Fatigue trajectories in long-term non-Hodgkin lymphoma survivors.

e20053 Background: Fatigue is a common and distressing effect of cancer and its treatment. Prior research suggests fatigue persists long after diagnosis and treatment in non-Hodgkin lymphoma (NHL) survivors. This study aimed to identify distinct trajectories of fatigue in NHL survivors and predictors of trajectories that could inform clinical care. Methods: Our secondary analysis used data from a longitudinal study of NHL survivors (n = 886) at least 2 years post-diagnosis. Fatigue was measured using the SF-36 vitality subscale across three time points. Prior literature informed the selection of baseline demographic (e.g. age, gender, race) and disease characteristics [e.g. NHL type, comorbidities, post-traumatic stress disorder (PTSD)] explored as possible predictors of fatigue trajectories. We used group-based trajectory modeling to identify distinct groups of patients experiencing similar patterns of fatigue. Variables significant in bivariate analysis were included in a stepwise multinomial logistic regression to identify factors predictive of group membership. Results: We identified four distinct trajectories that suggest levels of fatigue persist unchanged over time. The Low Fatigue Group (15.6%) experienced less fatigue than the general population. The Population Norm Group (42.5%) experienced a similar level of fatigue to the general population mean. The Significant Fatigue Group (27.5%) experienced fatigue levels almost one standard deviation worse than the general population. The Worst Fatigue Group (14.3%) experienced fatigue almost two standard deviations worse than the population norm. PTSD symptoms and comorbidity scores were predictive of levels of fatigue over time. Greater age at diagnosis increases the odds survivors experienced worse fatigue than the population mean (Table). Conclusions: Levels of fatigue experienced early in an NHL patients’ disease trajectory may persist for many years. Higher levels of PTSD symptoms and comorbidities were predictive of worse fatigue over time. Early interventions addressing PTSD symptoms and comorbidities may improve long term fatigue outcomes. [Table: see text]

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Quality of Life Among Long-Term Survivors of Non-Hodgkin Lymphoma: A Follow-Up Study

Journal of Clinical Oncology ◽

10.1200/jco.2011.40.6249 ◽

2013 ◽

Vol 31 (2) ◽

pp. 272-279 ◽

Cited By ~ 31

Author(s):

Sophia K. Smith ◽

Deborah K. Mayer ◽

Sheryl Zimmerman ◽

Christianna S. Williams ◽

Habtamu Benecha ◽

...

Keyword(s):

Quality Of Life ◽

Social Support ◽

Hodgkin Lymphoma ◽

Symptom Burden ◽

Non Hodgkin Lymphoma ◽

The Impact ◽

Long Term Survivors ◽

Over Time

Purpose Little is known about change in quality of life (QOL) among long-term cancer survivors. We examined change over time in QOL among long-term survivors of non-Hodgkin lymphoma and identified demographic, clinical, and psychosocial risk factors for poor outcomes. Methods Surveys were mailed to 682 lymphoma survivors who participated in a study 5 years earlier, when on average they were 10.4 years postdiagnosis. Standardized measures of QOL, perceptions of the impact of cancer, symptoms, medical history, and demographic variables were reported at both time points and examined using linear regression modeling to identify predictors of QOL over time. Results A total of 566 individuals participated (83% response rate) who were a mean of 15.3 years postdiagnosis; 52% were women, and 87% were white. One third of participants (32%) reported persistently high or improved QOL, yet a notable proportion (42%) reported persistently low or worsening QOL since the earlier survey. Participants who received only biologic systemic therapy reported improvement in physical health despite the passage of time. Older age, more comorbidity, and more or increasing negative and decreasing positive perceptions of cancer's impact were independent predictors of poor QOL. Lymphoma symptom burden, less social support, and having received a transplantation were related to negative perceptions of cancer's impact. Conclusion Moderate to severe symptom burden, limited social support, or having received a transplantation should alert the clinician to potential need for supportive services. Perceptions of cancer's impact are associated with QOL cross-sectionally and longitudinally; modifying these perceptions may thus provide a strategy for improving QOL.

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Faculty Opinions recommendation of Expected long-term survival of older patients diagnosed with non-Hodgkin lymphoma in 2008-2012.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717967961.793467618 ◽

2012 ◽

Author(s):

Alberto Quaglia

Keyword(s):

Hodgkin Lymphoma ◽

Older Patients ◽

Term Survival ◽

Long Term Survival ◽

Non Hodgkin Lymphoma

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Lymphoproliferative malignancies in patients with neurofibromatosis 1

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01856-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Christina Bergqvist ◽

François Hemery ◽

Arnaud Jannic ◽

Salah Ferkal ◽

Pierre Wolkenstein

Keyword(s):

General Population ◽

Medical History ◽

Hodgkin Lymphoma ◽

Incidence Rate ◽

Population Based ◽

Neurofibromatosis 1 ◽

Population Based Study ◽

Non Hodgkin Lymphoma ◽

History Of

AbstractNeurofibromatosis 1 (NF1) is an inherited, autosomal-dominant, tumor predisposition syndrome with a birth incidence as high as 1:2000. A patient with NF1 is four to five times more likely to develop a malignancy as compared to the general population. The number of epidemiologic studies on lymphoproliferative malignancies in patients with NF1 is limited. The aim of this study was to determine the incidence rate of lymphoproliferative malignancies (lymphoma and leukemia) in NF1 patients followed in our referral center for neurofibromatoses. We used the Informatics for Integrated Biology and the Bedside (i2b2) platform to extract information from the hospital’s electronic health records. We performed a keyword search on clinical notes generated between Jan/01/2014 and May/11/2020 for patients aged 18 years or older. A total of 1507 patients with confirmed NF1 patients aged 18 years and above were identified (mean age 39.2 years; 57% women). The total number of person-years in follow-up was 57,736 (men, 24,327 years; women, 33,409 years). Mean length of follow-up was 38.3 years (median, 36 years). A total of 13 patients had a medical history of either lymphoma or leukemia, yielding an overall incidence rate of 22.5 per 100,000 (0.000225, 95% confidence interval (CI) 0.000223–0.000227). This incidence is similar to that of the general population in France (standardized incidence ratio 1.07, 95% CI 0.60–1.79). Four patients had a medical history leukemia and 9 patients had a medical history of lymphoma of which 7 had non-Hodgkin lymphoma, and 2 had Hodgkin lymphoma. Our results show that adults with NF1 do not have an increased tendency to develop lymphoproliferative malignancies, in contrast to the general increased risk of malignancy. While our results are consistent with the recent population-based study in Finland, they are in contrast with the larger population-based study in England whereby NF1 individuals were found to be 3 times more likely to develop both non-Hodgkin lymphoma and lymphocytic leukemia. Large-scale epidemiological studies based on nationwide data sets are thus needed to confirm our findings.

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Acute symptoms of mild to moderate COVID-19 are highly heterogeneous across individuals and over time

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab090 ◽

2021 ◽

Author(s):

Thomas L Rodebaugh ◽

Madelyn R Frumkin ◽

Angela M Reiersen ◽

Eric J Lenze ◽

Michael S Avidan ◽

...

Keyword(s):

Temporal Dynamics ◽

Survey Methods ◽

Clinical Care ◽

Clinical Deterioration ◽

Symptom Profiles ◽

Fluctuating Course ◽

The Common ◽

Symptom Changes ◽

Over Time

Abstract Background The symptoms of COVID-19 appear to be heterogenous, and the typical course of these symptoms is unknown. Our objectives were to characterize the common trajectories of COVID-19 symptoms and assess how symptom course predicts other symptom changes as well as clinical deterioration. Methods 162 participants with acute COVID-19 responded to surveys up to 31 times for up to 17 days. Several statistical methods were used to characterize the temporal dynamics of these symptoms. Because nine participants showed clinical deterioration, we explored whether these participants showed any differences in symptom profiles. Results Trajectories varied greatly between individuals, with many having persistently severe symptoms or developing new symptoms several days after being diagnosed. A typical trajectory was for a symptom to improve at a decremental rate, with most symptoms still persisting to some degree at the end of the reporting period. The pattern of symptoms over time suggested a fluctuating course for many patients. Participants who showed clinical deterioration were more likely to present with higher reports of severity of cough and diarrhea. Conclusion The course of symptoms during the initial weeks of COVID-19 is highly heterogeneous and is neither predictable nor easily characterized using typical survey methods. This has implications for clinical care and early-treatment clinical trials. Additional research is needed to determine whether the decelerating improvement pattern seen in our data is related to the phenomenon of patients reporting long-term symptoms, and whether higher symptoms of diarrhea in early illness presages deterioration.

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Persistent fatigue among long-term non-Hodgkin lymphoma survivors

Leukemia & Lymphoma ◽

10.1080/10428194.2021.1984450 ◽

2021 ◽

pp. 1-9

Author(s):

Matthew R. LeBlanc ◽

Sheryl Zimmerman ◽

Thomas W. LeBlanc ◽

Ashley Leak Bryant ◽

Kathryn E. Hudson ◽

...

Keyword(s):

Hodgkin Lymphoma ◽

Non Hodgkin Lymphoma ◽

Persistent Fatigue ◽

Lymphoma Survivors

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Follicular non-Hodgkin lymphoma: long-term results of stem-cell transplantation

Current Opinion in Oncology ◽

10.1097/cco.0b013e32830b61ac ◽

2008 ◽

Vol 20 (5) ◽

pp. 502-508 ◽

Cited By ~ 10

Author(s):

Paul M Barr ◽

Hillard M Lazarus

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

Hodgkin Lymphoma ◽

Cell Transplantation ◽

Long Term Results ◽

Non Hodgkin Lymphoma

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Axicabtagene Ciloleucel (axi-cel; KTE-C19) in Patients with Refractory Aggressive Non-Hodgkin Lymphoma (NHL): Long-Term Follow-up of the Pivotal Zuma-1 Trial

Biology of Blood and Marrow Transplantation ◽

10.1016/j.bbmt.2017.12.644 ◽

2018 ◽

Vol 24 (3) ◽

pp. S74-S75 ◽

Cited By ~ 1

Author(s):

Sattva S. Neelapu ◽

Frederick L. Locke ◽

Nancy L. Bartlett ◽

Lazaros J. Lekakis ◽

David Miklos ◽

...

Keyword(s):

Hodgkin Lymphoma ◽

Non Hodgkin Lymphoma ◽

Long Term Follow Up

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Radioimmunotherapy with iodine 131I tositumomab for relapsed or refractory B-cell non-Hodgkin lymphoma: updated results and long-term follow-up of the University of Michigan experience

Blood ◽

10.1182/blood.v96.4.1259 ◽

2000 ◽

Vol 96 (4) ◽

pp. 1259-1266 ◽

Cited By ~ 346

Author(s):

Mark S. Kaminski ◽

Judith Estes ◽

Kenneth R. Zasadny ◽

Isaac R. Francis ◽

Charles W. Ross ◽

...

Keyword(s):

B Cell ◽

Hodgkin Lymphoma ◽

De Novo ◽

Hematologic Toxicity ◽

Low Grade ◽

Cell Transplant ◽

Non Hodgkin Lymphoma ◽

Therapeutic Doses ◽

131I Tositumomab

Abstract CD20-targeted radioimmunotherapy is a promising new treatment for B-cell non-Hodgkin lymphoma (NHL). We now provide updated and long-term data on 59 chemotherapy-relapsed/refractory patients treated with iodine 131I tositumomab in a phase I/II single-center study. Fifty-three patients received individualized therapeutic doses, delivering a specified total-body radiation dose (TBD) based on the clearance rate of a preceding dosimetric dose. Six patients received dosimetric doses only. Dose-escalations of TBD were conducted separately in patients who had or had not undergone a prior autologous stem cell transplant (ASCT) until a nonmyeloablative maximally tolerated TBD was established (non-ASCT = 75 cGy, post-ASCT = 45 cGy). Fourteen additional non-ASCT patients were treated with 75 cGy. Unlabeled antibody was given prior to labeled dosimetric and therapeutic doses to improve biodistribution. Forty-two (71%) of 59 patients responded; 20 (34%) had complete responses (CR). Thirty-five (83%) of 42 with low-grade or transformed NHL responded versus 7 (41%) of 17 with de novo intermediate-grade NHL (P = .005). For all 42 responders, the median progression-free survival was 12 months, 20.3 for those with CR. Seven patients remain in CR 3 to 5.7 years. Sixteen patients were re-treated after progression; 9 responded and 5 had a CR. Reversible hematologic toxicity was dose limiting. Only 10 patients (17%) had human anti-mouse antibodies detected. Long-term, 5 patients developed elevated thyroid-stimulating hormone levels, 5 were diagnosed with myelodysplasia and 3 with solid tumors. A single, well-tolerated treatment with iodine 131I tositumomab can, therefore, produce frequent and durable responses in NHL, especially low-grade or transformed NHL.

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