Long term outcome of 135 high grade non-Hodgkin’s lymphoma of the head and neck (HN NHL) treated with high dose CHOP regimen and involved field radiotherapy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 7550-7550
Author(s):  
L. Laccourreye ◽  
B. Desablens ◽  
C. Le Maignan ◽  
A. Le Mevel ◽  
C. Berthou ◽  
...  
Keyword(s):  
Salivary Gland ◽  
Erythrocyte Sedimentation Rate ◽  
Sedimentation Rate ◽  
High Efficiency ◽  
Univariate Analysis ◽  
High Dose ◽  
High Grade ◽  
Long Term Outcome ◽  
Erythrocyte Sedimentation

7550 Background: We present the results of a prospective study conducted by the GOELAMS group and evaluating long-term clinical outcome in a series of 135 patients with a HN NHL undergoing chemotherapy and radiotherapy. Methods: From 1986 through 1998, 135 patients aged from 17 to 69 years were enrolled in a prospective multicenter study for primary treatment of HN localized stage I/II high-grade NHL. Treatment regimen consisted in 3 VCAP + 40 Gy locoregional irradiation. Results: The median age was 48.5 years (17–69) with 36 patients being 60 or over. The main localization was Waldeyer’s ring (57) including tonsil (35), nasopharynx (14), whole Waldeyer (8), neck (49), nasal cavities (14), thyroid (8) salivary gland (5), mandibular bone (2). According to the WFC, histological subtype were as F (21%), G (57%) and H (20%) and unclassified (2%). Ann Harbor classification included 80 stage 1 and 55 stage II. The IPI score was 0 (49.7%), 1 (22.3%), 2 (10.4%), 3 (2.3%) undetermined (16.3%). PS>2 and bulk (≥ 5 cm) were observed in 7.5% and 43% of patients respectively. 94% achieved CR. 2 patients died during treatment. Relapses occurred in 23/127 (18.1%) at a median time of 31 months (5.5–80). 16 of these relapses occurred before 3 years of CR, 5 between 3 and 6 years and 2 after 6 years of CR. With a median follow up of 65 month (7–146) OS and EFS were 81.5% and 77% respectively. In univariate analysis age≥ 60, extension, PS≥2, Bulk≥5 cm, erythrocyte sedimentation rate≥ 40, high serum LDH,IPI≥2 and salivary gland or panwaldeyer localization significantly decrease EFS (P = 0.055, 0.017, 0.006, 0.0001, 0.04, 0.028, 0.014 and 0.043 or 0.0001 respectively). In multivariate analysis only the bulk≥5 cm, the erythrocyte sedimentation rate≥40 and the localization to salivary gland significantly decrease EFS (P = 0.004, 0.004 and 0.033 respectively). Conclusions: This study underlines the high efficiency of this protocol in treating HN NHL. HN NHL localized to the salivary glands or with a bulk ≥ 5 cm should be included in new therapeutic trials in order to improve their outcome. No significant financial relationships to disclose.

scholarly journals 1424. Association Between Erythrocyte Sedimentation Rate (ESR) Change and Treatment Failure in Patients with Osteomyelitis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S519-S519
Author(s):  
Christopher D Pearson ◽  
Dorothy Holzum ◽  
Ryan P Moenster ◽  
Travis W Linneman
Keyword(s):  
Treatment Failure ◽  
Regression Model ◽  
Erythrocyte Sedimentation Rate ◽  
Sedimentation Rate ◽  
Surgical Intervention ◽  
Treatment Success ◽  
Univariate Analysis ◽  
Initial Therapy ◽  
Anatomical Site ◽  
Erythrocyte Sedimentation

Abstract Background Erythrocyte sedimentation rate (ESR) is monitored during therapy for osteomyelitis (OM) but the degree of reduction associated with treatment success remains unclear. Methods This retrospective cohort study evaluated patients treated for at least 2 weeks with intravenous (IV) antibiotics for OM through the VA St. Louis HCS from 1 January 2010 to 1 January 2018 with at least 2 ESR values during their therapy. Patients were excluded if they had comorbidities that could cause elevations in ESR. The primary outcome was the rate of treatment failure in patients achieving ≥50% decrease in ESR from baseline compared with those without a 50% decrease. Treatment failure was defined as a need for unplanned surgical intervention or re-initiation of antibiotic therapy for OM of the same anatomical site within 6-months after initial therapy was discontinued. The presence of diabetes, peripheral vascular disease (PVD), age >70, baseline creatinine clearance (CrCl) < 50 mL/minute, surgical intervention as part of initial therapy, and ESR reduction ≥50% from baseline were included in a univariate analysis with variables with a P < 0.2 included in a multivariate logistic regression model. Results A total of 143 patients were included; 74 patients with a ≥50% decrease in ESR and 69 patients with a decrease <50%. Mean initial ESRs were not different between groups (79.5±31 vs. 79.9 ± 32 mm/hour, P = 0.95), but end-of-treatment values were significantly higher in the <50% reduction group vs. ≥50% (20.6 ± 14 vs. 72.4 ± 42 mm/hour, P < 0.05, respectively). There were no baseline differences between groups in regards to age, rates of diabetes, PVD, CrCl < 50 mL/minute, initial surgical therapy management, or definitive vs. empiric therapy. Thirty percent (22/74) of patients with a ≥50% reduction in ESR failed treatment vs. 55% (38/69) in patients with a <50% reduction (P < 0.01). Only ESR reduction of ≥50% met criteria for inclusion in the multivariate regression model and was associated with a 65.5% relative risk reduction in treatment failure (OR 0.345; 95% CI 0.173–0.687; P = 0.002). Conclusion Achieving an ESR reduction of ≥50% from baseline during treatment for OM was independently associated with a significant reduction in risk of treatment failure. Disclosures All authors: No reported disclosures.

Evolution of erythrocyte sedimentation rate as predictor of early relapse in posttherapy early-stage Hodgkin's disease.

1988 ◽  
Vol 6 (4) ◽  
pp. 596-602 ◽  
Author(s):  
S Friedman ◽  
M Henry-Amar ◽  
J M Cosset ◽  
P Carde ◽  
M Hayat ◽  
...  
Keyword(s):  
Erythrocyte Sedimentation Rate ◽  
Sedimentation Rate ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Stepwise Logistic Regression ◽  
European Organization ◽  
Term Survival ◽  
Early Relapse ◽  
Erythrocyte Sedimentation

A retrospective study was undertaken at the Institut Gustave Roussy (IGR) to determine the predictive ability of changes in the erythrocyte sedimentation rate (ESR) during posttherapy periods for early relapse (within 18 months from start of therapy) and long-term survival in Hodgkin's disease (HD). Three hundred one patients with clinical stages (CS) I or II HD entered in the European Organization for Research and Treatment of Cancer (EORTC) clinical trials were included in this study. All relevant data and long-term follow-up were available for these patients. A stepwise logistic regression was performed to assess the prognostic value of ESR changes independent of other prognostic parameters and treatment. The incidence of early relapse was found to be significantly increased in patients in whom ESR remained elevated (greater than 30 mm at one hour) after completion of therapy, regardless of the value before therapy. This was true whether the ESR was elevated in plateau fashion, oscillating between normal and abnormal, or was lower than at onset, but still abnormal. Moreover, early relapse predicted by elevated ESR posttherapy was associated with poor survival despite subsequent initiation of combination chemotherapy. Thus, the persistence of an abnormal ESR appears to be a reliable indicator for high probability of early relapse and subsequent poor prognosis. This might be introduced as a prognostic variable in the design of future therapy programs for HD.

scholarly journals Chikungunya Outbreak in Bangladesh (2017): Clinical and hematological findings

2019 ◽  
Author(s):  
Saeed Anwar ◽  
Jarin Taslem Mourosi ◽  
Fahim Khan ◽  
Mohammad Ohid Ullah ◽  
Olivier M. Vanakker ◽  
...  
Keyword(s):  
Erythrocyte Sedimentation Rate ◽  
Acute Phase ◽  
Sedimentation Rate ◽  
Post Infection ◽  
Joint Pain ◽  
Daily Activities ◽  
Memory Problems ◽  
Erythrocyte Sedimentation ◽  
Hematological Analysis

AbstractA massive outbreak of Chikungunya occurred in Bangladesh during the period of April-September, 2017 and over two million people were at risk of getting infected by the virus. A prospective cohort of viremic patients was constituted and analyzed to define the clinical, hematological and long-term aspects of this outbreak. A 35-day long comprehensive survey was conducted in two major, neighboring cities, Dhaka and Mymensingh. One-hundred and eighty-seven clinically proven Chikungunya cases were enrolled in the cross-sectional cohort study. Additionally, a smaller group of 48 Chikungunya patients was monitored for post-infection effects for 12 months. Clinical data revealed that a combination of fever and arthralgia (oligoarthralgia and/or polyarthralgia) was the cardinal hallmark (97.9% of cases) of the infection. Hematological analysis showed that, irrespective of age groups, hemoglobin level significantly decreased and erythrocyte sedimentation rate remarkably increased in Chikungunya confirmed patients. However, the majority of the patients had a normal range of whole WBC and platelet counts; RBC counts for mid aged (40 – 60 years) and senior (61+ years) patients (especially in the females) were beyond the reference values. The post-infection study revealed that children had an early recovery from the infection compared to the adults. Moreover, post-infection weakness, successive relapse of arthralgic pain and memory problems were the most significant aftereffects, which had an impact on daily activities of patients. This study represents a comprehensive overview of clinical and epidemiological features of the 2017 outbreak of Chikungunya in Bangladesh as well as its chronic outcomes till the 12th month. It provides insights into the natural history of this disease which may help to improve management of the Chikungunya patients.Author summeryThe clinical profile, epidemiology and the economic impacts during the acute phase of Chikungunya infection has been studied quite rigorously. However, studies regarding the hematological features and chronic consequences are very limited. In this study, a dataset of 187 clinically proven chikungunya patients were analyzed for the clinical and hematological features at acute phase of the infection. Additionally, the long-term consequences till month 12 after the infection were studied for a smaller group of 48 patients. Clinical data revealed that a combination of fever and joint pain (arthralgia) was the cardinal hallmark in the acute phase of the infection. Hematological analysis showed that, hemoglobin levels of the patients were significantly reduced and erythrocyte sedimentation rate increased remarkably. Also, RBC counts for mid-aged and older patients were beyond the reference values. The post-infection consequence study unveiled that children recovered better from the infection compared to the adults. Further, post-infection weakness, successive relapse of joint pain and memory problems were the most significant aftereffects. Overall, the infection had moderate to severe impact on daily activities of the respondents. This study provides insights into the clinical and hematological aspects of Chikungunya infection during the acute phase as well as describes an account for its chronic outcomes which puts forward to the knowledge for clinicians and epidemiologists regarding the infection diversity and to help improved patient management.

xxx

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 8123-8123
Author(s):  
C. Tarella ◽  
M. Zanni ◽  
A. Rambaldi ◽  
F. Benedetti ◽  
R. Passera ◽  
...  
Keyword(s):  
Complete Remission ◽  
High Dose ◽  
Low Grade ◽  
High Grade ◽  
Term Outcome ◽  
Term Survival ◽  
Long Term Outcome ◽  
Long Term Survival

8123 Background: The high-dose sequential (HDS) chemotherapy approach, including early dose-intensification and autograft with peripheral blood progenitor cells (PBPC), was introduced several years ago (Gianni & Bonadonna, 1989); subsequently, it has been broadly used in the management of both non-Hodgkin s (NHL) and Hodgkin s Lymphoma (HL). The outcome of a large series of lymphoma patients treated with the HDS approach at 10 GITIL Centers is reported. Methods: Data have been collected on 1,266 patients, who received either the original or slightly modified HDS regimens. There were 213 HL and 1,053 NHL (630 intermediate/high-grade, 423 low-grade); median age was 46 yrs. Overall, 671 (53%) patients had refractory/relapsed disease, 595 (47%) were at diagnosis. Most patients were autografted with PBPC; 158 (12%) patients did not undergo autografting due to toxicity, disease progression or poor harvests. Results: Overall, 1,013 (80%) patients reached Complete Remission (CR) following HDS. As to December 2006, 93 (7%) patients died for early/late toxicities, 328 (26%) died for lymphoma, 844 are known to be alive. At a lead follow-up of 18 years, and a median follow-up of 5 yrs, the 5-yr Overall Survival (OS) projection is 64% (S.E.: 2%). The long-term survival was quite favorable in patients achieving a Complete Remission (CR), with a 5-yr OS projection of 76%. The prolonged OS in patients achieving CR was consistent in all lymphoma subtypes, i.e. both low and high-grade NHL (5-yr OS: 77% in both), and HL (5-yr OS: 72%). Patients at diagnosis had a significantly better outcome compared to patients treated for relapsed/refractory disease, again CR achievement was associated with prolonged survival in both subgroups (82% and 69%, respectively, at 5 yrs.). On multivariate Cox survival analysis, CR achievement was the most powerful predictor of long-term survival (HR 0.13, c.i.: 0.10–0.17). Lastly, achieving substantial tumor reduction before autografting had a major influence on the clinical outcome. Conclusions: 1. the HDS program is feasible in a multicenter setting; 2. the long-term outcome is well influenced by the CR status after HDS; 3. the influence of CR achievement on the long-term survival holds true in all lymphoma subtypes, including indolent lymphomas; 4. an adequate pre-autograft tumor debulking may contribute to a favorable long-term outcome. [Table: see text]

scholarly journals Have Progestin Related and Sporadic High Grade Meningiomas the Same Natural History?

2021 ◽  
Author(s):  
Antoine Devalckeneer ◽  
Rabih Aboukais ◽  
Maxime Faisant ◽  
Philippe Bourgeois ◽  
Vannod-Michel Quentin ◽  
...  
Keyword(s):  
Gamma Knife Radiosurgery ◽  
Intracranial Meningioma ◽  
High Dose ◽  
High Grade ◽  
Long Term Outcome ◽  
Nomegestrol Acetate ◽  
Grade Ii ◽  
The Mean

Abstract Introduction: High grade progestin related meningiomas have been reported in recent series but we found no previous study describing their long-term outcome. Our study aimed to evaluate patients operated on for high grade intracranial meningioma and who underwent long term exposure to high dose of cyproterone acetate, nomegestrol acetate and chlormadinone acetate.Methods: Our study retrospectively included 9 patients with high grade progestin related intracranial meningioma between December 2006 and December 2020. In each patient, clinico-radiological follow-up was performed every 6 months after diagnosis and treatment withdrawal recommendation. Results: The mean progestative exposure was 11.4 years. Edema existence or absence of cleft sign on MRI were the key factors for surgical indication. All patients underwent surgery. Ajduvant radiotherapy was indicated in 1 patient, and Gamma Knife Radiosurgery was proposed in 2 other patients for a second location of mengioma. 6 patients harbored a grade II chordoïd meningioma subtype with 100% PR expression and 3 patients a grade II atypical meningioma subtype with lower PR expression. The mean follow-up was 7.1 years and none of the 9 patients presented with a recurrence.Conclusion: Patients with Grade II progestin related meningiomas have less tumor recurrence after surgery than patients with sporadic high grade meningomas, especially after progestin withdrawal. The presence/ appearance of peri-meningioma edema and the absence of cleft sign before volumetric change should suggest the existence of an underlying high grade meningioma. In these cases, surgical resection may immediately be considered and adjuvant radiotherapy should be reserved for proven recurrence cases.

Long-Term Outcome of Autologous Followed by Nonmyeloablative Allografting from HLA-Identical Sibling for Multiple Myeloma (MM).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3029-3029
Author(s):  
Marcello Rotta ◽  
Barry Storer ◽  
Firoozeh Sahebi ◽  
Judith A. Shizuru ◽  
Bruno Benedetto ◽  
...  
Keyword(s):  
Median Time ◽  
Progressive Disease ◽  
Chronic Gvhd ◽  
Univariate Analysis ◽  
Median Number ◽  
Initial Therapy ◽  
High Dose ◽  
Long Term Outcome ◽  
Autologous Hct

Abstract BACKGROUND: Nonmyeloablative allogeneic hematopoietic cell transplantation (HCT) as consolidation following high dose therapy with autologous HCT is a promising treatment for MM. Low early transplant mortality and high response rates were described in small patient (pts) cohorts with limited follow-up (FU). Here we report on the outcome of pts with HLA-identical siblings treated with this tandem auto/allo approach after a median FU of 5 year. PATIENTS: Pts with stage II-III MM (n=102) were treated with tandem auto/nonmyeloablative allografting at 8 centers between August 1998 and August 2005. Median age was 55(range 32–71) years. Median number of prior treatments was 1(1–2), and median number of prior cycles of treatment was 6 (2–18). Median time between initiation of treatment and autografting was 13(2–118) months and 73/102 (72%) pts initiated their tandem HCT within 10 months of initial therapy. Median time between auto and allo HCT was 80(40–281) days. Autologous HCT conditioning was with melphalan 200 mg/m2 and allogeneic conditioning with 2Gy total body irradiation (TBI) alone (n=75, 73%) or with 2Gy TBI plus fludarabine 90 mg/m2 (n=27, 23%). Post allografting immunosuppression was with mycophenolate mofetil (MMF) and cyclosporine (n=91, 89%) or MMF and tacrolimus (n=11, 11%). Sixty-seven pts (66%) had chemoresponsive disease and 35 (34%) were refractory. The disease status at allo HCT included complete remission (CR, 29 pts, 28%), partial remission (PR, 38 pts, 37%), refractory (RD, 27pts, 26%) or progressive disease (PD, 8pts, 8%). RESULTS: 101/102 pts had sustained donor engrafment. Forty one (41%) and 8 pts (8%) experienced grade 2 to 4 and 3 to 4 acute graft-versus-host-disease (GVHD); 70 pts (69%) had extensive chronic GVHD. Median FU post-allografting was 5(0.75–8.66) years. The overall response rate was 94%, with 64 (63%) and 32 pts (31%) achieving CR and PR respectively. Median time to progression was 4 years. Median progression-free survival (PFS) was 3 years while 5-year estimated PFS was 35%. Median overall survival (OS) has not been reached. Three and 5-year estimated OS were 75% and 63% respectively. Cumulative incidence of nonrelapse mortality (NRM) at 100 days, 1 and 5 year were 1%, 13% and 19% respectively. Most of the NRM (89%) was related to GVHD and/or infection. In the subset of 73 pts who initiated their tandem HCT within 10 months from initial therapy, the estimated OS and PFS at 3 and 5-years were 80% and 55%, 69% and 40% respectively. In univariate analysis refractory or progressive disease at allo HCT was associated with higher risk of relapse (p=0.004) and relapse plus NRM (p<0.0001). CONCLUSION: Long-term disease control and GVHD and its complications remain key issues to address following tandem auto/nonmyeloablative allogeneic HCT. Comparison with tandem autologous HCT awaits results of the BMT-CTN 0102 and similar trials.

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