Effective treatment of small-noncleaved-cell lymphoma with high-intensity, brief-duration chemotherapy.

1991 ◽  
Vol 9 (6) ◽  
pp. 941-946 ◽  
Author(s):  
M L McMaster ◽  
J P Greer ◽  
F A Greco ◽  
D H Johnson ◽  
S N Wolff ◽  
...  
Keyword(s):  
Poor Prognosis ◽  
Performance Status ◽  
Disease Free Survival ◽  
Poor Performance ◽  
Response To Therapy ◽  
Poor Performance Status ◽  
Inpatient Setting ◽  
Term Survival ◽  
Chemotherapeutic Regimen ◽  
Disease Free

Small-noncleaved-cell (SNC) lymphoma is a high-grade, biologically aggressive neoplasm notable for poor response to therapy, high relapse rate, and less than a 20% long-term survival. We treated 20 patients with SNC lymphoma with a novel chemotherapeutic regimen using intensive doses of chemotherapy at frequent intervals in the inpatient setting. All patients were previously untreated. Sixteen patients (80%) had stage IV disease. Most patients (95%) had at least one other characteristic associated with poor prognosis (bulky [greater than 10 cm] disease, multiple extranodal sites, poor performance status), and 85% had two or more characteristics associated with poor prognosis. Seventeen patients (85%) achieved a complete response (CR) to therapy, including all three patients with human immunodeficiency virus (HIV)-associated disease. There have been three relapses, all occurring less than 18 months after treatment, and two of three relapses occurred in patients who were unable to complete therapy. At a median follow-up of 29 months, 13 patients (65%) remain disease-free; the calculated 5-year actuarial disease-free survival is 60%. Toxicity, chiefly myelosuppression, was severe but manageable. There were two treatment-related deaths, both in elderly patients with poor performance status and advanced-stage disease. These data suggest that such a dose-intensive approach improves the response and survival of patients with SNC lymphoma.

T-cell lymphomas: immunologic, histologic, clinical, and therapeutic analysis of 63 cases.

1988 ◽  
Vol 6 (10) ◽  
pp. 1584-1589 ◽  
Author(s):  
B Coiffier ◽  
F Berger ◽  
P A Bryon ◽  
J P Magaud
Keyword(s):  
T Cell ◽  
Clinical Presentation ◽  
Performance Status ◽  
Stage Iv ◽  
Poor Performance ◽  
Large Cell ◽  
Response To Therapy ◽  
Poor Performance Status ◽  
T Cell Lymphomas ◽  
Stage Iv Disease

Sixty-three patients with T-cell lymphoma (TCL) were analyzed to correlate morphological and immunological features with clinical presentation, response to therapy, and survival. Clinical presentation was severe, with 59% of patients having stage IV disease, 60% B symptoms, 35% poor performance status, 44% large tumoral mass, and 40% a high number of extranodal localizations. Morphological subtypes were small-cell in four cases, diffuse-mixed in 29 cases, monomorphic medium-sized in two cases, immunoblastic in 21 cases, anaplastic large-cell in four cases, and unclassified in three cases. Immunological phenotypes were immature T in 11 cases, CD4 in 26 cases, CD8 in 13 cases, and undefined (CD4 + CD8) in ten cases. Response to therapy was poor except for the 39 patients treated by an intensive and sequential regimen (non-Hodgkin's lymphoma [LNH]-80 or LNH-84) that gave a 77% complete remission (CR) rate with a 23% relapse rate. Median survival was 35 months. No correlation was found between morphological subtypes and other variables. Helper (CD4) phenotype seemed to have a better prognosis than other phenotypes. Variables associated with long survival for all the patients were localized disease and absence of large tumoral mass and for the subgroup of patients treated by the LNH regimens CD4 phenotype, absence of B symptoms, absence of a large tumoral mass, and less than two extranodal sites of disease.

scholarly journals Intensive chemotherapy in aggressive lymphomas: updated results of LNH- 80 protocol and prognostic factors affecting response and survival

Blood ◽  
1987 ◽  
Vol 70 (5) ◽  
pp. 1394-1399 ◽  
Author(s):  
B Coiffier ◽  
PA Bryon ◽  
M Ffrench ◽  
M Blanc ◽  
C Sebban ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Multivariate Analysis ◽  
Performance Status ◽  
Bone Marrow Involvement ◽  
Poor Performance ◽  
Poor Performance Status ◽  
Term Survival ◽  
Factors Affecting ◽  
Negatively Associated ◽  
Intensive Courses

Abstract One hundred patients with aggressive malignant lymphomas treated with the LNH-80 regimen were evaluated for long-term survival and pretreatment characteristics predictive of response and survival. LNH- 80 consists of three intensive courses of adriamycin cyclophosphamide vindesine bleomycin (ACVB) followed by sequential consolidation and final intensification. Eighty-four patients went into complete remission (CR), eight had a partial response (PR), three failed to respond, and five died during induction. Twenty-three patients (27%) relapsed, in two of whom a prolonged second remission was obtained. Sixty-three patients are currently alive, two of them with disease. Four patients died in CR. Median survival and median freedom from relapse survival were not reached with a median follow-up of 4 1/2 years. Characteristics negatively associated with response in multivariate analysis were: poor performance status, bone marrow involvement, and two or more extranodal sites of disease. Duration of CR was associated with splenic involvement. Three characteristics were negatively associated with survival in multivariate analysis: age, high grade subtypes, and bone marrow involvement.

Impact of pathologic tumor characteristics in patients with sarcomatoid renal cell carcinoma.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 343-343
Author(s):  
B. Shuch ◽  
G. Bratslavsky ◽  
J. H. Shih ◽  
D. Finley ◽  
B. Castor ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Disease ◽  
Renal Cell ◽  
Performance Status ◽  
Poor Performance ◽  
Response To Therapy ◽  
Poor Performance Status ◽  
Tumor Characteristics ◽  
Sarcomatoid Renal Cell Carcinoma

343 Background: Patients with sarcomatoid renal cell carcinoma (sRCC) are known to have a poor prognosis and response to therapy. We sought to determine the influence of pathologic tumor characteristics on outcome in order to aid clinical management. Methods: A single center database was reviewed from 1989-2009 to identify all patients with sRCC. Clinical and staging variables were collected and pathologic information including histology, necrosis, percentage of sarcomatoid features (PSF), and microvascular invasion (MVI) was recorded. Influence of clinicopathologic variables on outcome was assessed. Results: A total of 104 patients had confirmed sRCC. The median size of tumors was 9.5 cm (range 2.5-30), 65% of patients had areas of clear cell RCC, and 69.2% had metastatic disease at presentation. The PSF did not influence tumor size, stage, necrosis, MVI, nodes, or metastasis. A total of 85 patients (81.7%) died during the follow-up period with a median survival of 5.9 months. In the overall cohort poor performance status, metastatic disease, and MVI were independent predictors of poor survival. Increased PSF was associated with worse outcome, but it failed to reach significance on multivariate analysis. In a subset analysis of those with non-metastatic disease, MVI and non-clear histology influenced prognosis, but only PSF was the only predictor of outcome. Conclusions: The PSF has limited influence on pathologic characteristics. However, increased PSF amounts may impact survival, especially in those with non-metastatic disease. The presence of MVI is an independent predictor of poor outcome while carcinoma grade and subtype have limited impact on survival. When counseling patients or designing clinical trials for these patients, PSF and MVI, not carcinoma grade or subtype should be considered. No significant financial relationships to disclose.

scholarly journals No Prognostic Impact of p53 and P-Glycoprotein Expression in Patients with Diffuse Large B-Cell Lymphoma

ISRN Oncology ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-6
Author(s):  
Pairaya Rujirojindakul ◽  
Kumpol Aiempanakit ◽  
Kanita Kayasut ◽  
Arnuparp Lekhakula ◽  
Hutcha Sriplung
Keyword(s):  
De Novo ◽  
Performance Status ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Poor Performance ◽  
B Cell Lymphoma ◽  
Poor Performance Status ◽  
Prognostic Impact ◽  
P Glycoprotein ◽  
Formalin Fixed Paraffin Embedded

The aim of this study was to determine the clinical significances of p53 and p-glycoprotein (P-gp) expression on outcome predictors for patients with DLBC. We assessed the immunohistochemical expression of p53 and P-gp using formalin-fixed, paraffin-embedded specimens in 108 patients diagnosed with de novo DLBC. A high expression of p53 was found in 53.7% of the patients. No expression of P-gp was demonstrated in any of the specimens. There were no significant differences in the complete remission (CR) rate (P=0.79), overall survival (OS) (P=0.73), or disease-free survival (DFS) (P=31) between the p53-positive and p53-negative groups. The final model from multivariate analysis that revealed poor performance status was significantly associated with CR (P<0.001) and OS (P<0.001). Moreover, the advanced stage was a significant predictor of DFS (P=0.03). This study demonstrated no impact of the expression of p53 on either response or survival rates.

scholarly journals Cetuximab Rechallenge and Monotherapy in Patients with Squamous Cell Carcinoma of the Head and Neck

2015 ◽  
Vol 8 (3) ◽  
pp. 503-508 ◽  
Author(s):  
Greg Knutzen ◽  
Shanmuga Subbiah
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Poor Prognosis ◽  
Case Reports ◽  
Performance Status ◽  
Poor Performance ◽  
Poor Performance Status ◽  
Durable Response

Smokers with squamous cell carcinoma of the head and neck (SCCHN) have a particularly poor prognosis when compared with human papillomavirus-positive SCCHN. Here, we present case reports of two smokers with SCCHN treated with cetuximab-based therapy, highlighting the potential benefit of cetuximab before definitive chemoradiotherapy in patients with poor performance status as well as cetuximab rechallenge after progression. We conclude that cetuximab demonstrated notable effectiveness in two patients at high risk for poor prognosis, yielding a durable response in one and retaining activity on rechallenge in the other.

A phase II randomized four-regimen selection trial incorporating response for sequential chemotherapy in metastatic, unresectable urothelial cancer: Final results from the M. D. Anderson Cancer Center

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5071-5071 ◽  
Author(s):  
A. O. Siefker-Radtke ◽  
A. M. Kamat ◽  
D. L. Williams ◽  
N. M. Tannir ◽  
S. Tu ◽  
...  
Keyword(s):  
Urothelial Cancer ◽  
Performance Status ◽  
Treatment Algorithm ◽  
Poor Performance ◽  
Sequential Therapy ◽  
Cancer Center ◽  
Poor Performance Status ◽  
Sequential Chemotherapy ◽  
Term Survival ◽  
Metastatic Urothelial Cancer

5071 Background: We developed a clinical trial incorporating response into the treatment algorithm. Patients meeting a certain threshold of response continued with the same treatment; those with insufficient response were switched to alternative chemotherapy. We now report on final results from this trial. Methods: Patients were randomly assigned to one of four regimens: ifosfamide, doxorubicin, gemcitabine; ifosfamide, paclitaxel, cisplatin; gemcitabine, cisplatin; or cisplatin, gemcitabine, and ifosfamide. To continue with chemotherapy, patients must have had at least a 40% response after the first 6-week interval, and a >90% response after the second 6 weeks. Otherwise, they were re-randomized to alternate chemotherapy. Overall success (OSX) was defined as patients with a >90% response with either front-line or second-line therapy. Surgical consolidation was offered to patients at the discretion of their treating physician. Results: Median overall survival (OS) for 120 patients was 19.1 mo. (3 and 5-yr survival: 33% and 20%). OSX was achieved in 41 patients (median OS: 51 mo.); the median OS in the other 79 patients was 15 mo. (p = 0.0001), with a 5-yr survival of 42% and 10% respectively. Surgical consolidation was performed in 35 patients: 23 with nodal metastases to pelvic and/or RPLN, 6 with cT4b tumors, and an additional 6 patients with distant metastases. Their median OS from surgery was 23.7 months, (5-yr survival: 31%). Surgical consolidation in the setting of OSX was associated with a 42% 5-yr survival as compared to 11% in those undergoing surgery in the absence of OSX. Visceral metastases and poor performance status were associated with a worse prognosis. Conclusions: With sequential therapy, 34% of patients had a >90% response (OSX). A potential benefit in long-term survival was seen in patients who had surgical consolidation in the setting of OSX. This trial design provides a novel method for assessing the benefits of sequential chemotherapy, and enhancing the population of patients who may be offered surgical consolidation in the setting of initially unresectable, or metastatic urothelial cancer. No significant financial relationships to disclose.

scholarly journals Intensive chemotherapy in aggressive lymphomas: updated results of LNH- 80 protocol and prognostic factors affecting response and survival

Blood ◽  
1987 ◽  
Vol 70 (5) ◽  
pp. 1394-1399
Author(s):  
B Coiffier ◽  
PA Bryon ◽  
M Ffrench ◽  
M Blanc ◽  
C Sebban ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Multivariate Analysis ◽  
Performance Status ◽  
Bone Marrow Involvement ◽  
Poor Performance ◽  
Poor Performance Status ◽  
Term Survival ◽  
Factors Affecting ◽  
Negatively Associated ◽  
Intensive Courses

One hundred patients with aggressive malignant lymphomas treated with the LNH-80 regimen were evaluated for long-term survival and pretreatment characteristics predictive of response and survival. LNH- 80 consists of three intensive courses of adriamycin cyclophosphamide vindesine bleomycin (ACVB) followed by sequential consolidation and final intensification. Eighty-four patients went into complete remission (CR), eight had a partial response (PR), three failed to respond, and five died during induction. Twenty-three patients (27%) relapsed, in two of whom a prolonged second remission was obtained. Sixty-three patients are currently alive, two of them with disease. Four patients died in CR. Median survival and median freedom from relapse survival were not reached with a median follow-up of 4 1/2 years. Characteristics negatively associated with response in multivariate analysis were: poor performance status, bone marrow involvement, and two or more extranodal sites of disease. Duration of CR was associated with splenic involvement. Three characteristics were negatively associated with survival in multivariate analysis: age, high grade subtypes, and bone marrow involvement.

scholarly journals Suggestions for Escaping The Dark Ages for Pediatric Diffuse Intrinsic Pontine Glioma Treated with Radiotherapy: Analysis of Prognostic Factors From The National Multicenter Study

2021 ◽  
Author(s):  
Hyun Ju Kim ◽  
Joo Ho Lee ◽  
Youngkyong Kim ◽  
Do Hoon Lim ◽  
Shin-Hyung Park ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Therapeutic Strategy ◽  
Performance Status ◽  
Poor Performance ◽  
Diffuse Intrinsic Pontine Glioma ◽  
Poor Performance Status ◽  
Pontine Glioma ◽  
Term Survival

Abstract Purpose This multicenter retrospective study aimed to investigate prognostic factors for survival, encompassing clinical and radiologic features and treatments, in newly diagnosed diffuse intrinsic pontine glioma (DIPG) patients treated with radiotherapy. Methods Patients <30 years of age who underwent radiotherapy as an initial treatment for DIPG between 2000 and 2018 were included; patients who did not undergo an MRI at diagnosis and those with pathologically diagnosed grade I glioma were excluded. We examined medical records of 162 patients collected from 10 participating centers in Korea. The patients’ clinical and radiological variables, molecular and histopathologic data, and treatment response were evaluated to identify the prognosticators for DIPG and estimate survival outcomes. Results The median follow-up period was 10.8 months (interquartile range, 7.5–18.1). The 1- and 2-year overall survival (OS) rates were 53.5% and 19.0%, respectively, with a median OS of 13.1 months. Long term survival rate (≥2 years) was 16.7%, and median OS was 43.6 months. Age (<10 years), poor performance status, treatment before 2010, and post-radiotherapy necrosis were independent prognostic factors related to poor OS in the multivariate analysis. In patients with increased post-radiotherapy necrosis, the median OS was 13.3 months for bevacizumab group and 11.4 months for no-bevacizumab group (P = 0.138). Conclusion Therapeutic strategy for DIPG has remained unchanged over time, and its prognosis remains poor. Our findings suggest that appropriate efforts are needed to reduce the occurrence of post-radiotherapy necrosis. Further well-designed clinical trials are recommended to improve the poor prognosis observed in DIPG patients.

Immune-related saliva micro-RNA’s to predict clinical response to a combination of cetuximab and low-dose chemotherapy in head and neck cancer (HNSCC) patients (pts) with poor performance status (PS).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17548-e17548
Author(s):  
Marcelo Raul Bonomi ◽  
Safoa Ado ◽  
Mitra Kooshki ◽  
Tamjeed Ahmed ◽  
Christopher Sullivan ◽  
...  
Keyword(s):  
Clinical Response ◽  
Clinical Benefit ◽  
Low Dose ◽  
Performance Status ◽  
Poor Performance ◽  
Response To Therapy ◽  
Poor Performance Status ◽  
Weekly Chemotherapy ◽  
Ecog Ps ◽  
Low Dose Chemotherapy

e17548 Background: Recurrent/Metastatic HNSCC is an immunosuppressive disease, especially in the group of patients with poor performance status. Recent studies have shown that low dose chemotherapy, which is much better tolerated than full dose cytotoxic chemotherapy, can increase the anti-tumor immune response and cause tumor regression. In this study we assessed the immune-effects of weekly cetuximab in combination with low dose weekly chemotherapy in HNSCC pts with poor PS by measuring saliva and plasma immune modulatory micro RNAs (miRs). Methods: Patients with recurrent/metastatic HNC with an ECOG PS of 2 or 3 were treated with low-dose weekly carboplatin (AUC 1) and paclitaxel (25 mg/m2) along with weekly cetuximab (400mg/m2 followed by 250 mg/m2). Seven immune modulatory miRs (146a, 155, 181, 20a, 223, 335, 125b) were measured in the saliva and plasma by quantitative PCR prior to treatment and at week 5. Results: Between 4/2016 and 1/2017, 30 patients were enrolled in this study. 24 patients were evaluable for response. Mean age was 69 years (range 51-89), Male/Female: 14/8. ECOG PS 2/3: 13/9. Site of disease: oral cavity 7, pharynx 9, larynx 4, para-nasal 2, unknown 2. Treatment was well tolerated. The most common dose limiting toxicity was skin rash in 10/24 pts (41.5%). Response: partial response 12 (50%); stable disease 4 (16.5%); progressive disease 8 (33.5%). Reduction in miR levels by week 5 were associated with clinical response. Reduction in saliva levels of miRs 146a and 181 correlated with clinical benefit (PR+SD). Pre-treatment saliva levels of miR 146a also showed to be a predictor of tumor response to therapy. Plasma levels of the immune modulatory miRs tested were not associated with response to therapy. Conclusions: The combination of cetuximab and low-dose chemotherapy is active and well tolerated in HNSCC patients with poor PS. Reduction in saliva levels of immune modulatory miRs 146a and 181 were associated with clinical benefit to therapy.

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