Early Lymphocyte Recovery Predicts Superior Disease Free Survival and Overall Survival after High Dose Chemotherapy and Autologous Stem Cell Transplantation in Non-Hodgkin Lymphoma Patients

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3992-3992
Author(s):  
Walter G Borelli ◽  
Cristina Otero ◽  
Ana Ines Landoni ◽  
Alicia Magariños ◽  
Mercedes Zamora ◽  
...  
Keyword(s):  
Overall Survival ◽  
Hodgkin Lymphoma ◽  
Progression Free Survival ◽  
High Dose ◽  
Free Survival ◽  
Cell Dose ◽  
Non Hodgkin Lymphoma ◽  
Group 2 ◽  
Autologous Hsct ◽  
Group 1

Abstract Introduction. An early absolute lymphocyte count (ALC) recovery after high dose therapy (HDT) and autologous hematopoietic stem cell transplantation (HSCT) in non Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), multiple myeloma and acute leukemia patients has been related with an improved outcome due to a better immune restoration. In this retrospective study we analyze a population of NHL patients to evaluate ALC recovery after autologous HSCT and its relation with post-transplant survival. Patients and methods. Fifty-three consecutive adult NHL patients received HDT followed by autologous HSCT in a single center between 2000 and 2012. Only individuals with at least 6 months post-transplant follow up were included. All patients received the same conditioning regimen (BEAM: carmustine, etoposide, cytarabine and melphalan) followed by peripheral blood stem cells previously collected by leukapheresis. Median CD34+ cell dose was 4.13 x 106/kg (1.62 – 12.58). Patients were divided into two groups: ALC at day +15 inferior than 500/mm3 (group 1) and ALC at day +15 superior or equal than 500/mm3 (group 2). Differences between groups were analyzed using t-Student and Chi-Square tests, with statistical significance determined at p<0.05. Progression-free survival (PFS) and overall survival (OS) were analyzed by Kaplan Meier method. Differences in survival between the two groups were determined by log-rank test. Results. No differences were observed between groups regarding gender, histology, disease status at transplant and cell dose. Patients into group 1 were older and more heavily pre-treated. Neutrophil and platelet engraftment were significantly faster in group 2 (Table 1). After a median follow-up of 56 months, progression-free survival (PFS) and overall survival (OS) were superior in group 2 patients. Median PFS was 47 months and not reached (p=0.013) and OS was 51 months and not reached (p=0.016) in groups 1 and 2 respectively (figures 1 and 2). Discussion. An early ALC recovery after autologous HSCT is associated with a better PFS and OS in NHL patients. Patients with ALC major or equal than 500/mm3 had a shorter time to neutrophil and platelet recovery and a shorter stay at transplant unit. In this study, CD34+ cell dose does not appears as a determinant factor for lymphocyte recovery. The extent of pre-transplant chemotherapy may influence ALC recovery after transplant. These results confirm the association between lymphocyte recovery and outcome in NHL patients after autologous HSCT. Table 1.Patient characteristics and comparison between groups 1 and 2.Group 1Group 2pALC< 500 /mm3> 500/mm3N2528Age, median (range)57 (29 - 66)41 (15 - 65)0.008Female gender (n)1214NSHistology (n)DLBCL1316 NSFollicular lymphoma62Mantle cell lymphoma32Peripheral T cell lymphoma13Indolent lymphoma12Others13Individuals who received two or more lines of pre-transplant treatment (n)1180.01Disease status at transplant (n)Complete remission711 NSPartial remission1613Progressive disease21CD34+ cells dose, median (range) (10E6/kg)3.45 (1.62 - 9.12)4.40 (2.28 - 12.58)NSMononuclear cells dose, median (range) (10E8/kg)8,84 (3,55 - 18,74)6,7 (1,94 - 27)NSDays to achieve ANC > 500/mm3, median (range)11 (7 - 30)8 (3 - 16)0.034Days to achieve platelets > 20.000/mm3, median (range)9 (2 - 49)5 (1 - 10)0.003Length of stay in transplant unit, days, median (range)30 (20 - 59)24 (20 - 35)0.001 Figure 1. PFS and ALC on day +15. Group 1: patients with ALC < 500/mm3 (dotted line); group 2: patients with ALC > 500/mm3 (solid line). Figure 1. PFS and ALC on day +15. Group 1: patients with ALC < 500/mm3 (dotted line); group 2: patients with ALC > 500/mm3 (solid line). Figure 2. Figure 2. OS and ALC on day +15. Group 1: patients with ALC < 500/mm3 (dotted line); group 2: patients with ALC > 500/mm3 (solid line). Disclosures No relevant conflicts of interest to declare.

Substantially Improved Outcome of Adult Burkitt Non-Hodgkin Lymphoma and Leukemia Patients with Rituximab and a Short-Intensive Chemotherapy; Report of a Large Prospective Multicenter Trial

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 667-667
Author(s):  
Dieter Hoelzer ◽  
Jan Walewski ◽  
Hartmut Döhner ◽  
Mathias Schmid ◽  
Wolfgang Hiddemann ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
Burkitt Lymphoma ◽  
Progression Free Survival ◽  
Multicenter Trial ◽  
High Dose ◽  
Intensive Chemotherapy ◽  
Free Survival ◽  
Non Hodgkin Lymphoma ◽  
Prospective Multicenter Trial

Abstract Abstract 667 Aim. The aim of this study was to prove in a large prospective multicenter trial the tolerance and efficacy of short-intensive chemotherapy combined with the antibody Rituximab directed against CD20 for patients with Burkitt Non-Hodgkin lymphoma (B-NHL) and Burkitt leukemia (B-L). Background. In adult Burkitt lymphoma/leukemia with short-intensive chemotherapy regimen - mostly derived from pediatric protocols - a complete remission (CR) rate of 83% and an overall survival (OS) of 62% (both weighted mean) could be achieved. Further intensification of chemotherapy apparently did not improve the overall outcome. This was the rationale to integrate the monoclonal anti-CD20 antibody Rituximab in B-NHL / leukemia patients with a CD20 expression of >90%. Patients and Methods. 363 adult patients (229 B-NHL and 134 B-L), 15 years or older (without age limit) were recruited from 98 centers in the German Multicenter Study Group for Adult Acute Lymphoblastic Leukemia (GMALL) B-ALL/NHL 2002 protocol, initiated in 8/2002 until 06/2011. Median age of the Burkitt lymphoma cohort was 40 years (16–79) and for the Burkitt leukemia cohort 47 years (16–85). CNS involvement was observed in 6% / 18%. In the Burkitt lymphoma cohort, 6% had mediastinal tumor, 53% had stage III/IV and IPI>2 of 35%. Treatment. The treatment consisted of 6 five-day chemotherapy cycles with high-dose methotrexate (HD-MTX) 1500 mg/m2 (total 6 doses), high-dose cytosine arabinoside (HD-AraC) 2000 mg/m2 (total 4 doses), cyclophosphamide, etoposide, ifosphamide and corticosteroids, and a triple intrathecal therapy (MTX, AraC, Dexa). Elderly patients >55 years received reduced drug doses (500 mg/m2), particularly no C-cycles with HD-AraC among other drugs. Rituximab was given d ⦵1 before each cycle and twice at 4 week intervals thereafter, for overall 8 doses. Total treatment duration was 28 weeks (figure 1). Results. CR rate in B-NHL patients was 91% (182/229) and 86% (162/182) in B-L patients. For the B-NHL cohort the results were excellent with an OS of 88%, and a progression-free survival (PFS) of 83% at >7 yrs, with no significant difference in OS for adolescents 15-≤25 yrs with 91%, adults 26-'55 yrs with 91% or elderly >55 yrs with 80%. In Burkitt leukemia the OS for adolescents was also very promising with 90%, for adults OS was 71%, but inferior for elderly patients with 46%. Therefore two cycles C, including high dose AraC, were added for older patients in an amendment. Prognostic factors. In B-NHL patients the age adapted International Prognostic Index (aIPI) was the only significant prognostic factor for OS (p = 0.02) whereas in B-L patients the factors age 15-≤25, 26-≤55 and >55 yrs (p = 0.0007) and a lower platelet count <25000/μl (p = 0.01) had an adverse influence on OS. Major toxicity grade III/IV was less pronounced in B-NHL than in B-L, neutropenia 64% vs. 68%, mucositis 31% vs. 54% and infections 23% vs. 49%. Neurotoxicity was low in both cohorts. Conclusion. In the largest prospective trial for adult Burkitt NHL/leukemia, overall survival and progression-free survival could be substantially improved by a combination of short-intensive chemotherapy with Rituximab with manageable toxicity. Even with lower doses of HD-MTX outcome of B-NHL was excellent in all age groups, including elderly. Disclosures: No relevant conflicts of interest to declare.

Clinicopathologic Characteristics and Clinical Outcomes in Patients with Testicular Non-Hodgkin Lymphoma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 5111-5111
Author(s):  
Jeongseok Kim ◽  
Dok Hyun Yoon ◽  
Ji Hyun Park ◽  
Il Young Jang ◽  
Shin Kim ◽  
...  
Keyword(s):  
Overall Survival ◽  
T Cell ◽  
Hodgkin Lymphoma ◽  
Clinical Outcomes ◽  
Group Performance ◽  
Progression Free Survival ◽  
Clinicopathologic Characteristics ◽  
Free Survival ◽  
Non Hodgkin Lymphoma ◽  
Ecog Ps

Abstract Abstract 5111 Purpose We aimed to evaluate the clinicopathologic characteristics and clinical outcomes in patients with testicular non-Hodgkin lymphoma. Material and Methods We reviewed the medical records of 24 patients with testicular non-Hodgkin lymphoma diagnosed at the Asan Medical Center between November, 2000 and June, 2012. Results Median age of the patients was 52 years (23–79 years). Histopathologic subtypes were as follows: DLBCL (n=18, 75%), Burkitt's lymphoma (n=2, 8. 3%), extranodal natural killer/T-cell lymphoma (NKTCL) (n=2, 8. 3%), chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) (n=1, 4. 2%) and T-cell lymphoblastic lymphoma (T-LBL) (n=1, 4. 2%). Ten patients (41. 7%) were in stage I, 1 patient (4. 2%) in stage II, and the other 13 patients (54. 2%) were in stage IV. Eastern Cooperative Oncology Group Performance Status (ECOG PS) was 1 in 22 patients (87. 5%) and >1 in 5 patients (20. 8%). Serum LDH levels were elevated in 14 patients (58. 3%). International Prognostic index (IPI) score was low (0–1) in 6 patients (25%), low-intermediate (2) in 8 patients (33. 3%), high-intermediate (3) in 7 patients (29. 2%), high (4–5) in 3 patients (12. 5%). B-symptoms were present in 4 patients (16. 7%). Bilateral testicular involvement was observed in 5 patients (20. 8%). Fifteen patients (62. 5%) underwent orchiectomy as an initial therapeutic and diagnostic procedure. All the patients underwent chemotherapy: R-CHOP (n=16, 66. 6%), CHOP (n=2, 8. 3%), and other regimens (n=6, 25%). None received intrathecal prophylaxis just except a T-LBL patient. Prophylactic radiotherapy to contralateral testis was given in 12 patients (50%). Twenty-one patients (87. 5%) achieved complete response. At a median follow-up duration of 22 months (1–139 months), 2 patients (8. 3%) showed disease progression and 7 patients (29. 2%) experienced disease recurrence; in the central nervous system (n=2, 8. 3%), regional lymph nodes (n=3, 12. 5%), bone marrow (n=1, 4. 2%), nasopharynx (n=1), skin (n=1), and testicular bed (n=1). Five patients (20. 8%) died of sepsis (n=3, 12. 5%) or progression of disease (n=2, 8. 3%). Median progression free survival and overall survival were 20 months (1–139 months) and 22 months (1–139 months), respectively. ECOG PS >1 (p=0. 015) and bilateral testicular involvement (p=0. 000) were associated with a significantly short progression free survival (PFS). ECOG PS >1 (p=0. 001), high-intermediate or high risk of IPI (p=0. 010), presence of B symptoms (p=0. 035), and bilateral testicular involvement (p=0. 001) were associated with a significantly short overall survival. Conclusions Testicular lymphoma is a rare but aggressive extranodal lymphoma. High ECOG PS, high IPI, B symptom, and bilateral testicular involvement were associated with poor prognosis. Disclosures: No relevant conflicts of interest to declare.

scholarly journals EPID-13. A RETROSPECTIVE ANALYSIS TO STUDY THE SURVIVAL CHARACTERISTICS OF PATIENTS WITH FIRST PROGRESSION OF GLIOBLASTOMA AT THE CLEVELAND CLINIC

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii81-ii81
Author(s):  
Yasmeen Rauf ◽  
Jimmy Yao ◽  
Addison Barnett ◽  
Yanwen Chen ◽  
Brian Hobbs ◽  
...  
Keyword(s):  
Overall Survival ◽  
Clinical Trials ◽  
Median Overall Survival ◽  
Cleveland Clinic ◽  
Progression Free Survival ◽  
Free Survival ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract BACKGROUND Glioblastoma (GBM) is the most aggressive primary central nervous system malignancy. The median overall survival is 15 to 18 months with treatment and decreases to nine months after first progression. METHODS This is a retrospective study. Data was collected from all patients with first progression of GBM treated at CCF between Jan 2012 to Jan 2020. Eight cohorts of patients were evaluated: Group 1 received cytotoxic chemotherapy, Group 2 received bevacizumab alone, Group 3 received surgical or reirradiation alone, Group 4 were enrolled in clinical trials. Each group was divided into methylated and unmethylated cohorts. RESULTS Median overall survival was 12.4 months for patients with first progression of GBM (n= 248). Among the methlylated patients, the median overall survival was 16.5 months for group 1, 13.4 for group 2, 23.7 for group 3, and 17.3 for group 4. Among the unmethylated patients, the Median overall survival was 8.6 months for group 1, 7.7 months for group 2, 11.7 months for group 3 and 10.7 months for group 4. (p= 0.00016). Progression free survival (PFS) was 4.3 months for all patients with first progression of GBM. Among the unmethlylated patients, the PFS was 3.6 months for group 1, 15.3 months for group 2, 4.8 months for group 3, and 6.1 months for group 4. Among the unmethylated patients, the PFS was 2.3 months for group 1, 3.9 months for group 2, 3.8 months for group 3, and 4.4 months for group 4. (p &lt; 0.0001). CONCLUSION Patients with first progression of GBM had the best overall survival in the cohort that underwent a surgical or reirradiation. The best progression free survival was for patients who were treated with Bevacizumab if they were methylated and those enrolled in clinical trials if they were unmethylated. The study was statistically significant.

Survival characteristics of patients with first progression of glioblastoma at Cleveland Clinic Foundation.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14526-e14526
Author(s):  
Yasmeen Rauf ◽  
Jimmy Yao ◽  
Addison Barnett ◽  
Yanwen Chen ◽  
Brian Hobbs ◽  
...  
Keyword(s):  
Overall Survival ◽  
Clinical Trials ◽  
Median Overall Survival ◽  
Methylation Status ◽  
Progression Free Survival ◽  
Free Survival ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

e14526 Background: Glioblastoma (GBM) is the most common primary central nervous system malignancy, with a median overall survival of 14 to 17 months. First progression refers to progressive disease after initial radiation with or without chemotherapy. The median overall survival of patients with the first progression of GBM is nine months. Currently, there is no standard treatment for progressive GBM. Common treatment options include clinical trials, surgical resection, re-irradiation, stereotactic radiosurgery, cytotoxic chemotherapies, bevacizumab, and tumor treating fields. Methods: This retrospective study reviewed 244 patients with the first progression of GBM who were treated at CCF between Jan 2012 to Jan 2020. Statistical analyses included patients who had biopsy-proven GBM, a known MGMT methylation status, a KPS of more than 70 and presented with the first progression on MRI brain. Four cohorts of patients were evaluated: Group 1 received cytotoxic chemotherapy, Group 2 received bevacizumab alone, Group 3 received surgical or radiation therapy alone, Group 4 received experimental treatments. Results: The median overall survival (OS) and progression-free survival (PFS) was 12.4 months (95% CI: 10.9 to 14.3) and 4.3 months (95% CI: 3.9 to 5.4), respectively. The cohorts demonstrate statistical significant differentiation for PFS (p = 0.021) but not OS (p = 0.19). Second progression was noted at a median interval of 5.6 months in Group 4, 4.3 months in Group 2, 3.8 months Group 3 and 3.2 months in Group 1. Conclusions: Patients with the first progression of GBM had a better progression-free survival on experimental clinical trials than those in other cohorts.

Immediate and long-term results of the first line chemotherapy in patients with metastatic triple negative breast cancer. Final analysis of randomized study

2020 ◽  
pp. 75-80
Author(s):  
S.A. Lyalkin ◽  
◽  
L.A. Syvak ◽  
N.O. Verevkina ◽  
◽  
...  
Keyword(s):  
Breast Cancer ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Randomized Study ◽  
Progression Free Survival ◽  
First Line ◽  
Free Survival ◽  
Group 2 ◽  
Line Chemotherapy ◽  
Group 1

The objective: was to evaluate the efficacy of the first line chemotherapy in patients with metastatic triple negative breast cancer (TNBC). Materials and methods. Open randomized study was performed including 122 patients with metastatic TNBC. The efficacy and safety of the first line chemotherapy of regimens АТ (n=59) – group 1, patients received doxorubicine 60 мг/м2 and paclitaxel 175 мг/м2 and ТР (n=63) – group 2, patients received paclitaxel 175 мг/м2 and carboplatin AUC 5 were evaluated. Results. The median duration of response was 9.5 months (4.5–13.25 months) in patients received AT regimen and 8.5 months (4.7–12.25 months), in TP regimen; no statistically significant differences were observed, р=0.836. The median progression free survival was 7 months (95% CI 5–26 months) in group 1 and 7.5 months (95% CI 6–35 months) in group 2, p=0.85. Both chemotherapy regimens (AT and TP) had mild or moderate toxicity profiles (grade 1 or 2 in most patients). No significant difference in gastrointestinal toxicity was observed. The incidence of grade 3–4 neutropenia was higher in patients of group 2 (TP regimen): 42.8% versus 27% (р<0.05). Conclusions. Both regimens of chemotherapy (AT and TP) are appropriate to use in the first line setting in patients with metastatic TNBC. Key words: metastatic triple negative breast cancer, chemotherapy, progression free survival, chemotherapy toxicity.

scholarly journals Efficacy of Chemotherapy or Chemo-Anti-PD-1 Combination after Unsatisfactory Response of Anti-PD-1 Therapy for Relapsed and Refractory Hodgkin Lymphoma: A Retrospective Series from Lysa Centers

Blood ◽  
2017 ◽  
Vol 130 (Suppl_1) ◽  
pp. 652-652
Author(s):  
Cédric Rossi ◽  
Julia Gilhodes ◽  
Marie Maerevoet ◽  
Charles Herbaux ◽  
Pauline Brice ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Hodgkin Lymphoma ◽  
Research Funding ◽  
Checkpoint Inhibitors ◽  
Objective Response ◽  
Complete Response ◽  
High Rate ◽  
High Dose ◽  
Group 2 ◽  
Group 1

Abstract Introduction: Hodgkin lymphoma (HL) pts who relapse after high-dose therapy (HDT) and autologous stem cell transplantation (ASCT) and brentuximab vedotin (BV) therapy have a poor outcome. For these relapsed and refractory (R/R) HL pts, anti-PD-1 therapy gives a high rate of objective responses. However, the rate of complete response (CR) remains modest and in the updated results of anti-PD-1 therapy clinical trials, about 50% of pts are still without progressive disease after one year of treatment. As anti-PD-1 therapy modifies the anticancer immune response, we hypothesize that anti-PD-1 therapy may increase sensitivity to chemotherapy (CT) given after anti-PD-1 therapy (sequential strategy) or in combination with anti-PD-1 therapy after an unsatisfactory response to immunotherapy (concomitant strategy). We retrospectively analyzed these two clinical situations in 30 R/R HL pts from LYSA centers treated with anti-PD-1 therapy. Methods: We included R/R HL pts from 14 LYSA centers who received anti-PD-1 therapy in the context of clinical trials (N=4) or an authorization for temporary use (ATU) from the French medical drug agency (N=26). Before the anti-PD-1 therapy, pts had received a median of six (range, 2-14) lines of therapy, 69% had HDT+ASCT, 14% had allograft and 93% had been treated with BV. We considered two groups of pts: i. 19 pts (63%) in whom the anti-PD-1 therapy was stopped at the introduction of CT (Group 1); ii. 11 pts (37%) with an unsatisfactory response to anti-PD-1 therapy in whom a combination of CT with immunotherapy was initiated to optimize the response (Group 2). The quality of the response after the introduction of CT was evaluated retrospectively by each treating physicians according to Cheson 2007 or 2014 criteria. We also determined whether new CT treatments after and in combination with anti-PD-1 therapy led to unexpected toxicities and whether new treatment schedules made pts eligible for allograft. Results: At the start of anti-PD-1, the median age of pts was 37 years old (range, 20-75), 24% had Ann Arbor III/IV stages, 34% had B symptoms and 21% had a performance status (PS) of 2-3. Patients received a median of 10 infusions (range, 2-52) of anti-PD-1 therapy with nivolumab (N=26, 87%) or pembrolizumab (N=4, 13%). The best responses achieved during anti-PD-1 therapy were a complete response (CR) for 5 patients, a partial response (PR) for 17 pts, stable disease (SD) for 2 pts and progression for 6 pts. In group 1, 17 pts were in progression, one pt in PR, and another pt in SD at the end of anti-PD-1 therapy alone. In group 1, after anti-PD-1 therapy, the pts were treated with vinblastine (N=3), gemcitabine (N=2) or bendamustine alone (N=3) or in combination with BV (N=4), GVD (N=1), ICE (N=1), DHAP (N=1), escalated BEACOPP (N=1), vinorelbine (N=1), vepeside (N=1) and caelyx (N=1). In group 2, before the combination, the response status was progression for 7 pts and PR for 4 pts. In group 2, to optimize the response to anti-PD-1, pts received vinblastine (N=7), gemcitabine (N=2) and BV (N=2). In the 28 evaluable pts, 11/18 (61%) in group 1 and 9/10 (90%) in group 2 showed an improved response after chemotherapy alone or combination with anti-PD-1 therapy respectively. In group 1, there were 6 CR (32%), 5 PR (26%), 1 SD (5%) and 6 PD (32%) (Figure 1B). In group 2, there were 5 CR (45%), 5 PR (45%) and 1 SD (10%) (Figure 1A). Of note, among the ten pts treated with vinblastine, 4 were in CR, 3 in RP, 1 in SD and 2 in progression. No unexpected toxicity was observed during the CT. Four pts had an allograft after the sequential CT (N=3) and concomitant CT strategy (N=1). Three pts were in CR 274, 279 and 480 days after the allograft and the fourth has not yet been evaluated. Allografts are now scheduled for 6 pts. With a median follow-up of 9.1 months (95%CI, 6.1-14) following the initiation of chemotherapy (alone or combined) the median PFS and OS were 8.4 and 14.6 months, respectively. Conclusions: Our retrospective study showed that pts with an unsatisfactory response or PD with anti-PD-1 therapy had a new objective response with CT alone (61%) or CT in combination with anti-PD-1 therapy (90%). This response could make some pts eligible for allograft. Prospective clinical trials are needed to confirm the synergistic effect of CT with anti-PD-1 therapy and to determine which CT provides the best results in combination with these checkpoint inhibitors. Figure 1 Figure 1. Disclosures Ysebaert: Janssen: Consultancy, Research Funding, Speakers Bureau. Ghesquières: Celgene and Mundipharma: Consultancy, Honoraria; Roche: Research Funding.

Staged management of cardiac disease and concomitant early lung cancer: a 20-year single-center experience

2020 ◽  
Author(s):  
Jérémy Tricard ◽  
Daniel Milad ◽  
Anaëlle Chermat ◽  
Serge Simard ◽  
Yves Lacasse ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Overall Survival ◽  
Disease Free Survival ◽  
Free Survival ◽  
Cardiac Procedure ◽  
Independent Risk Factors ◽  
Group 2 ◽  
Disease Free ◽  
Group 1

Abstract OBJECTIVES The association of unstable heart disease and resectable lung cancer is rare. The impacts of staged management, cardiac surgery with cardiopulmonary bypass (CPB) versus angioplasty, on long-term survival and cancer recurrence remain debated. We report our experience using staged management. METHODS From 1997 to 2016, 107 patients were treated at the Quebec Heart and Lung Institute: 72 underwent cardiac surgery with CPB (group 1), 35 were treated with angioplasty (group 2), followed by oncological pulmonary resection. RESULTS Two postoperative deaths (3%) and 1 ischaemic heart complication (1%) were reported in group 1. One death (3%) was reported in group 2. Two-year overall survival was 82% (59/72) in group 1 and 80% (28/35) in group 2; 5-year overall survival was 62% (33/53) in group 1 and 63% (19/30) in group 2. Two-year disease-free survival in group 1 was 79% (57/72) and 77% (27/35) in group 2; 5-year disease-free survival was 58% (31/53) in group 1 and 60% (18/30) in group 2. The independent risk factors for death after thoracic surgery were transfusions (P = 0.004) and grade ≥3 complications (P = 0.034). Independent risk factors for recurrence included the cancer stage (P &lt; 0.001) and, paradoxically, a shorter delay between cardiac and lung procedures (P = 0.031). CONCLUSIONS When a staged management remains feasible after cardiac procedure, oncological outcomes of patients with cardiopathy and lung cancer are satisfactory. CPB does not seem to be deleterious. The delay between procedures should intuitively be as small as possible but not at the expense of good recovery after the cardiac procedure.

Single or Tandem Autologous Stem-Cell Transplantation Given According to Prognostic Factors at Relapse for Hodgkin Lymphoma.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2069-2069
Author(s):  
Pauline Brice ◽  
Franck Morschhauser ◽  
Marine Divine ◽  
Christophe Ferme ◽  
Gilles Salles
Keyword(s):  
Stem Cell ◽  
Prognostic Factors ◽  
Stem Cell Transplantation ◽  
Hodgkin Lymphoma ◽  
Induction Chemotherapy ◽  
High Dose ◽  
Refractory Disease ◽  
High Dose Therapy ◽  
Group 2 ◽  
Group 1

Abstract Patients with relapsed hodgkin lymphoma (HL)have a different prognostic after high-dose therapy (HDT)according to time to relapse and extend of relapse. From 1995 to 1997, 48 patients with early relapse or refractory HL were included in a pilot study of tandem transplantation to evaluate the feasibility before the protocol. From 1998 to 2002, 200 patients with refractory disease or first relapse of HL were prospectively treated with induction chemotherapy followed by HDT and autologous stem-cell transplantation (ASCT). Patients were stratified in 2 groups according to prognostic factors at relapse: groupe 1 (unfavorable relapse: primary refractory disease or early/disseminated relapse) and group 2 (favorable relapse: patients with either early or disseminated relapse). Induction chemotherapy consisted of ifosfamide/etoposide with doxorubicin (IVA) in 70% of patients or with vinorelbine and mitoguazone (MINE)for the remainings. Group 1, patients received 2 cycles of chemotherapy, PBSC collection and tandem ASCT, with a CBV mitoxantrone (30 mg/m2) and 2 months later cytarabine (6g/m2), melphalan (140mg/m2)with total body irradiation (40%) or busulfan (12 mg/kg) followed by the second ASCT. Group 2, patients received 3 cycles of chemotherapy, PBSC collection and a BEAM regimen followed by ASCT. Final results, updated, January 2005 are presented with 245 evaluable patients. Results: after induction chemotherapy overall response rate was at 61% in group 1 and 96% in group 2. In group 1, 70% received the two ASCT, the major reason not to receive the procedure was disease progression after induction chemotherapy (10%) or after the first ASCT (15%), than low stem-cell collection (4%) or toxicity (2%). In group 2, 97% of patients received ASCT and 1 patient received a tandem ASCT for refractory relapse. 5 patients died from toxicity in group1 and none in group2, but 2 secondary leukemia were observed in this group. In intent to treat analysis, at a 3 years median follow-up from the relapse, the EFS was at 45% in group 1 versus 75% in group 2 and the survival at 55% in group 1 versus 80% in group 2. Despite a different consolidation between group 1 and 2, results remained better in group 2. In conclusion, these results confirmed the importance of prognostic factors at relapse of HL.No differences were found in the unfavorable group 1 between refractory patients and early/disseminated relapse. HL patients with adverse prognostic factors (group 1) but responding to second line chemotherapy and eligible for tandem ASCT may benefit from this procedure with an EFS at 70%. The major cause of failure was chemoresistance either at induction or after high-dose therapy.

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