scholarly journals Characteristics and treatment outcomes of patients with primary ocular adnexal lymphoma in Northern Thailand

2020 ◽  
Vol 17 (1) ◽  
pp. 86-97
Author(s):  
Kasem Seresirikachorn ◽  
Sakarin Ausayakhun ◽  
Damrong Wiwatwongwana ◽  
Ponsak Mahanupab ◽  
Teerada Daroontum ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Response Rate ◽  
Stage Iv ◽  
High Response Rate ◽  
University Hospital ◽  
Treatment Modalities ◽  
Low Grade ◽  
Northern Thailand ◽  
Ocular Adnexal Lymphoma ◽  
Operative Notes

Purpose: To assess the characteristics and treatment outcomes of patients with primary ocular adnexal lymphoma (OAL) in Northern Thailand. Design: Retrospective cohort study. Methods: Data was collected from electronic medical records and operative notes from Chiang Mai University Hospital between January 2009 and December 2014. All available tissue biopsies of 54 patients were reviewed by agreement of two pathologists. The clinical characteristics and treatment outcomes were collected and analyzed. Results: A total number of 54 patients were identified of which 57.4% were female. The median age was 61.0 years (range, 4-86). The most common subtype of lymphoma was extranodal marginal zone lymphoma (ENMZL) of mucosa-associated lymphoid tissue (MALT) (n = 46, 85.2%). Seventy-five percent of the patients presented with a mass at the ocular adnexa, while 14.8% of the patients presented with proptosis. The sites of origin were as follows: lacrimal (46.3%), orbit (31.5%), conjunctiva (13%) and eyelid (7.4%). Two-thirds of the patients had Ann-Arbor Stage I, while 22% of patients had Stage IV. The majority of the patients (68.1%) had a low-risk international prognosis index (IPI). Treatment modalities involved field radiation (IFRT, 50%), chemotherapy (31.6%), combined chemoradiotherapy (7.9%) and surgical resection (10.5%). The overall response rate was 100% with a complete response rate of 77.8%. In patients with low-grade lymphoma, including MALT lymphoma, the 3-year progression-free survival (PFS) and overall survival were 69.9% and 92.5%, respectively. Conclusion: ENMZL of MALT was the major subtype of primary OAL. Radiotherapy was an effective treatment for the lower stages of disease providing a high response rate and encouraging survival outcomes.

High Response Rate to DLI Based Strategies for the Treatment of Refractory Disease/Relapse Following Allogeneic HSCT for Lymphoproliferative Disease.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1653-1653
Author(s):  
Nigel H. Russell ◽  
Jenny L. Byrne ◽  
Emma P. Das-Gupta ◽  
Michelle Gilyead ◽  
Andy P. Haynes
Keyword(s):  
Mantle Cell Lymphoma ◽  
Acute Gvhd ◽  
Response Rate ◽  
Cell Lymphoma ◽  
Lymphoproliferative Disease ◽  
High Response Rate ◽  
Low Grade ◽  
High Grade ◽  
Allogeneic Hsct ◽  
Mantle Cell

Abstract Allogeneic HSCT is increasingly being performed for lymphoproliferative disease, particularly with reduced intensity conditioning (RIC). DLI are an important part of this strategy however there is a paucity of information in this setting although responses have been reported in Hodgkin’s disease and follicular lymphoma. We have treated 17 patients (median age 51 year; 30–62yr) with refractory disease (n=7) or disease relapse (n=10) following allogeneic HSCT for lymphoma with a DLI based strategy. The diagnosis was CLL, including 1 Richter’s (n=5); mantle cell lymphoma (n=4); high grade NHL (n=4) and follicular NHL (n=4). 15 patients received RIC transplants with either Beam/Alemtuzumab (n=11), or fludarabine/melphelan/alemtuzumab (n=4). Two patients received myeloablative conditioning with TBI and cyclophosphamide. The median time to DLI was 0.96 years (0.23 to 4.58yr) and in 15/17 the donor was a matched sibling (n=13) or 1 antigen mismatched sibling (n=2) and in 2 cases was an unrelated donor. At DLI, 6 patients had mixed chimaerism (20–95%) and 8 had full donor chimaerism with the chimaerism status being unknown in 5 cases. Patients with low grade disease received DLI either alone (n=7) or following initial radiotherapy (n=1). Patients with high-grade NHL, MCL or Richter’s transformation of CLL (n=11) all received chemtherapy pre-DLI. For the 15 sibling donors the median first dose of CD3+ cells infused was 2.0 x 10 7/kg ( range 0.5–6 x 10 7/kg) following which 6 achieved CR. 6 patients received a 2nd infusion (median dose 5 x 10 7/kg) with 2 achieving CR and 1 patient receiving a 3rd DLI and achieving CR. Both MUD DLI recipients achieved a CR after 2 and 3 infusions. Overall 10 out of 17 patients achieved a CR including 3/4 patients with CLL, 4/4 with MCL; 3/4 with follicular NHL but none of the 5 patients with high-grade NHL/Richter’s transformation responded. The median CD3 cell dose required to achieve CR for sibling donors was 2x 107/kg whereas non-responders received a median of 5.0 x 107/kg. An additional patient with CLL who developed aplasia following the first DLI had a second transplant from the same donor and is in CR at 14m giving a final overall CR rate of 70%. Response to DLI was independent of chimaerism status at relapse. Acute GvHD developed in 11 patients and was grade II in 8/10 and grade 111/IV in 3 cases. 1 patient died in CR of acute GvHD. Chronic GvHD developed in 9 of 11 surviving patients. Only 1 patient with mantle cell lymphoma has relapsed at 18m post-DLI. The median follow-up for the surviving patients is 34m (range 6m–60m). The overall survival at a median of 30 months post DLI is 58%. We conclude that lymphoma patients, particularly those with low grade NHL including mantle cell lymphoma relapsing following an allogeneic transplant have a high response rate to DLI based strategies,superior to that seen in myeloma and comparable to that seen in CML. Furthermore these responses appear durable with a low risk of relapse. Patients with high-grade disease appear to have a poor response rate despite using pre-DLI chemotherapy

Effect of exogenous triiodothyronine [T3] on free thyroxine depletion and tumor response: A compassionate care study.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e22077-e22077
Author(s):  
Aleck Hercbergs
Keyword(s):  
Solid Tumor ◽  
Tumor Response ◽  
Response Rate ◽  
Thyroid Hormone Receptor ◽  
Stage Iv ◽  
High Response Rate ◽  
Brain Stem Glioma ◽  
Compassionate Care ◽  
Free T4 ◽  
Therapeutic Implications

e22077 Background: A thyroid hormone receptor on plasma membrane integrin av β3 initiates the actions of the hormone thyroxine [T4] on cancer cell proliferation and angiogenesis, initiated nongenomically, independently of the classical thyroid nuclear receptor. In studies of recurrent glioma, induced hypothyroidism significantly prolonged survival but associated fatigue has restricted acceptance of this approach. Triiodothyronine[T3] is the metabolically dominant hormone but in physiological extracellular concentrations is 10-100 fold less mitogenic than T4 in solid tumor models (R Meng et al., PLoS 2011; 6[11]:e27547). Exogenous T3 also maintains eumetabolism but inhibits TSH release to induce free T4 depletion [FT4D] defined as[< 0.93 ng/dL.] Maximal therapeutic free T4 depletion [FT4D] by T3 may therefore be feasible if combined with methimasole[MET]. Aims of study: Retrospective analysis of 1.) exogenous T4 withdrawal and 2.) daily exogenous T3 [ET3] and MET on tumor response and survival Methods: 21 Patients at geographically dispersed sites with recurrent or stage IV solid tumors: GBM 8 patients, brain stem glioma 1, pancreas 1, salivary gland 2, Lacrimal duct 1, breast 1, mesothelioma 1, ovarian 4, lung 2. 1.) In 7 patients exogenous T4 was terminated and replaced by exogenous T3 [ET3] 15 to 30μg daily in three divided doses. 2.) 15 euthyroid patients received 15-30μg ET3 and 20-40 mg. methimasole [MET] daily to induce [FT4D] usually obtained within 6-10 weeks. Results: There was no treatment related toxicity. 3/7 patients had PR to withdrawal of T4 only. 20/21 patients experienced PR[16] or CR[4]. to concurrent or sequential chemo,hormonal or radiation therapy for an overall response rate of 90% CHT elicited repeated responses in some patients. The 6 month PFS for the GBM cohort [n=8] was 70%. Two survived 36 and 53 months. For other solid tumor types survival was above /in the 90th percentile of reported survival studies. Conclusions: A high response rate was observed in advanced compassionate care cancer patients undergoing exogenous T3 modulated FTD. Tumor response to exogenous T4 withdrawal is a novel observation with potentially important therapeutic implications.

Clinical benefit of EGFR-TKIs plus radiotherapy for treating EGFR-mutated metastatic non-small cell lung cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20694-e20694
Author(s):  
Ran Lin Wang ◽  
Tao Li ◽  
Jiahua Lv ◽  
Chang Sun ◽  
Qiuling Shi
Keyword(s):  
Response Rate ◽  
Cox Model ◽  
Tumour Response ◽  
Stage Iv ◽  
Progression Free Survival ◽  
High Response Rate ◽  
Egfr Mutations ◽  
Egfr Mutated ◽  
Egfr Tki ◽  
Egfr Tkis

e20694 Background: Despite the high response rate and prolonged OS of patients with EGFR mutations treated with gefitinib or erlotinib, there are still major clinical obstacles. The local control rate is still low, only 19.4%–58%, with first-line treatment using EGFR-targeted therapy. The aim of this study is to provide scientific evidence to support the clinical benefits of EGFR-TKI combined with radiotherapy compared to EGFR-TKI alone. Methods: From February 2015 to May 2017, a total of 103 patients with stage IV EGFR-mutated NSCLC treated at Sichuan Cancer Hospital & Institute were analysed retrospectively. 50 patients were treated with EGFR-TKIs (gefitinib or erlotinib) plus radiotherapy (Group TKI-RT) and 53 patients received EGFR-TKIs alone (Group TKI). Tumour response, survival and toxicities were compared between the two groups. Results: Median follow up time was 11.7 months (range: 2.8–36.3 months). The overall response rate (ORR) and disease control rate (DCR) in Group TKI-RT vs. Group TKI were 62% vs. 37.7% (P = 0.014) and 88% vs. 75.5% (P = 0.101), respectively. The median progression-free survival (PFS) and median overall survival (OS) in Group TKI-RT were superior to those of Group TKI (18.87 months vs. 12.80 months, P = 0.035 and 23.10 months vs. 18.30 months, P = 0.011). OS rates in Group TKI-RT and Group TKI were 56.0% vs. 35.8% at 1-year (P = 0.04) and 16.0% vs. 3.8% at 2-year (P = 0.036). Multivariate Cox model found that TKI-RT related to significantly better OS (hazard ratio = 0.209; 95% CI, 0.066 to 0.661; P = 0.008) than TKI alone. Adverse events did not differ significantly between the two groups. Conclusions: Compared with EGFR-TKIs alone, EGFR-TKIs combined with radiotherapy was well tolerated and showed benefit in tumour response and survival for EGFR mutation-positive metastatic NSCLC patients.

Checkpoint inhibitor treatment in patients with isolated in-transit melanoma metastases.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 10070-10070
Author(s):  
Lucy Storey ◽  
Mohammed Abdul-Latif ◽  
Sophia Kreft ◽  
Emma Barrett ◽  
Lisa M Pickering ◽  
...  
Keyword(s):  
Response Rate ◽  
Checkpoint Inhibitors ◽  
Single Agent ◽  
Interleukin 2 ◽  
High Response Rate ◽  
Treatment Modalities ◽  
Clinical Indication ◽  
Disease Characteristics ◽  
Melanoma Metastases ◽  
In Transit

10070 Background: In the context of multiple in-transit melanoma metastases without nodal involvement, a variety of treatment modalities have historically been employed including surgery, laser, isolated limb perfusion/infusion, intralesional interleukin-2, T-VEC and electrochemotherapy. Unfortunately, most patients treated with these modalities experience subsequent disease progression. While checkpoint inhibitors (CPI) are a standard of care for bulky unresectable stage III and for stage IV melanoma, patients with isolated in-transit metastases were rarely included in registration studies. There are anecdotal reports of lower response rates in these patients despite them having disease characteristics that would usually be associated with a good response. Methods: We report data from 11 retrospective patient cohorts treated at cancer centres across Europe who received CPI between 2016 and April 2019. All patients had multiple in-transit metastases without clinical or radiological evidence of nodal or distant disease. Disease response was assessed using CT, PET-CT or MRI depending on clinical indication. All patients had at least one prior resection of loco-regional relapsed disease and were deemed not curable by further surgery. Results: Sixty three patients meeting criteria were identified, 40 females and 23 males. Median age was 72 years and 54 (86%) patients had a normal lactate dehydrogenase (LDH). 19 (30%) patients had a BRAF mutation. At treatment initiation, the majority 55 (87.3%) received single agent PD-1 inhibitor, 7 (11.1%) combination ipilimumab + nivolumab and 1 (1.6%) received single agent anti-CTLA 4. The overall response rate was 62% for the full population. The response rate with anti-PD1 monotherapy was 59%. With a median FU of 23 months, the median PFS was 26 months, median OS not reached. OS estimates with 95% CI: 12 month - 93% (87-100%), 24 month - 88% (80-98%), 36 month - 80% (67-95%). Conclusions: The results show a high response rate to CPI in patients with in-transit metastases and support early treatment with CPI following identification of in-transit metastases not curable with surgery whilst disease characteristics remain favourable.

Sign in / Sign up

Export Citation Format

Share Document