). Regimens most frequently applied were: Bendamustine-containig (66.9%), Rituximab-containing (62.3%), Chlorambucil-containing (61.5%), Bendamustine+Rituximab-combinations (48.2%) and Fludarabine-containing (40.9%). 21.0% of patients were treated within a clinical trial. 5 and 10 year absolute overall survival was 83.6% and 60.9%. Relative survival after 5 and 10 years was 96.1% and 82.3%. Median overall survival according to Binet stage was 16 years for Binet A, 9 years for Binet B and 8 years for Binet C. Median relative survival was 20.8 years for Binet A, 14.0 years for Binet B and 8.6 years for Binet C. Patients who needed therapy had a median overall survival of 11 years (0-41) compared to 18 years (0-23+) of patients who never needed any therapy. Conclusions 55.7% of CLL-patients never needed any therapy. Patients who needed therapy had a much lower life expectancy compared to patients who never needed therapy. Treatment consisted mainly of Bendamustine, Rituximab, Chlorambucil, Bendamustine+Rituximab-combinations and Fludarabine leading to a marked prolongation of survival compared to historical controls and registry data. Disclosures: No relevant conflicts of interest to declare.


Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3777-3777
Author(s):  
Hana Kim ◽  
Darae Kim ◽  
Jinoh Choi ◽  
Eunseok Jeon ◽  
Jung Eun Lee ◽  
...  

Abstract Exploration of the Appropriate NT-proBNP Level for AL Amyloidosis Staging Hana Kim, MD 1, Darae Kim, MD, PhD 2, Jin-Oh Choi, MD, PhD 2, Eun-Seok Jeon, MD, PhD 2, Jung Eun Lee, MD, PhD 3, Ju-Hong Min, MD, PhD 4, Joon Young Choi, MD, PhD 5, Jung-Sun Kim, MD, PhD 6, Seok Jin Kim, MD, PhD 1, Kihyun Kim, MD, PhD 1 1 Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 2 Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 3 Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 4 Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 5 Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 6 Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea The most important factor affecting prognosis of systemic light chain (AL) amyloidosis is severity of cardiac damage. For this reason, cardiac biomarkers are used in European 2015 and Mayo clinic 2012, two representative staging systems for AL amyloidosis. Since the NT-proBNP levels of the existing AL amyloidosis staging systems are different, we tried to find the appropriate NT-proBNP level in our 16-year AL amyloidosis patient cohort. Newly diagnoded AL amylodosis patients between August 2004 and July 2020 were included in this study (n=401). Patients who did not have laboratory results for staging had been exclude (n=86). Among them, 86 patients of stage III and 145 patients of stage IV patients (according to Mayo clinic 2012 stage) were analyzed (n=231). Of the 231 stage III, IV patients, 25, 82, 47, and 77 patients were classified as a group of NT-proBNP ≤1800, 1800 < NT-proBNP ≤5000, 5000< NT-proBNP ≤8000, and NT-proBNP >8000 (ng/L), respectively. The characteristics and overall survival of each group were investigated through statistical analysis. Age at diagnosis (p=0.016), ECOG (p=0.046), serum creatinine(p=0.001), and Estimated glomerular filtration rate (eGFR) (p=0.003) had statistically significant differences in the groups divided by the NT-proBNP criteria. With 54.4 months of median follow up, the overall survivals analyzed by Mayo clinic 2012 were stage I: not reached, stage II: 49.6 months, stage III: 46.8 months, and stage IV: 11.9months, respectively. As a result of European 2015 analysis, stage I: not reached, stage II: 65.9 months, stage IIIa: 41.4 months, stage IIIb: 4.3 months.) In our analysis according to NT-proBNP (ng/L) in stage III and IV patients, the overall survival of NT-proBNP ≤1800 group has not yet been reached. The median OS of group 1,800<NT-proBNP ≤5000, 5000< NT-proBNP ≤8000, and NT-proBNP >8000 were 54.8 months, 11.9 months, and 4.5 months, respectively (p <0.001). The Kaplan-Meier's curve for OS had a clear difference at NT-proBNP 5000 value. On the basis of NT-proBNP, the OS of less than 5000 group was 62 months, and the OS of 5000 or more group was 5.9 months. In analysis of factors affecting the OS, statistically significant results were age at diagnosis (p = 0.018), ECOG (p = 0.002), and NT-proBNP 5000 ng/L or higher (p < 0.001). The dFLC included in the Mayo clinic 2012 was found to have a statistically insignificant on the overall survival (p=0.584). Although disease stage is important in predicting the prognosis of AL amyloidosis, it was revealed that NT-proBNP is the most important factor in predicting survival prognosis. In this study we confirmed that AL amyloid patients with high NT-proBNP of >5000 ng/L may have particularly poor survival rate. When staging AL amyloidosis, it can be considered based on NT-proBNP 5000 ng/L level. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.


1996 ◽  
Vol 14 (5) ◽  
pp. 1532-1536 ◽  
Author(s):  
E Schvartzman ◽  
G Chantada ◽  
A Fandiño ◽  
M T de Dávila ◽  
E Raslawski ◽  
...  

PURPOSE To describe the treatment of retinoblastoma at a single institution using a prospective protocol based on histopathologic staging. PATIENTS AND METHODS We included 116 consecutive patients (101 eligible, 46 bilateral) from August 1987 to December 1993. Treatment was enucleation or conservative therapy for intraocular disease (stage I patients). Stage II patients (orbital or postlaminar invasion) received vincristine, cyclophosphamide, and doxorubicin for 57 weeks. Patients with orbital mass and extension beyond the cut end of the optic nerve also received orbital radiotherapy (45 Gy). The latter received intrathecal therapy. In those with CNS (stage III) or hematogenous metastasis (stage IV), cisplatin and etoposide were added along with cranial (in patients with a CNS mass and prophylactically in stage IV) or craniospinal (in patients with positive CSF) radiotherapy. RESULTS The median follow-up time was 39 months (range, 12 to 84). The overall survival rate was 0.84. Survival rates according to stage were as follows: stage I probability of overall survival [pOS] = 0.97) (alive/total), 59 of 60; stage II (pOS = 0.85) including patients with scattered episcleral cells, three of three; orbital mass, one of one; postlaminar invasion up to and beyond the cut end of optic nerve, 10 of 11 and 11 of 14, respectively; of stage III (pOS = 0), zero of six; and stage IV (pOS = 0.50), three of six. Only those patients with preauricular adenopathy as the only metastatic site survived in the latter group. Acute toxicity was mild. CONCLUSION Chemotherapy is not warranted to prevent systemic metastasis for intraocular disease. Patients with extraocular orbital disease and had a good outcome with this therapy. Patients with metastatic disease fared poorly, except for those with isolated malignant preauricular adenopathy.


2019 ◽  
Author(s):  
Matías Nicolás Tellado ◽  
Felipe Horacio Maglietti ◽  
Sebastián Diego Michinski ◽  
Guillermo Ricardo Marshall ◽  
Emanuela Signori

ABSTRACTElectrochemotherapy is a treatment modality which has been increasingly used in veterinary and human medicine for treating cutaneous and subcutaneous tumors. In this prospective work we evaluated the outcome of using electrochemotherapy as a first-line treatment for canine oral melanoma in different stages, with the aim of determining predictive factors of response to the treatment. Mucosal melanoma is the most common cause of oral cancer in dogs. Canine oral malignant melanoma is very similar to human oral melanoma in many aspects, being a very good translational model for studying response to this treatment. Sixty-seven canine patients were treated. Intravenous bleomycin was the preferred drug, and the standard operating procedures for electrochemotherapy were followed. The patients were followed-up for two years. According to WHO criteria, the objective response per stage was: stage I 100%, stage II 89.5%, stage III 57.7% and, stage IV 36.4%. The overall median survival was 7.5 months (2-30 months, mean 9.1 months). Median overall survival of patients in stage I was 16.5 months, in stage II was 9 months, in stage III 7.5 months, and in stage IV 4.5 months. The average number of electrochemotherapy sessions was 1.5 for every stage. The incidence of new metastases among treated patients was 28.4%. Patients in advanced stages, with bone involvement, and caudal location of the tumor had poorer response rates and shorter overall survival times. The treatment greatly improved the quality of life of the patients. Electrochemotherapy is an important technique in the oncological armamentarium against melanoma, and these results can be used to predict human response to this therapy in each stage.


Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5611-5611
Author(s):  
Rudolf Weide ◽  
Stefan Feiten ◽  
Vera Friesenhahn ◽  
Jochen Heymanns ◽  
Kristina Kleboth ◽  
...  

Abstract Introduction Progress has been made in diagnosis and treatment of patients with Morbus Waldenström who receive their treatment within prospective clinical trials. Due to necessary inclusion and exclusion criteria only a very limited number of patients are treated in studies. Therefore results from clinical trials can't be transferred into routine care. Little practice data are available how patients with Morbus Waldenström are diagnosed and treated in routine care and whether improvements in survival are achieved. Methods A retrospective analysis of all patients with Morbus Waldenström who were treated in an oncology group practice in Germany between 1995-2012. Relevant clinical data concerning diagnosis, treatment and survival were transferred from clinical files into a database and analyzed statistically using SPSS and SURVSOFT. Results 52 patients with a median age of 67 (36-84) were identified. 67.3% were male and 32.7% female. Distribution according to IPSSWM-stage was: 21.2% low risk, 61.5% intermediate risk, 17.3% not evaluable (in most cases due to lacking β2 microglobulin data). 59.6% needed therapy with a median of 3 therapies (1-12). Regimens most frequently applied were: Bendamustine-containig (74.2%), Rituximab-containing (74.2%), Bendamustine+Rituximab-combinations (61.3%) and Chlorambucil-containing (45.2%). 6.5% of patients were treated within a clinical trial. Median overall survival was 12 years (0-19). Median relative survival was 13.6 years. 10-year relative survival was 86%. 10-year relative survival according to IPSSWM-stage was as follows: low risk 92%, intermediate risk 71%. Median overall survival of the patients who never needed any therapy was 11 years compared to 12 years of those patients who needed therapy. Median relative survival for patients who never needed therapy was not reached yet, median relative survival of the patients who needed therapy was 13.6 years. Conclusions Systemic treatment of patients with Morbus Waldenström in routine care consists mainly of Bendamustine, Rituximab and Bendamustine+Rituximab-combinations. Employment of the most active chemoimmunotherapies leads to a marked prolongation of survival compared to historical controls and registry data. Disclosures: No relevant conflicts of interest to declare.


2020 ◽  
Vol 28 (1) ◽  
pp. 138-151
Author(s):  
Kelly A. Stahl ◽  
Elizabeth J. Olecki ◽  
Matthew E. Dixon ◽  
June S. Peng ◽  
Madeline B. Torres ◽  
...  

Gastric cancer is the third most common cause of cancer deaths worldwide. Despite evidence-based recommendation for treatment, the current treatment patterns for all stages of gastric cancer remain largely unexplored. This study investigates trends in the treatments and survival of gastric cancer. The National Cancer Database was used to identify gastric adenocarcinoma patients from 2004–2016. Chi-square tests were used to examine subgroup differences between disease stages: Stage I, II/III and IV. Multivariate analyses identified factors associated with the receipt of guideline concordant care. The Kaplan–Meier method was used to assess three-year overall survival. The final cohort included 108,150 patients: 23,584 Stage I, 40,216 Stage II/III, and 44,350 Stage IV. Stage specific guideline concordant care was received in only 73% of patients with Stage I disease and 51% of patients with Stage II/III disease. Patients who received guideline consistent care had significantly improved survival compared to those who did not. Overall, we found only moderate improvement in guideline adherence and three-year overall survival during the 13-year study time period. This study showed underutilization of stage specific guideline concordant care for stage I and II/III disease.


2018 ◽  
Vol 8 (2) ◽  
pp. 14-21
Author(s):  
Syaifurrahman Hidayat ◽  
Laylatul Hasanah ◽  
Dewi Herlina Susantin
Keyword(s):  
Stage Iv ◽  
T Test ◽  
Stage I ◽  
Stage Ii ◽  

Daun salam (syzygiumpolyanthum) merupakan salah satu dari jenis terapi herbal yang digunakan untuk berbagai penyakit salah satunya yaitu untuk menangani penyakit hipertensi,untuk menurunkan hipertensi dibutuhkan 10 lembar daun salam dan 300 ml air lalu direbus hingga mendidih dan menyusut menjadi 200 ml dan dikonsumsi sebanyak 2 kali sehari pada pagi dan sore hari, masing-masing 100 ml. Penelitian ini bertujuan untuk mengetahui pengaruh air rebusan daun salam dalam menurunkan tekanan darah pada lansia di wilayah kerja UPT Puskesmas Guluk-Guluk. Penelitian ini menggunakan desain penelitian eksperimen Pre post test design, dimana pada rancangan ini berupaya mengungkapkan hubungan sebab akibat dengan cara melibatkan kelompok eksperimental, dengan sampel sebanyak 30 0rang Pengumpulan data menggunakan observasi tekanan darah langsung dan wawancara ke responden.  Hasil penelitian menunjukkan bahwa sebelum diberikan perlakuan pada responden sebagian besar berada pada stage III sebanyak 22 orang (73,3 %), lalu sebagian kecil berada pada stage IV dengan 2 orang (6,7 %). Setelah dilakukan penelitian menunujukkan sesudah diberikan perlakuan pada responden sebagian besar menempati stage II sebanyak 28 orang (93,3 %), sebagian kecil berada pada stage I hanya 2 orang (6,7 %). Hasil uji T test paried dan uji T test didapatkan nilai signifikan 0.000 yang nilainya lebih kecil dari taraf kesalahan α 0.05. sehingga H0 ditolak dan H1 diterima yang berarti ada pengaruh air rebusan daun salam terhadap penurunan tekanan darah pada lansia yang menderita hipertensi di wilayah kerja UPT Puskesmas Guluk-Guluk Kecamatan Guluk-Guluk. Daun salam mempunyai kandungan kimia seperti minyak atsiri, sitrat, euganol, tannin serta flavanoid yang dipercaya mampu untuk menurunkan tekanan darah, mekanisme kerja dari daun salam ini yaitu merangsang sekresi cairan empedu sehingga lemak akan keluar bersamaan dengan usus yang kemudian mengurangi gumpalan lemak yang mengendap dalam pembuluh darah sehingga aliran darah menjadi lancar dan tekanan darah akan normal.


Author(s):  
Viktor Dmytryk ◽  
Tetiana Luhovska ◽  
Pavel Yakovlev ◽  
Olexiy Savchuk ◽  
Ludmila Ostapchenko ◽  
...  

Bladder Cancer (BC) is a common disease worldwide. Chronic inflammation is one of the key mechanisms for the development of BC. This study enrolled 40 patients. Preoperative plasma levels of IL-1β, IL-4, IL-6, IL-10, IL-12β, TNF-α and IFN-γ were determined by ELISA. In our study, we observed diverse changes in the levels of cytokines in patients with BC Stage I, II, III and IV. The levels of IL-1β was increased for stage I, stage II, and stage III. The level of TNF-α was increased for stage II, stage III, stage IV. The levels of IL-4, IL-6, IL-10 and IL-12β were increased in patients with stage III and IV only. The levels of IFN- γ declined for stage II, stage III and stage IV with the lowest levels in patients with Stage IV. In our study, we investigated alteration in levels of Th-1 and Th-2-like cytokine profile, but some deficiency in Th1- status discovered in patients with BC.


2000 ◽  
Vol 18 (14) ◽  
pp. 2665-2675 ◽  
Author(s):  
Jorge A. Ortega ◽  
Edwin C. Douglass ◽  
James H. Feusner ◽  
Marleta Reynolds ◽  
John J. Quinn ◽  
...  

PURPOSE: Previous studies demonstrated that chemotherapy with either cisplatin, vincristine, and fluorouracil (regimen A) or cisplatin and continuous infusion doxorubicin (regimen B) improved survival in children with hepatoblastoma. The current trial is a randomized comparison of these two regimens. PATIENTS AND METHODS: Patients (N = 182) were enrolled onto study between August 1989 and December 1992. After initial surgery, patients with stage I–unfavorable histology (UH; n = 43), stage II (n = 7), stage III (n = 83), and stage IV (n = 40) hepatoblastoma were randomized to receive regimen A (n = 92) or regimen B (n = 81). Patients with stage I–favorable histology (FH; n = 9) were treated with four cycles of doxorubicin alone. RESULTS: There were no events among patients with stage I-FH disease. Five-year event-free survival (EFS) estimates were 57% (SD = 5%) and 69% (SD = 5%) for patients on regimens A and B, respectively (P = .09) with a relative risk of 1.54 (95% confidence interval, 0.93 to 2.5) for regimen A versus B. Toxicities were more frequent on regimen B. Patients with stage I-UH, stage II, stage III, or stage IV disease had 5-year EFS estimates of 91% (SD = 4%), 100%, 64% (SD = 5%), and 25% (SD = 7%), respectively. Outcome was similar for either regimen within disease stages. At postinduction surgery I, patients with stage III or IV disease who were found to be tumor-free had no events; those who had complete resections achieved a 5-year EFS of 83% (SD = 6%); other patients with stage III or IV disease had worse outcome. CONCLUSION: Treatment outcome was not significantly different between regimen A and regimen B. Excellent outcome was achieved for patients with stage I-UH and stage II hepatoblastoma and for subsets of patients with stage III disease. New treatment strategies are needed for the majority of patients with advanced-stage hepatoblastoma.


2012 ◽  
Vol 518-523 ◽  
pp. 5813-5816
Author(s):  
Liang Chen ◽  
Zheng Qing Wang ◽  
Yan Shi Xie ◽  
Wei Huang

In this paper, factor analysis are used to study the early Paleogene paleoenvironmental evolution from the Sanshui Basin, and main conclusions can be obtained as follows: stage I (89.0-73.0m), relatively dry and relatively low temperatures; stage II (73.0-52.5m), warm and humidity of the climate and environment; stage III (52.5-22.5m), the ancient climate conditions change quickly, showing the alternating warm and humidity and dry; stage IV (22.5-0m), prevailing warm and moist climatic conditions.


Sign in / Sign up

Export Citation Format

Share Document