scholarly journals PRIMARY BONE LYMPHOMAS: RETROSPECTIVE ANALYSIS OF 42 CONSECUTIVE CASES

2018 ◽  
Vol 26 (2) ◽  
pp. 103-107
Author(s):  
TELMA MURIAS DOS SANTOS ◽  
JUAN PABLO ZUMÁRRAGA ◽  
FÁBIO MAZETTI REAES ◽  
CARLOS HENRIQUE MAÇANEIRO JUNIOR ◽  
ANDRÉ MATHIAS BAPTISTA ◽  
...  
Keyword(s):  
Chemotherapy Regimen ◽  
International Prognostic Index ◽  
Case Series ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Low Grade ◽  
Level Of Evidence ◽  
International Prognostic Index Score ◽  
Primary Bone

ABSTRACT Objective: It is difficult to define parameters for management and factors associated with primary bone lymphoma (PBL). This article presents the experience in a single institution with 42 patients with PBL over a 16-year period (2000-2016). Methods: Fifty-five patients were retrospectively evaluated, and forty-two were included (76.3%). Results: Median age at diagnosis was 51.5 years, and median follow-up was 102.7 months. One patient had HIV. Pain in the affected site was the most prevalent symptom. The average time between symptom onset and diagnosis was 5.4 months. The vertebrae were most affected (n=16, 33.3%). According to the International Prognostic Index Score (IPI), 64.3% of the patients were classified as having low-grade lymphoma and 25.7% as low-intermediate. The most common histology was diffuse large B cell lymphoma (DLBCL) (85.7%). Immunophenotyping was CD20 positive in 93.5% of patients, and 11 patients had pathological fracture. All patients received chemotherapy and 30% of the regimens included rituximab. Thirty-eight percent of patients received radiation therapy. Overall survival was 50%, and survival median time was 80 months. Age and chemotherapy regimen influenced patient survival. Younger patients and patients who received RCHOP had better prognoses. Conclusions: The choice of chemotherapy regimen associated with age influenced survival for patients with PBL. Level of Evidence IV; Case series.

Modified Magrath IVAC Regimen as Second-Line Therapy for Relapsed and Refractory Aggressive Non-Hodgkin Lymphoma in Developing Countries: The Experience of a Single Center in Brazil.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4588-4588
Author(s):  
Luis F. Pracchia ◽  
Juliana Pereira ◽  
Marcelo Belesso ◽  
Beatriz Beitler ◽  
Dalton A. Chamone
Keyword(s):  
Hodgkin Lymphoma ◽  
Median Overall Survival ◽  
Overall Response Rate ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Non Hodgkin Lymphoma ◽  
Grade 3 ◽  
Relapsed Disease

Abstract In this retrospective study we described the response and toxicity of a modified Magrath IVAC (mIVAC) regimen in 25 patients with refractory/relapsed aggressive non-Hodgkin lymphoma (NHL). The mIVAC consisted of ifosfamide 1,500mg/m2 (one-hour infusion beginning at 9:00; D1 to D5), mesna 300mg/m2 (bolus at hours 9:00, 13:00, 17:00; D1 to D5), citarabine 2,000 mg/m2 (two one-hour infusions beginning at 8:00 and 16:00; D1 and D2) and etoposide 60 mg/m2 (one-hour infusion beginning at 10:00; D1 to D5). Treatment was repeated every four weeks for a maximum of six cycles. Patients who achieved partial remission or complete remission after at least three courses were offered autologous stem cell transplantation (ASCT), if eligible. The median age was 37 years (range 18 to 59 years). Twenty-two (88%) patients had diffuse large B-cell lymphoma, fourteen (56%) had relapsed disease and 10 (40%) were considered high-intermediate and high risk by age-adjusted International Prognostic Index. The overall response rate was 68% (95% CI: 46%–90%). A total of 64 cycles were given, with a median of three courses per patient. Grade 3/4 neutropenia was observed after 85,6% of the courses, and grade 3/4 thrombocytopenia was observed after 87,5% of the courses. Grade 3/4 neutropenic fever occurred after 28% of the courses. Non-hematologic toxic effects were rare, predominantly grade 1/2. No toxic deaths were observed. Fifteen (88%) of the 17 responding patients underwent ASCT. With a median follow-up of 14 months, the median overall survival time for mIVAC sensitive patients was 16 months. This regimen may be feasible for patient with relapsed and refractory aggressive NHL in countries with inadequate numbers of hospital beds.

Non-Follicular Low Grade B-Cell Lymphomas: Patterns of Presentation and Management with Comparative Prognostic Utility of IPI and FLIPI

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1563-1563
Author(s):  
Laura S. Jacobus ◽  
Julianne Lunde ◽  
Matthew J Maurer ◽  
Ahmet Dogan ◽  
Sergei I Syrbu ◽  
...  
Keyword(s):  
B Cell ◽  
Marginal Zone ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Low Grade ◽  
University Of Iowa ◽  
Prognostic Utility ◽  
The University

Abstract Abstract 1563 Intro: Optimal treatment for non-follicular low grade B-cell lymphoma (NFLGL) is not well defined. Clinical trial design for these subtypes would be enhanced by further understanding of early presentation and management. A large prospective observational study was used to identify presenting clinical features, describe patterns of care and compare the prognostic utility of International Prognostic Index (IPI) and the Follicular Lymphoma International Prognostic Index (FLIPI). Methods: The University of Iowa/Mayo Clinic SPORE Molecular Epidemiology Resource (MER) is a prospective, longitudinal observational study designed to collect information on patterns of care and outcomes for patients with newly diagnosed lymphoma. Patients seen at the Mayo Clinic, Rochester MN and the University of Iowa within 9 months of their initial diagnosis of lymphoma are offered enrollment. Baseline patient reported data, clinical data and initial management are collected using a standard protocol and a central pathology review is performed. After enrollment, patients are actively followed for events (disease progression, retreatment, and death) and disease related comorbidities. This analysis includes 198 patients diagnosed with extranodal marginal zone (EMZL), 22 with nodal marginal zone (NMZL), 47 with splenic marginal zone (SMZL), 48 with lymphoplasmacytic lymphoma (LPL), as well as 67 patients with unclassifiable low-grade B-cell lymphoma (B-NOS). Results: 382 newly diagnosed NFLGBL patients were enrolled in the MER from 2002–2009. The median age at enrollment was 63 years (range 22–95). 52% were male. The most common types of initial therapy after diagnosis were observation (41 %), alkylator- based chemotherapy +/− rituximab (R) (17%), radiation therapy alone (15%) and R monotherapy (13%). At median follow-up of 60 months (range 1–121), 51 patients were deceased and 155 had an event. The clinical characteristics that comprise the IPI and FLIPI were similar across the subtypes. Approximately half of the cases presented at low risk (55% IPI; 48% FLIPI). A majority had a normal LDH (81%), limited nodal involvement (91% had ≤ 4 groups), normal hemoglobin (71% ≥12 g/dL), good performance status (95% 0–1), and advanced stage (57% stages III-IV). There were notable differences among the NFLGBL subtypes. Patients with SMZL and LPL presented with high risk FLIPI of 3–5 (49% and 46% respectively) and high to high-intermediate IPI of 3–5 (21% and 13%). Abnormal LDH and anemia (< 12 g/dL) were more frequent in patients with SMZL (40%; 56%) and LPL (25%; 62%). EMZL presented with lower stages (70% stage I-II) and NMZL presented with increased nodal involvement (38% >4 sites). SMZL had the highest rates of surgical resection (21%) and EMZL was more frequently treated with radiation therapy (25%). LPL (30%) and NMZL (32%) more commonly received alkylator based chemotherapy +/− R. While both IPI and FLIPI differentiated outcome in these patients, FLIPI had higher c-statistics than IPI for both EFS (0.583 vs 0.568) and OS (0.685 vs 0.661), respectively. Conclusions: This large prospective collection of data on NFLGBL patients presenting to academic medical centers provides a modern picture of presentation and management patterns useful to investigators designing clinical trials. FLIPI may have more prognostic utility than IPI in this group of patients. Disclosures: Ansell: Seattle Genetics, Inc.: Research Funding.

scholarly journals Infection-related morbidity and mortality among older patients with DLBCL treated with full- or attenuated-dose R-CHOP

2021 ◽  
Vol 5 (8) ◽  
pp. 2229-2236
Author(s):  
Toby A. Eyre ◽  
William Wilson ◽  
Amy A. Kirkwood ◽  
Julia Wolf ◽  
Catherine Hildyard ◽  
...  
Keyword(s):  
Older Patients ◽  
Rating Scale ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Dose Intensity ◽  
B Cell Lymphoma ◽  
Morbidity And Mortality ◽  
Risk Of Infection ◽  
Increased Risk

Abstract Infection-related morbidity and mortality are increased in older patients with diffuse large B-cell lymphoma (DLBCL) compared with population-matched controls. Key predictive factors for infection-related hospitalization during treatment with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and deaths as a result of infection in older patients during and after treatment with R-CHOP remain incompletely understood. For this study, 690 consecutively treated patients age 70 years or older who received full-dose or attenuated-dose R-CHOP treatment were analyzed for risk of infection-related hospitalization and infection-related death. Median age was 77 years, and 34.4% were 80 years old or older. Median follow-up was 2.8 years (range, 0.4-8.9 years). Patient and baseline disease characteristics were assessed in addition to intended dose intensity (IDI). Of all patients, 72% were not hospitalized with infection. In 331 patients receiving an IDI ≥80%, 33% were hospitalized with ≥1 infections compared with 23.3% of 355 patients receiving an IDI of &lt;80% (odds ratio, 1.61; 95% confidence interval, 1.15-2.25; P = .006). An increased risk of infection-related admission was independently associated with IDI &gt;80% across the whole cohort. Primary quinolone prophylaxis independently reduced infection-related admission. A total of 51 patients died as a result of infection. The 6-month, 12-month, 2-year, and 5-year cumulative incidences of infection-related death were 3.3%, 5.0%, 7.2%, and 11.1%, respectively. Key independent factors associated with infection-related death were an International Prognostic Index (IPI) score of 3 to 5, Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score ≥6, and low albumin, which enabled us to generate a predictive risk score. We defined a smaller group (15%) of patients (IPI score of 0-2, albumin &gt;36 g/L, CIRS-G score &lt;6) in which no cases of infection-related deaths occurred at 5 years of follow-up. Whether patients at higher risk of infection-related death could be targeted with enhanced antimicrobial prophylaxis remains unknown and will require a randomized trial.

L-mind: MOR208 combined with lenalidomide (LEN) in patients with relapsed or refractory diffuse large b-cell lymphoma (R-R DLBCL)—A single-arm phase II study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 7514-7514 ◽  
Author(s):  
Kami J. Maddocks ◽  
Eva González Barca ◽  
Wojciech Jurczak ◽  
Anna Marina Liberati ◽  
Johannes Duell ◽  
...  
Keyword(s):  
Phase Ii ◽  
Phase Ii Study ◽  
International Prognostic Index ◽  
Single Agent ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Cell Transplant ◽  
Cell Of Origin

7514 Background: The Fc-enhanced CD19 antibody MOR208 and the immunomodulatory drug LEN have demonstrated single agent activity in patients (pts) with R-R DLBCL. MOR208 and LEN have shown synergy in vitro and in vivo in preclinical lymphoma models. This ongoing phase II study assesses the safety and efficacy of MOR208 + LEN in pts with R-R DLBCL. Methods: Pts >18 years old with R-R DLBCL, ECOG 0–2, adequate organ function, having previously received ≥1 but not more than 3 prior therapies, including ≥1 CD20-targeting regimen and who are not candidates for autologous stem cell transplant (ASCT), are eligible. Treatment comprises up to 12, 28-day (d) cycles (C) of MOR208 12 mg/kg IV, weekly during C1–3 (loading dose d4 of C1); every second week C4–12 + LEN 25 mg po d1–21, C1–12. Pts progression-free after 12 cycles receive up to 12 additional cycles of MOR208 (every second week). The primary endpoint is the overall response rate (ORR) by central radiology assessment. Secondary endpoints include disease control, duration of response, progression-free and overall survival, safety, and response by cell of origin and other biomarkers. A preplanned safety evaluation was undertaken. Results: 31 of 80 planned pts were enrolled prior to data cutoff (3 January 2017). Median age was 74 years (range 47–82); 45% of pts received ≥2 prior lines of therapy; 23% had rituximab refractory disease; 74% had Ann Arbor stage ≥III disease; 65% had elevated lactate dehydrogenase level, and 52% had a poor revised International Prognostic Index (3-5). The most common treatment-emergent adverse events (any grade/grade ≥3 [% pts]) were neutropenia (39/26), anemia (23/0) thrombocytopenia (16/6), infections (26/10) diarrhea (13/0), pyrexia (13/0), and rashes (13/6). Of 26 response evaluable pts (median follow-up 3.3 months), ORR (investigator assessed) was 58% (15 pts), with 7 (27%) complete responses. Median time to response was 1.8 months. Conclusions: The combination of MOR208 + LEN is well tolerated and shows promising activity in pts with R-R DLBCL. Accrual and follow-up of pts is ongoing, as are cell of origin and other biomarker analyses. Clinical trial information: NCT02399085.

Fludarabine, Mitoxantrone and Dexametasone in the Treatment of Relapsed and Refractory Low-Grade Non-Hodgkin Lymphoma.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4738-4738
Author(s):  
Joanna Sawczuk-Chabin ◽  
Ewa Kalinka ◽  
Piotr Centkowski ◽  
Katarzyna Budziszewska ◽  
Bernadeta Ceglarek ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Performance Status ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Response Duration ◽  
Low Grade ◽  
International Prognostic Index Score ◽  
Non Hodgkin Lymphoma ◽  
D 20 ◽  
Grade Iii

Abstract The purpose of the study was to evaluate response, duration of response, and toxicity of fludarabine (F), mitoxantrone (M), and dexamethason (D) (FMD) in patients (pts) with relapsed or refractory low-grade non-Hodgkin lymphoma (LGNHL). 26 pts with advanced relapsed/refractory LGNHL exposed to previous chemotherapy (CHT) received 3–6 monthly cycles of FMD. The median age was 60 years (range 34–73), included 13 male (50%) and 13 female (50 %). The regimen consisted of F (25 mg/m2 i.v., day 1–3), M (10 mg/m2 i.v., day 1) and D (20 mg p.o., day 1–5). Parameters analyzed included response, toxicity and infection rates, number of previous CHT lines, performance status (ECOG), Ann Arbor scale, LDH, International Prognostic Index score, freedom from progression (FFP) and overall survival (OS). In total 78 cycles of FMD was administered. This induced 25% complete and 37,5% partial response, with a total response rate of 62,5%. After 14 months of the median follow-up of the pts remaining alive, median FFP was 11 months and median OS has not been achieved yet. Out of 78 administered cycles 16 (20%) were associated with toxicity, including 8 (10%) severe infections despite prophylaxis and 6 (8%) grade III/IV neutropenias. In addition, one case of grade III/IV thrombocytopenia and acute noninflammatory renal dysfunction were observed. Toxicity rate was not correlated with the number of previous CHT lines or ECOG, but IPI >2 was significant factor predictive for FMD-related toxicity (p=.037). Shorter OS was observed for the pts with ECOG>1 (p=.049), IPI>2 (p=.005) and FMD-related toxicity (p=.036). FMD is an active regimen for relapsed and refractory LGNHL. Toxicity rate is substantial and seems to predict survival.

Clinicopathologic Analysis of Follicular Lymphoma (FL) Patients with Coexisting Diffuse Large B-Cell Lymphoma (DLBCL) Undergoing Rituximab-Containing Chemotherapy

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3693-3693 ◽  
Author(s):  
Suguru Fukuhara ◽  
Dai Maruyama ◽  
Ken-ichi Miyamoto ◽  
Sung-Won Kim ◽  
Takashi Watanabe ◽  
...  
Keyword(s):  
Research Funding ◽  
De Novo ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Initial Diagnosis ◽  
The Other ◽  
Low Grade ◽  
Other Hand ◽  
Significant Difference

Abstract Abstract 3693 Background: Histopathologically, some FLs have components of DLBCL at diagnosis. In the pre-rituximab era, there were two reports regarding the characteristics and prognosis of patients (pts) with these particular FLs1,2). Hans et al. reported that the overall survival (OS) of pts with FL grade 3 having a predominant (> 50%) DLBCL component is similar to that of pts with DLBCL1). Ghesquières et al. concluded that pts with DLBCL presenting with a low-grade component have a similar OS to those with de novo DLBCL2). However, the clinical implications and prognosis of FL pts with coexisting DLBCL at diagnosis undergoing rituximab-containing chemotherapy remain unclear. Patients and Methods: We retrospectively analyzed the clinicopathologic features of 59 FL pts with coexisting DLBCL (FL/DLBCL) initially undergoing rituximab-containing chemotherapy. Furthermore, the prognosis of FL/DLBCL pts was compared with that of 223 FL pts without DLBCL as well as 285 DLBCL pts without FL3). All pts received a rituximab-containing regimen as the initial chemotherapy. These pts with FL/DLBCL or FL were diagnosed and treated at our institution between 2001 and 2010, and DLBCL pts between 2003 and 2010. Results: The median age of the 59 pts with FL/DLBCL was 54 years (range: 22–83). Among them, 41 (69%) pts had FL grade 1–3a and the remaining 18 (31%) had FL grade 3b components. Thirty (51%) pts had a predominant (> 50%) DLBCL component. With regard to treatment, all pts except one received the R-CHOP regimen. Forty-nine (83%) pts achieved CR, but 22 of them (37%) relapsed. With a median follow-up of 5.4 years, the estimated 5-year OS and progression-free survival (PFS) for all 59 pts were 83 and 64%, respectively. The International Prognostic Index (IPI) and FLIPI were not correlated with OS and PFS, whereas the revised-IPI (R-IPI) and FLIPI2 were significantly correlated with PFS. A predominant DLBCL component was predictive of neither OS nor PFS. In the 41 pts with FL grade 1–3a with DLBCL, %CR, 5-year OS, and PFS rates were 80, 84, and 60%, respectively. On the other hand, in the 18 pts with FL grade 3b with DLBCL, they were 89, 82, and 72%, respectively. The %CR and PFS rates of the latter cohort showed superior tendencies to those of the former cohort, with no statistically significant difference. Among 22 relapses, 10 were confirmed histologically: 5 DLBCL, 4 FL, and 1 HL. In 16 relapsed pts with FL grade 1–3a at initial diagnosis, 4 relapsed as FL, one each as DLBCL and HL. Two pts who had relapsed as FL and HL subsequently developed DLBCL. On the other hand, 4 out of 5 relapsed pts with FL grade 3b at the initial diagnosis relapsed as DLBCL. Additionally, the prognosis of FL/DLBCL pts was compared with that of FL and DLBCL pts. The 5-year OS rate of FL/DLBCL pts (83%) was significantly worse than that of DLBCL pts (91%, p=0.039) as well as FL pts (97%, p=0.001) (Fig 1). The 5-year PFS rate of FL/DLBCL pts (64%) was not significantly different from that of DLBCL pts (72%, p=0.120). The PFS curves (Fig 2) suggested a slight increase in progression or mortality in FL/DLBCL pts during the first 2 years. However, the FL/DLBCL pts had a low incidence of events after 2 years. The PFS curve of FL/DLBCL pts was similar to that of DLBCL pts. By multivariate analysis of pts with FL/DLBCL and DLBCL, coexisting FL components was a significant predictor of inferior OS, but not PFS. Conclusions: The PFS curve of FL/DLBCL pts was similar to that of DLBCL pts, although pts with FL/DLBCL had poorer prognosis than DLBCL pts in the rituximab era. Furthermore, in our present analysis, predominant DLBCL component was predictive of neither OS nor PFS. Disclosures: Kobayashi: Nippon Shinyaku: Research Funding; Ariad: Research Funding; Ohtsuka: Research Funding; Celgene: Research Funding; Behringer : Research Funding. Tobinai:Grant Support: Zenyaku, Chugai/Roche, GSK, Biomedics Other.

Safety and Efficacy of High-Dose Cyclophosphamide, Etoposide, and Ranimustine (CEM) Regimen Followed by Autologous Peripheral Blood Stem Cell Transplantation for Patients with High Risk De Novo Diffuse Large B-Cell Lymphoma or Diffuse Large B-Cell Lymphoma Associated with Follicular Lymphoma.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3121-3121
Author(s):  
Yujin Kobayashi ◽  
Yoshihiro Hatta ◽  
Atsuko Hojo ◽  
Masaru Nakagawa ◽  
Machiko Kusuda ◽  
...  
Keyword(s):  
High Risk ◽  
De Novo ◽  
Late Onset ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
History Of ◽  
Autologous Pbsct

Abstract Abstract 3121 Background We evaluated the safety and efficacy of the CEM regimen containing ranimustine (MCNU) with autologous peripheral blood stem cell transplantation (PBSCT) in adult patients with relapsed or high-risk de novo DLBCL or DLBCL associated with follicular lymphoma (FL/DLBCL) in our institution. Patients and methods We retrospectively analyzed 55 consecutive patients who underwent autologous PBSCT following the CEM regimen between March 1999 and June 2011 for the treatment of relapsed or high-risk DLBCL and FL/DLBCL. High-risk DLBCL was defined as partial or no response to initial treatment or high-intermediate/high risk disease according to international prognostic index (IPI) at initial diagnosis. Age-adjusted IPI was used for patients under 60. The CEM regimen consisted of CY (60 mg/kg on days -7 and -6), etoposide (500 mg/m2 on days -6 to -4) and MCNU (250 mg/m2on day -3 and -2), followed by PBSCT. Results Median age at transplant was 51 years (range, 23–66), and median time from diagnosis to transplant was 5 months (range, 3–241). Of them, 7 patients received radiation therapy before transplant, and 11 had no history of rituximab use before transplant. The 36 patients in CR1 at transplant were with high or high-intermediate risk according to international prognostic index at diagnosis. Other 15 patients in CR2, and 4 patients who were not in CR1/2 at transplant were included. CY dose was reduced in five patients by physicians choice. The median number of infused CD34-positive cells was 3.98 × 106/kg (range, 1.36–26.87). The median post-transplant days of neutrophil recovery and platelet were 11 days (range, 9–20) and 12 days (range, 7–53), respectively. Common grade 3/4 non-hematological treatment-related toxicities within the first 100 days after transplant were nausea (24%), vomit (4%), stomatitis (15%), and diarrhea (9%). Infections included febrile neutropenia (85%), sepsis (15%) which contained catheter-related bacteremia (n=4) and pneumonia (n=2). Other less common severe toxicities were acute renal impairment (n=3), and pleural effusion (n=1). No sever cardiac, neurologic toxicity, or veno-occlusive disease of the liver was observed in any of the patients. Late-onset adverse effects during follow-up period includes chronic renal impairment (n= 5), therapy-related myelodysplastic syndrome (refractory anemia) (n=1, 120 months), and prostate cancer (n=1, 83 months). Serious late cardiac or pulmonary impairment was not diagnosed in this cohort. Median follow-up duration of 42 patients surviving at the time of the analysis was 52 months (range, 1–159). Relapse or disease progression after PBSCT was documented in 21 cases (range, 0–81 months after PBSCT). No therapy related mortality (TRM) associated with PBSCT was observed, and all the 13 deaths were due to disease relapse/progression. The 5-year estimated overall survival (OS) and progression-free survival (PFS) were 70.6% (95% CI, 54.0–82.1)% and 57.0% (95% CI, 39.5–71.2)% for all patients, respectively. In a univariate analysis for factors affecting OS and PFS, no significant factors associated with unfavorable OS and PFS was found including age at transplant, gender, history of rituximab use, histology, disease status at transplant, and previous BM involvement. Conclusion We conclude that the CEM regimen using MCNU would be a tolerable, effective conditioning regimen of autologous PBSCT for high-risk or relapsed de novo DLBCL or FL/DLBCL. Although no TRM was observed, relapse was the major cause of treatment failure. Late-onset complications in long-term survivors can occur, and should be carefully monitored. Disclosures: No relevant conflicts of interest to declare.

What Is the Appropriate Dose Attenuation System of RCHOP for Elderly DLBCL Patients? - A Single Institutional Analysis in 115 Cosecutive Patients From Japan -

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3639-3639
Author(s):  
Akira Tanimura ◽  
Risen Hirai ◽  
Atsushi Sato ◽  
Miki Nakamura ◽  
Masataka Takeshita ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Elderly Patients ◽  
Conflicts Of Interest ◽  
Univariate Analysis ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Age Related

Abstract Abstract 3639 Background: The combination therapy of RCHOP [rituximab (R), cyclophosphamide (CY), doxorubicin (DOX), vincristine (VCR), and prednisone (PSL)] is a standardized treatment for diffuse large B-cell lymphoma (DLBCL). However, its clinical outcome is worse in elderly patients because of comorbidities, age-related decrease in organ function, and impaired drug metabolism. If possible, the dose of RCHOP in elderly patients and patients with comorbidities should be adjusted appropriately. Since 2005, we have used a unified dose attenuation system for RCHOP according to the age and comorbidities of patients. This study retrospectively verified this system. Patients/Methods: We analyzed 115 consecutive DLBCL patients treated at our institute from September 2001, when rituximab was approved in Japan, to December 2010. From September 2001 to August 2005, 33 patients received dose adjustment of RCHOP according to the physician's discretion (PHY group). From September 2005, 82 patients received RCHOP according to the unified dose attenuation system (UNI group). In the UNI group, patients younger than 60 years received the standard RCHOP dose [R, 375 mg/m2; CY, 750 mg/m2; DOX, 50 mg/m2; VCR, 1.4 mg/m2 (max 2.0 mg/body); PSL, 100 mg/m2]. In patients older than 60 years, the doses of CY, DOX, VCR, PSL, and R were attenuated as shown in Table 1. In addition to age, the doses of CY, DOX, and VCR were adjusted according to organ functions (Table 2). The two groups were compared statistically. Results: The median age of patients was 70 years (range, 38–91), with 70.4% of patients classified as stage III or IV DLBCL, 40.4% with an international prognostic index (IPI) score of 0–2, and 70.2% with a ECOG performance status (PS) of 0 or 1. Low serum albumin levels (under normal range) were observed in 50.5% patients, and a high Charlson comorbidity index (CCI) score of >1 was found in 58.3%. The characteristics of the patients in the two groups were almost similar. The UNI system was completed in 94% of patients. The complete response (CR) rate was 63% in all patients (UNI group, 73%; PHY group, 39%; P = 0.0006). Univariate analysis revealed that better prognostic factors for CR were a low IPI score, better PS, and the UNI group. In the multivariate analysis, only the UNI group was a significantly better prognostic factor for CR. With a median follow-up of 26 months, the 5-year event-free survival (EFS) and overall survival (OS) were 39.3% and 68% in all patients, 43% and 72% in the UNI group, and 27% and 59% (5-year EFS; P = 0.0083, 5-year OS; P = 0.16) in the PHY group, respectively. Multivariate analysis showed that better prognostic factors for EFS were a low IPI score, a low CCI score, and the UNI group, and that for OS were low IPI and low CCI scores. In elderly patients aged >70 years (N = 59), the CR rates were 81% and 13% in the UNI and PHY groups, respectively (P = 0.0004), with OS in the UNI group being longer than that in the PHY group (72% vs. 59%; P = 0.02; Fig.1). In the UNI group, patient age did not affect the CR rate (<70, 71% vs. 70–79, 83% vs. >79, 79%; P = 0.56) or 5-year OS (<70, 76% vs. 70–79, 70% vs. >79, 66%; P = 0.58). The actual dose of CY, DOX, and VCR compared with the standard RCHOP dose was 64% and 26%, 63% and 16%, and 63% and 21% in the UNI and PHY groups, respectively. Disease progression during treatment, discontinuation of therapy, and death during treatment were observed in 10% and 15%, 5% and 24%, and 5% and 3% in the UNI and PHY groups, respectively. Nineteen patients (23%) from the UNI group died over a median follow-up of 15 months, while 15 patients (45%) of the PHY group died over a median follow-up period of 29 months. Lymphoma-related deaths were 12 (14%) in the UNI group and 8 (24%) in the PHY group. Five secondary primary malignancies (SPM) were observed (1 colon cancer and 1 breast cancer in the PHY group, and 1 lung cancer and 2 myelodysplastic syndrome in the UNI group). Four deaths were related to SPM. Conclusion: The unified dose attenuation system determined by the patients' age and comorbidities may achieve an effective dose level and better prognosis in elderly DLBCL patients. Disclosures: No relevant conflicts of interest to declare.

The Revised International Prognostic Index (R-IPI) Score Is Predictive Of Survival In Aggressive Transformed Lymphomas (TL) From Low Grade Non-Hodgkin Lymphomas In The Chemoimmunotherapy Era

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4275-4275 ◽  
Author(s):  
Tsao Christina ◽  
Samir Dalia ◽  
Celeste M. Bello ◽  
Lubomir Sokol ◽  
Eduardo M. Sotomayor ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Stage Iii ◽  
Low Grade ◽  
Cell Transplant ◽  
Bulky Disease ◽  
Histological Transformation ◽  
Extranodal Disease

Abstract Introduction Histologic transformation of low grade non Hodgkin lymphoma (LG-NHL) occurs with a variable frequency. Several factors have been associated with survival in transformed lymphoma (TL) and the prognosis has been generally poor. The R-IPI has been shown to be prognostic in the pre rituximab era. Purpose To assess R-IPI as prognostic at lymphoma transformation in the rituximab era. Methods Patients with a diagnosis of diffuse large B-cell lymphoma transformed from LG-NHL (DLBCL-TL) were identified between January 2001 and December 2011 through the Moffitt Cancer Center Total Cancer Care Database. LG-NHL included follicular lymphoma (FL), marginal zone lymphoma (MZL), mucosa associated tissue lymphoma (MALT) and other low grade histologies. Patients with small lymphocytic lymphoma (SLL) with Richter’s transformation were excluded. All patients received rituximab based chemotherapy at transformation. Clinical data, pathologic data include morphology and immunohistochemistry (IHC) including CD10, BCL6, MUM1/IRF4 were recorded. Overall survival (OS) was calculated from the date of transformation. OS was estimated by the Kaplan-Meier method and compared using the long-rank test. A p-value< 0.05 was considered statistically significant. Results A total of 81 patients were identified with DLBCL-TL. At diagnosis and transformation the median ages were 60 and 64 years (22 – 89), respectively. The male:female ratio was 0.72. The most common LG-NHL diagnosis was FL (75.3%). The median time to DLBCL transformation (TTT) was 3.4 years. At LG-NHL diagnosis 67.9% of patients were stage III/IV, 23.5% had bulky disease, 35.8% had extranodal disease (ED) and 14.8% were FLIPI1 score > 3. At transformation 29.6% had B symptoms, 77.8% had stage III/IV disease, 25.9% had ED, and 40.4% had an elevated LDH. DLBCL-GCB as per Hans algorithm was present in 65.5% of cases at transformation. The mean hemoglobin (Hb) and serum albumin (SA) level at transformation were 12.6 g/dl and 3.9 g/dl, respectively and an IPI > 3 was present in 22.2% of cases. R-IPI categories were very good in 4.9%, good in 72.8% and poor in 22.2%. Patients received rituximab prior to transformation in 65.4% with R-CHOP being the most common regimen used (84%). Radioimmunotherapy (RIT) was given in 17.3% of patients. Patients received 3 or more treatment lines in 74.1%. Patients underwent autologous and allogeneic stem cell transplant in 24.7 and 2.5% of cases, respectively. The median OS was 6.2 years. Poorer OS was associated with R-IPI > 3 at transformation (median OS 1.9 y, HR 2.9 [CI 1.5 – 5.9], p<0.0001) (Figure 1), FLIPI1 score 3 or more (median OS 1.7y, HR 2.9 [CI 1.7 – 5.1], p<0.0001), TTT< 2 years (median OS 2.8y, HR 3.2 [0.9 – 10.5], p=0.041), B symptoms (median OS 2.8y, HR 3.1 [1.5 – 6.4] p=0.003) and elevated LDH (median OS 2.8y, HR 2.6[1 – 6.6], p=0.04). The median OS with IPI< 2 was not reached. No survival differences were seen with FL vs non FL histology, older age, extranodal disease, bulky disease, use of RIT, number of treatment lines or rituximab prior to TL. There was a trend towards poorer OS with SA< 3.7 g/dl (median OS 2.8y, p=0.068). Conclusions An R-IPI >3 at transformation was associated with poorer OS in patients with LG-HNL who undergo histological transformation into DLBCL and treated with chemoimmunotherapy. This suggests that R-IPI can be used at the time of transformation to better assess the aggressiveness of disease. A confirmation of these findings will be needed in multicenter and prospective cohorts. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Lymphomas with concurrent BCL2 and MYC translocations: the critical factors associated with survival

Blood ◽  
2009 ◽  
Vol 114 (11) ◽  
pp. 2273-2279 ◽  
Author(s):  
Nathalie A. Johnson ◽  
Kerry J. Savage ◽  
Olga Ludkovski ◽  
Susana Ben-Neriah ◽  
Ryan Woods ◽  
...  
Keyword(s):  
Overall Survival ◽  
B Cell ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
International Prognostic Index Score ◽  
Risk Patients ◽  
Bcl2 Protein

Abstract BCL2 and MYC are oncogenes commonly deregulated in lymphomas. Concurrent BCL2 and MYC translocations (BCL2+/MYC+) were identified in 54 samples by karyotype and/or fluorescence in situ hybridization with the aim of correlating clinical and cytogenetic characteristics to overall survival. BCL2+/MYC+ lymphomas were diagnosed as B-cell lymphoma unclassifiable (BCLU; n = 36) with features intermediate between Burkitt lymphoma and diffuse large B-cell lymphoma (DLBCL); DLBCL (n = 17), or follicular lymphoma (n = 1). Despite the presence of a t(14;18), 5 cases were BCL2 protein–negative. Nonimmunoglobulin gene/MYC (non-IG/MYC) translocations occurred in 24 of 54 cases (44%) and were highly associated with DLBCL morphology (P < .001). Over a median follow-up of 5.3 years, 6 patients remained in remission and 32 died within 6 months of the MYC+ rearrangement, irrespective of whether MYC+ occurred at diagnosis (31 of 54) or transformation (23 of 54; P = .53). A non-IG/MYC translocation partner, absent BCL2 protein expression and treatment with rituximab-based chemotherapy, were associated with a more favorable outcome, but a low International Prognostic Index score and DLBCL morphology were independent predictors of overall survival. A comprehensive cytogenetic analysis of BCL2 and MYC status on all aggressive lymphomas may identify a group of high-risk patients who may benefit from chemotherapeutic regimens that include rituximab and/or BCL2-targeted therapy.

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