Residual abdominal masses in aggressive non-Hodgkin's lymphoma after combination chemotherapy: significance and management.

1988 ◽  
Vol 6 (12) ◽  
pp. 1832-1837 ◽  
Author(s):  
A Surbone ◽  
D L Longo ◽  
V T DeVita ◽  
D C Ihde ◽  
P L Duffey ◽  
...  
Keyword(s):  
Complete Remission ◽  
Combination Chemotherapy ◽  
Residual Disease ◽  
Aggressive Lymphoma ◽  
Radiographic Examination ◽  
Bulky Disease ◽  
Residual Mass ◽  
Negative Laparotomy ◽  
Abdominal Masses ◽  
Residual Masses

When patients with aggressive lymphoma present with intraabdominal disease, a stable residual mass is frequently detected radiographically at the time of the clinical complete remission. To discern the optimal management for this clinical problem, we reviewed 241 patients with aggressive lymphoma treated at the National Cancer Institute (NCI) from 1977 to 1986. Seventy-two/241 patients (30%) had an abdominal mass at diagnosis and 29/72 (40%) were left with a radiographically detectable residual mass at clinical complete remission. The likelihood of a residual mass was much higher for patients with bulky disease (P2 less than .0003) (two-tailed test [P2]). Twenty-nine patients had radiologically stable residual masses after therapy, and of 22 (76%) with pathologic evaluations, 21 had negative specimens (95%) and one was positive (5%). None of the patients with negative pathologic evaluation has relapsed in the abdominal site (median follow-up, 31 months). Seven patients were observed clinically without laparotomy: five are alive, without evidence of disease, at 2 to 9 years; two relapsed with disseminated disease within 2 months of chemotherapy. Initial tumor size and size of the residual mass did not correlate with residual disease, since residual masses identified by radiographic examination did not usually harbor viable lymphoma cells. Aspiration cytology was negative for residual tumor in 15/16 cases. One negative result was not confirmed at laparotomy, presumably due to sampling error. The one positive aspiration was followed by a negative laparotomy, possibly due to subsequent tumor necrosis. Restaging laparotomy has a low yield. In most patients with aggressive lymphoma who have otherwise completely responded to carefully administered full-dose combination chemotherapy, stable residual abdominal masses can be closely followed clinically without surgical exploration.

Dimension of Residual CT Scan Mass in Hodgkin's Lymphoma (HL) Is a Negative Prognostic Factor in Patients with PET Negative After Chemo+/− Radiotherapy

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 93-93 ◽  
Author(s):  
Massimo Magagnoli ◽  
Katia Marzo ◽  
Monica Balzarotti ◽  
Marcello Rodari ◽  
Rita Mazza ◽  
...  
Keyword(s):  
Ct Scan ◽  
Treatment Program ◽  
Prognostic Impact ◽  
Line Treatment ◽  
Bulky Disease ◽  
Residual Mass ◽  
Pet Ct ◽  
Significant Difference ◽  
Residual Masses ◽  
Pet Ct Scan

Abstract Abstract 93 BACKGROUND. Positron emission tomography (PET) with 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) currently represents the mainstay for response assessment in HL, as defined by revised response criteria (Cheson, 2007). PET negativity is mandatory to define complete remission (CR), independently from the persistence of residual masses at computed tomography (CT scan). Nevertheless, some reports suggest a slightly worse prognosis among patients (pts) with CT scan residual masses. The aim of this study was to evaluate the unfavorable predictive value of residual CT scan masses in HL pts with PET negative at the end of treatment. MATERIAL AND METHODS. The present analysis was retrospectively conducted in 105 pts with negative PET at the end of first or second line treatment, at our institution, from February 2004 to February 2009. All pts had disease evaluation performed also with CT scan. RESULTS. Main clinical characteristics: median age 58 years, males 62, B-symptoms 25, bulky disease 41, prior radiotherapy 57. Seventy-four pts were evaluated after first line treatment program, while 31 pts after salvage therapy program. In 76 pts, residual CT scan mass (PET-/CT scan +) of at least 2.0 cm in the largest diameter was assessed. Fifty-seven had only one site residual mass, while 19 pts had more than one site. Considering the whole series, with a median follow-up of 45 months, 23 pts relapsed, nine patients died and 94 are alive without disease. The five year disease-free survival (DSF) for PET-/CT scan- vs PET-/CT scan+ pts was 89.4% and 68.7% respectively (P=0.053). The prognostic impact of residual mass at CT scan had a correlation with the dimension of the residual itself in a continuous fashion: the larger is the mass, the lower the DFS: HR 1.03 (1.01; 1.05) p 0.007. This difference is even more pronounced when a cut-off of 4 cm in the largest diameter of the residual mass is applied: in patients with a mass diameter ≥ vs < 4 cm, DFS is 50% vs 82% respectively (HR 3.25: CI 1.5; 7.04, p 0,029 – figure 1). Among all the other prognostic factors analyzed (number of masses, first vs salvage treatment program, sex, bulky disease, B-symptoms), no correlation with DSF or overall survival (OS) emerged. CONCLUSIONS. In our study we observe a significant difference in DFS among PET negative pts with or without CT scan residual masses after therapy for HL. This difference is more significant when the residual mass is larger than 4 cm. Thus, despite PET is the main tool in respons-e definition, CT scan maintains an important role and can not yet be abandoned. The role of consolidation radiotherapy in these cases should be focused. Disclosures: No relevant conflicts of interest to declare.

Treatment of localized aggressive lymphomas with combination chemotherapy followed by involved-field radiation therapy.

1989 ◽  
Vol 7 (9) ◽  
pp. 1295-1302 ◽  
Author(s):  
D L Longo ◽  
E Glatstein ◽  
P L Duffey ◽  
D C Ihde ◽  
S M Hubbard ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Complete Remission ◽  
Combination Chemotherapy ◽  
Hospital Admissions ◽  
Artery Bypass ◽  
Large Cell ◽  
Aggressive Lymphoma ◽  
High Dose ◽  
Field Radiation ◽  
Involved Field

Localized lymphomas of diffuse and aggressive histology sometimes undergo early hematogenous dissemination such that local therapies (surgery alone or followed by radiation therapy) are not curative in 100% of cases. We have treated 47 clinical stage I or IE patients with aggressive lymphoma histologies (diffuse large-cell, diffuse mixed, diffuse immunoblastic, follicular large-cell, diffuse small-non-cleaved cell) with four monthly cycles of an eight-drug combination chemotherapy program consisting of cyclophosphamide, etoposide, doxorubicin, nitrogen mustard (mechlorethamine), procarbazine, high-dose methotrexate with leucovorin rescue, and prednisone (Pro-MACE-MOPP) administered systemically followed by 40 Gy involved-field radiation therapy. Forty-five (96%) patients achieved a complete remission and no patient has relapsed with a median follow-up time of 42 months (range, 8 to 90). Both patients failing to achieve a complete remission died of lymphoma, and one patient died free of lymphoma 45 months after diagnosis during coronary artery bypass surgery unrelated to lymphoma or its treatment. Hospital admissions were necessary to manage complications on nine of 188 (5%) cycles of treatment. There were no treatment-related deaths. ProMACE-MOPP plus involved-field radiation therapy is safe and effective treatment for localized aggressive lymphoma.

Treatment outcome and prognostic factors for primary nasal lymphoma.

1995 ◽  
Vol 13 (3) ◽  
pp. 666-670 ◽  
Author(s):  
R Liang ◽  
D Todd ◽  
T K Chan ◽  
E Chiu ◽  
A Lie ◽  
...  
Keyword(s):  
T Cell ◽  
Complete Remission ◽  
Combination Chemotherapy ◽  
Disease Free Survival ◽  
Stage I ◽  
Stage Iii ◽  
Chinese Patients ◽  
Low Grade ◽  
Bulky Disease ◽  
Nasal Lymphoma

PURPOSE To report our experience managing a large series of Chinese patients with primary nasal lymphoma. PATIENTS AND METHODS From January 1975 to December 1993, 100 patients (median age, 50 years) with newly diagnosed primary nasal lymphoma were studied. There were four low-grade, 62 intermediate-grade, nine high-grade, and 25 unclassifiable lymphomas. Immunophenotyping was performed in 45 patients: eight B cell, 35 T cell, and two uncertain. All cases of angiocentric lymphoma that were typed were T cell. Fifty-two patients had stage I disease, 15 had stage II, four had stage III, and 29 had stage IV. Only 15 patients had B symptoms (weight loss, night sweats, and/or fever), and 11 had bulky disease. Thirty-nine patients with clinically localized stage I and II disease received local radiotherapy alone (before 1980), and the remaining 28 stage I and II patients received combination chemotherapy followed by local radiotherapy. The 33 patients with advanced stage III and IV disease were given combination chemotherapy, and additional radiotherapy was given to five of them who had bulky local disease. RESULTS Significantly higher complete remission rates were observed in patients with early stages of disease and those without B symptoms. Superior disease-free survival after complete remission was observed in patients with stage I/II disease. Univariate factors associated with a better overall survival included age less than 60 years, stage I disease, and absence of B symptoms. Survival was significantly better in the subgroup of patients with stage I disease. CONCLUSION Patients with nasal lymphoma, especially those with advanced disease, seemed to have a poor prognosis, and their clinical outcome was not improved significantly by the use of chemotherapy instead of radiotherapy or the use of doxorubicin-containing chemotherapeutic regimens.

Combined approach (chemotherapy plus surgery) in advanced testis tumours

1992 ◽  
Vol 59 (1_suppl) ◽  
pp. 124-126
Author(s):  
P. Tombolini ◽  
M. Ruoppolo ◽  
C. Bellorofonte ◽  
F. Beleggia ◽  
C. Zaatar ◽  
...  
Keyword(s):  
Complete Remission ◽  
Combination Chemotherapy ◽  
Advanced Disease ◽  
Germ Cell Tumors ◽  
Residual Tumor ◽  
Combined Approach ◽  
Beta Hcg ◽  
Residual Masses ◽  
Disease Free

Eight consecutive patients with stage III or bulky stage II germ cell tumors were treated with 4 cycles of cisplatin, etoposide and bleomycin combination chemotherapy (PEB). 3 patients were in complete remission (CR) after surgery of residual masses. 5 patients received 2–4 additional courses of P.V.I. (cisplatin, vinblastine and iphosphamide) chemotherapy and had complete remission (3 cases after surgery of residual masses). No residual tumor was found in 2 cases at surgery (25%). In the present series 3 patients had extrapulmonary disease, 2 retroperitoneal lymphnodes larger than 10 cm. and pulmonary disease. 1 patient had previous incomplete RPND. After a median follow-up period of 30 months (15–37) all the patients are disease-free with normal levels of AFP and beta HCG. In conclusion we repeat that intensive combination chemotherapy is the key for successful surgery of residual malignancy in patients with disseminated testicular cancer. Second-line of chemotherapy is more favourable than early surgery, in our opinion, for treatment of far-advanced disease.

Combination Chemotherapy with Cyclophosphamide, Adriamycin, Vincristine and Prednisone (CHOP) for Non-Hodgkin's Lymphomas with Unfavorable Histology: Preliminary Results

1980 ◽  
Vol 66 (6) ◽  
pp. 749-756 ◽  
Author(s):  
Pasquale Cornelia ◽  
Giuseppe Abate ◽  
Giuseppe Cornelia ◽  
Giovanni S. Bruni ◽  
Donato Zarrilli ◽  
...  
Keyword(s):  
Complete Remission ◽  
Combination Chemotherapy ◽  
Remission Rate ◽  
Early Stage ◽  
Stage I ◽  
Bone Marrow Toxicity ◽  
Actuarial Survival ◽  
Actuarial Survival Rate ◽  
Moderate Nausea ◽  
Hodgkin's Lymphomas

From January 1978 to June 1979, 29 selected, previously untreated patients with unfavorable histology of non-Hodgkin's lymphomas (12 DPDL, 7 DM, 9 DH and 1 DU) were submitted to the combination chemotherapy CHOP (cyclophosphamide, 750 mg/m2 i.v. on day 1; adriamycin, 50 mg/m2 i.v. on day 1; vincristine, 1.4 mg/m2 i.v. on day 1, and prednisone, 100 mg p.o. on day 1 through 5) every 21 days. Eighteen patients were in early stage (I or II) and 11 of them were also submitted to involved field radiotherapy (60Co), immediately before (stage I) or during (stage II) the chemotherapy, with a mean dosage of 4,500 rad. The remaining 11 patients were in advanced stage (III or IV) of disease and were treated with chemotherapy alone. We obtained 20 complete remissions (68%), 8 partial remissions (28 %) and 1 no response (4 %) to therapy. Sixteen of 18 patients (89 %) in early stages and 4 of 11 patients (36 %) in advanced stages achieved a complete remission. The bone marrow toxicity of the chemotherapy was moderate. Nausea, vomiting and diarrhea were frequent but well controlled by the support therapy. The actuarial survival rate of patients, after 18 months of follow-up, is 41 % (40 % in complete remission). The patients who achieved a complete remission are all alive and 65 % of them still relapse free. We believe that the combination chemotherapy CHOP improves the complete remission rate as well as the survival of patients with unfavorable histology of non-Hodgkin's lymphomas.

Early Molecular Response of Marrow Disease to Biologic Therapy Is Highly Prognostic in Neuroblastoma

2003 ◽  
Vol 21 (20) ◽  
pp. 3853-3858 ◽  
Author(s):  
Irene Y. Cheung ◽  
M. Serena Lo Piccolo ◽  
Brian H. Kushner ◽  
Nai-Kong V. Cheung
Keyword(s):  
Bone Marrow ◽  
Complete Remission ◽  
Minimal Residual Disease ◽  
Partial Remission ◽  
Progressive Disease ◽  
Residual Disease ◽  
Gm Csf ◽  
Stage 4 ◽  
Secondary Refractory ◽  
Minimal Residual

Purpose: A promising treatment strategy for stage 4 neuroblastoma patients is the repeated application of anti-GD2 immunotherapy after activating myeloid effectors with granulocyte-macrophage colony-stimulating factor (GM-CSF). To use early marrow response as a prognostic marker is particularly relevant for patients not likely to benefit from this therapy. Patients and Methods: Eighty-six stage 4 neuroblastoma patients older than 1 year at diagnosis were classified in four clinical groups on protocol entry: complete remission or very good partial remission (n = 33), primary refractory (n = 33), secondary refractory (n = 10), and progressive disease (n = 10). Bone marrow samples collected before and following treatment were assayed for GD2 synthase mRNA by real-time reverse transcriptase polymerase chain reaction. Response and survival analyses were performed on posttreatment samples before the third cycle at 1.8 months from protocol entry. Results: GD2 synthase mRNA was evident in pretreatment marrow samples of the four clinical groups (42%, 52%, 60%, and 80% of samples, respectively), with median transcript level of 10.0, 16.6, 26.5, and 87.2, respectively. This marker became negative following antibody plus GM-CSF in 77% of complete remission or very good partial remission, 45% of primary refractory, 25% of secondary refractory, and 0% of progressive disease group. Progression-free survival was statistically different between responder and nonresponder groups (P < .0001). Among patients with minimal residual disease, molecular responders had a significantly lower risk of disease progression at a median follow-up of 29.8 months (P = .0001). Conclusion: GD2 synthase mRNA is a sensitive response marker of neuroblastoma in the bone marrow. It is particularly useful for minimal residual disease evaluation and may potentially be useful as an early predictor of resistance to antibody plus GM-CSF immunotherapy.

scholarly journals COMPLETE REMISSION AFTER COMBINATION CHEMOTHERAPY FOR STAGE IV GASTRIC CANCER WITH PERITONEAL DISSEMINATION AND LIVER METASTASES

2003 ◽  
Vol 11 (1-2) ◽  
pp. 169-181 ◽  
Author(s):  
Masaya Mukai ◽  
Tomoya Hinoki ◽  
Takayuki Tajima ◽  
Hisao Nakasaki ◽  
Shinkichi Sato ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Complete Remission ◽  
Liver Metastases ◽  
Combination Chemotherapy ◽  
Peritoneal Dissemination ◽  
Stage Iv ◽  
Stage Iv Gastric Cancer

Measurable residual disease response in acute myeloid leukemia treated with venetoclax and azacitidine.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 7018-7018
Author(s):  
Keith Pratz ◽  
Brian Andrew Jonas ◽  
Vinod Pullarkat ◽  
Christian Recher ◽  
Andre C. Schuh ◽  
...  
Keyword(s):  
Complete Remission ◽  
Residual Disease ◽  
Disease Response ◽  
Multiparametric Flow Cytometry ◽  
Laboratory Services ◽  
Best Response ◽  
Response Table ◽  
Group Response ◽  
Grade 3 ◽  
Measurable Residual Disease

7018 Background: In the phase 3 VIALE-A trial, rates of composite complete remission (CRc; complete remission [CR] + CR with incomplete hematologic recovery [CRi]) and measurable residual disease response (MRD<10-3) were higher in patients (pts) treated with venetoclax (Ven) + azacitidine (Aza) compared to Aza alone (23.4%/7.6%, p<0.001). There is limited evidence of the clinical significance of MRD monitoring in pts receiving low-intensity chemotherapy. Herein, we explored the outcomes of pts treated with Ven+Aza who achieved both CRc and MRD<10-3 in the VIALE-A trial (NCT02993523). Methods: Enrolled pts were ≥18 years and unfit for intensive chemotherapy. Pts received Ven 400 mg orally; days 1–28 and Aza 75 mg/m2; days 1-7/28-day cycle. Bone marrow aspirate samples for multiparametric flow cytometry assessments by integrated leukemia-associated immunophenotypes and different than normal procedures were collected for central analysis (Covance Central Laboratory Services) at baseline, end of cycle 1, and every 3 cycles thereafter. Assessments were performed independent of disease responses. MRD response was defined as <1 residual blast /1000 leukocytes (<10-3). CRc, DoR, OS, and EFS were assessed. Disease assessments were per modified International Working Group response criteria for AML. Results: 211/286 (74%) pts treated with Ven+Aza with at least one valid post-baseline MRD assessment were considered MRD evaluable; 78/211 (37%) achieved MRD<10-3 and 133/211 (63%) had MRD≥10-3. Median age (MRD<10-3/ MRD≥10-3) was 76 (range: 49-89)/77 (58-91) yrs. Pts (MRD<10-3/ MRD≥10-3) received median of 14.5 (range: 1-28) /7.0 (1-30) cycles of Ven+Aza. At median follow-up of 22.0 (range: 20.1-23.0)/20.8 (19.8-22.3) months (mos), CRc + MRD<10-3/ MRD≥10-3 was achieved by 67 (86%)/ 97 (73%); 20/67 (30%) achieved CRc + MRD<10-3 by end of cycle 1. Median DoR, OS, and EFS were not reached in pts with CRc + MRD<10-3 response (Table). The 12-mo estimates for DoR, OS, and EFS for pts with CRc + MRD<10-3response were 81.2%, 94.0%, and 83.2%, respectively. Adverse events ≥grade 3 (MRD<10-3/ MRD≥10-3) were febrile neutropenia (50%/43%), neutropenia (50%/35%), and thrombocytopenia (44%/44%), similar to the overall population. Conclusions: Pts with best response of CRc who achieved MRD<10-3 response with Ven+Aza treatment had longer DoR, OS, and EFS than pts who were CRc and MRD positive. Clinical trial information: NCT02993523. [Table: see text]

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