ACUTE MYELOID LEUKEMIA AFTER CHEMOTHERAPY: REPORTING CLINICAL CASE SERIES IN THE DEPARTMENT OF CHEMOTHERAPY - CENTER OF ONCOLOGY - 103 MILITARY HOSPITAL AND RETROSPECTIVE LITERATURE REVIEW

Recently, Secondary cancers, particularly acute myeloid leukemia after chemotherapy have been significantly concerned. Our team at the Department of Chemotherapy - Center of Oncology - 103 Military Hospital reports clinical case series diagnosed with acute myeloid leukemia after breast, colon, stomach cancer treatments and retrospective literature review.

Factors associated with the development of secondary cancers after radioiodine therapy in differentiated thyroid cancer: A multicenter retrospective study

Purpose The objective of this study was to estimate the incidence of secondary cancers and the factors associated with their development among patients who underwent radioiodine therapy (RIT) with differentiated thyroid cancer. Methods We retrospectively collected medical records for patients who underwent first RIT between January 1, 2000 and December 31, 2005 from seven tertiary hospitals in South Korea after total thyroidectomy for differentiated thyroid cancer. Cancer incidence and calculated standardized rate ratio was compared with Korean cancer incidence data. The association between the development of secondary cancers and various parameters was analyzed by Cox-proportional hazard regression. Results A total of 3106 patients were included in this study. Mean age at the time of diagnosis of thyroid cancer was 45.7 ± 13.3 years old, and 2669 (85.9%) patients were female. The follow-up period was 11.9 ± 4.6 (range, 1.2–19.6) years. A total of 183 secondary cancers (5.6%), which included 162 solid and 21 hematologic cancers occurred in 173 patients. There was no significant difference between solid cancer incidence in our study population who underwent RIT and the overall Korean population, but the incidence of hematologic cancers and total cancer in our study was significantly higher compared with that of the Korean population. A multivariate analysis identified independent prognostic factors for the development of secondary cancer including age at 1st RIT, male, and total cumulative dose over 200 mCi. Conclusion We need to assess the risk benefit for patients who receive over 200 mCi of a total cumulative dose.

Lenalidomide plus rituximab in patients with rituximab-resistant indolent B-cell and mantle cell lymphomas: 10-year follow-up.

7539 Background: Lenalidomide (len) plus rituximab is now a standard-of-care option for indolent B-cell non-Hodgkin lymphomas (iNHL) and mantle cell lymphomas (MCL). We previously demonstrated the efficacy of len plus rituximab in patients (pts) with rituximab-refractory iNHL and MCL (Chong et al. Clin Can Res 2015). We now report the longest experience to date with this regimen. Methods: We conducted an open-label phase II trial in pts with iNHL or MCL and rituximab resistance, defined as failure to respond or progression of disease within 6 months (mo) of rituximab or a rituximab-containing regimen. Pts received len 10 mg daily for 8 weeks, followed by 4 weekly doses of rituximab 375 mg/m2 and continued len maintenance until disease progression, toxicity or pt choice. Results: 50 pts (30 FL, 14 MCL, 2 MZL, 4 SLL) were treated between 2008-2012. Median follow-up was 10.5 years (yr). Pts received a median of 3 prior therapies (range: 1–7). Progression free survival (PFS) for all pts at 5 and 10 yrs was 20.0% [95%CI 8-35] & 13% [95%CI 3-30%]; 5- and 10-yr response duration (RD) was 27% [95% CI 12-46] and 18% [95% CI 4-40], respectively; 5- and 10-yr overall survival (OS) was 58% [95%CI 43-70] and 45% [95%CI 30-58], respectively. 5-yr OS from the time pts were deemed rituximab-resistant is 64.0% and 10-yr OS 51.9%. For pts with FL, 5- and 10-yr PFS were both 13%, and 5- and 10-yr OS were 60% and 40%. For MCL, 5- and 10-yr PFS were both 25% and 5- and 10-yr OS were 50% and 36%. At 10.5 yr, 4 pts (2 FL, 1 MCL, 1 MZL) remain in complete remission (CR), 3 of whom discontinued len at 7.0-yr, 8.8-yr and 10.1-yr in CR. 1 pt with FL discontinued study in CR after 11.6-yr but continues on commercial len at 5 mg daily. The most common grade 1–2 adverse events (AEs) requiring dose reductions were neuropathy (n = 3) and diarrhea (n = 5), which all resolved with dose reduction. The most common grade 3–4 AEs requiring dose reductions were neutropenia (n = 6, 12%) and tumor flare (n = 3, 6%). Pts discontinued therapy due to toxicity at a median of 4.9 mo (range 0.3–25.7) from len start due to grade 3–4 rash (n = 2), grade 2 abdominal pain (n = 1), and grade 3–4 thrombocytopenia (n = 2). Only 1 patient discontinued len after > 1 yr (25.7 mo) due to persistent diarrhea. The pt who developed grade 2 abdominal pain was retreated with len without recurrence of pain and sustained a second CR for 5 yrs. 5 (10%) pts developed secondary cancers at a median of 15.5 mo (range: 0.8–50.5) from starting len, including 2 hematological (acute myeloid leukemia, B-acute lymphoblastic leukemia) and 3 solid cancers (NSCLC, renal cell carcinoma, prostate cancer). Prior to enrollment, 4/5 of the patients with secondary cancers had received alkylating agents and 3/5 had received anthracyclines. Conclusions: These data represent the longest reported outcomes for len plus rituximab in NHLs. We demonstrate durable responses and a manageable safety profile with rituximab plus low-dose len. Clinical trial information: NCT00783367.