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Khan A, Brahim A, Ruiz M, Nagovski N. Relapsed/refractory Burkitt lymphoma and HIV infection. Int J STD AIDS 2017; 29:695-703. [PMID: 29264956 DOI: 10.1177/0956462417748239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The care of patients with HIV and Burkitt lymphoma poses a challenge to clinicians. Due to the limited treatment options that exist for relapsed/refractory Burkitt lymphoma, there is a need for the development of new therapies. This review aims to discuss evidence for current management strategies including chemotherapy and stem cell transplant, and highlight gaps in knowledge that will need to be addressed in the future.
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Affiliation(s)
- Alina Khan
- Memorial Cancer Institute, Memorial Hospital West, Pembroke Pines, FL, USA
| | - Amanda Brahim
- Memorial Cancer Institute, Memorial Hospital West, Pembroke Pines, FL, USA
| | - Marco Ruiz
- Memorial Cancer Institute, Memorial Hospital West, Pembroke Pines, FL, USA
| | - Neil Nagovski
- Memorial Cancer Institute, Memorial Hospital West, Pembroke Pines, FL, USA
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52
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Adult high-grade B-cell lymphoma with Burkitt lymphoma signature: genomic features and potential therapeutic targets. Blood 2017; 130:1819-1831. [PMID: 28801451 DOI: 10.1182/blood-2017-02-767335] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/22/2017] [Indexed: 12/15/2022] Open
Abstract
The adult high-grade B-cell lymphomas sharing molecular features with Burkitt lymphoma (BL) are highly aggressive lymphomas with poor clinical outcome. High-resolution structural and functional genomic analysis of adult Burkitt lymphoma (BL) and high-grade B-cell lymphoma with BL gene signature (adult-molecularly defined BL [mBL]) revealed the MYC-ARF-p53 axis as the primary deregulated pathway. Adult-mBL had either unique or more frequent genomic aberrations (del13q14, del17p, gain8q24, and gain18q21) compared with pediatric-mBL, but shared commonly mutated genes. Mutations in genes promoting the tonic B-cell receptor (BCR)→PI3K pathway (TCF3 and ID3) did not differ by age, whereas effectors of chronic BCR→NF-κB signaling were associated with adult-mBL. A subset of adult-mBL had BCL2 translocation and mutation and elevated BCL2 mRNA and protein expression, but had a mutation profile similar to mBL. These double-hit lymphomas may have arisen from a tumor precursor that acquired both BCL2 and MYC translocations and/or KMT2D (MLL2) mutation. Gain/amplification of MIR17HG and its paralogue loci was observed in 50% of adult-mBL. In vitro studies suggested miR-17∼92's role in constitutive activation of BCR signaling and sensitivity to ibrutinib. Overall integrative analysis identified an interrelated gene network affected by copy number and mutation, leading to disruption of the p53 pathway and the BCR→PI3K or NF-κB activation, which can be further exploited in vivo by small-molecule inhibitors for effective therapy in adult-mBL.
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Armitage JO, Gascoyne RD, Lunning MA, Cavalli F. Non-Hodgkin lymphoma. Lancet 2017; 390:298-310. [PMID: 28153383 DOI: 10.1016/s0140-6736(16)32407-2] [Citation(s) in RCA: 338] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/09/2016] [Accepted: 09/22/2016] [Indexed: 12/12/2022]
Abstract
Lymphomas can affect any organ in the body, present with a wide range of symptoms, and be seen by primary care physicians and physicians from most specialties. They are traditionally divided into Hodgkin's lymphoma (which accounts for about 10% of all lymphomas) and non-Hodgkin lymphoma, which is the topic of this Seminar. Non-Hodgkin lymphoma represents a wide spectrum of illnesses that vary from the most indolent to the most aggressive malignancies. They arise from lymphocytes that are at various stages of development, and the characteristics of the specific lymphoma subtype reflect those of the cell from which they originated. Since this topic was last reviewed in The Lancet in 2012, advances in understanding the biology and genetics of non-Hodgkin lymphoma and the availability of new diagnostic methods and therapies have improved our ability to manage patients with this disorder.
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Affiliation(s)
| | - Randy D Gascoyne
- British Columbia Cancer Agency and British Columbia Cancer Research Centre, Vancouver, BC, Canada
| | | | - Franco Cavalli
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Höring E, Staiger AM, Lenze D, Horn H, Vöhringer M, Steurer W, Aulitzky WE, Ott G. Burkitt lymphoma and diffuse large B-cell lymphoma: a unique case of a composite lymphoma of different clonal origin. Leuk Lymphoma 2017; 59:249-252. [PMID: 28583033 DOI: 10.1080/10428194.2017.1330469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Elisabeth Höring
- a Department of Hematology and Oncology , Robert-Bosch-Hospital , Stuttgart , Germany
| | - Annette M Staiger
- b Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology and University of Tuebingen , Stuttgart , Germany.,c Department of Clinical Pathology , Robert-Bosch-Hospital , Stuttgart , Germany
| | - Dido Lenze
- d Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin , Berlin , Germany
| | - Heike Horn
- b Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology and University of Tuebingen , Stuttgart , Germany
| | - Matthias Vöhringer
- a Department of Hematology and Oncology , Robert-Bosch-Hospital , Stuttgart , Germany
| | - Wolfgang Steurer
- e Department of General and Visceral Surgery , Robert-Bosch-Hospital , Stuttgart , Germany
| | - Walter E Aulitzky
- a Department of Hematology and Oncology , Robert-Bosch-Hospital , Stuttgart , Germany
| | - German Ott
- c Department of Clinical Pathology , Robert-Bosch-Hospital , Stuttgart , Germany
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55
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Short NJ, Kantarjian HM, Ko H, Khoury JD, Ravandi F, Thomas DA, Garcia-Manero G, Khouri M, Cortes JE, Wierda WG, Verstovsek S, Estrov Z, Ferrajoli A, Thompson PA, Pierce S, O'Brien SM, Jabbour E. Outcomes of adults with relapsed or refractory Burkitt and high-grade B-cell leukemia/lymphoma. Am J Hematol 2017; 92:E114-E117. [PMID: 28295472 DOI: 10.1002/ajh.24720] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/06/2017] [Accepted: 03/13/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Nicholas J. Short
- Division of Cancer Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Hagop M. Kantarjian
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Heidi Ko
- Department of Internal Medicine; The University of Texas Health Science Center; Houston Texas USA
| | - Joseph D. Khoury
- Department of Hematopathology; The University of Texas Health Science Center; Houston Texas USA
| | - Farhad Ravandi
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Deborah A. Thomas
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Guillermo Garcia-Manero
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Maria Khouri
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Jorge E. Cortes
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - William G. Wierda
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Srdan Verstovsek
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Zeev Estrov
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Alessandra Ferrajoli
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Philip A. Thompson
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Sherry Pierce
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Susan M. O'Brien
- Chao Family Comprehensive Cancer Center, University of California Irvine; Orange California USA
| | - Elias Jabbour
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
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56
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Dozzo M, Carobolante F, Donisi PM, Scattolin A, Maino E, Sancetta R, Viero P, Bassan R. Burkitt lymphoma in adolescents and young adults: management challenges. Adolesc Health Med Ther 2017; 8:11-29. [PMID: 28096698 PMCID: PMC5207020 DOI: 10.2147/ahmt.s94170] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
About one-half of all Burkitt lymphoma (BL) patients are younger than 40 years, and one-third belong to the adolescent and young adult (AYA) subset, defined by an age between 15 and 25-40 years, based on selection criteria used in different reports. BL is an aggressive B-cell neoplasm displaying highly characteristic clinico-diagnostic features, the biologic hallmark of which is a translocation involving immunoglobulin and c-MYC genes. It presents as sporadic, endemic, or epidemic disease. Endemicity is pathogenetically linked to an imbalance of the immune system which occurs in African children infected by malaria parasites and Epstein-Barr virus, while the epidemic form strictly follows the pattern of infection by HIV. BL shows propensity to extranodal involvement of abdominal organs, bone marrow, and central nervous system, and can cause severe metabolic and renal impairment. Nevertheless, BL is highly responsive to specifically designed short-intensive, rotational multiagent chemotherapy programs, empowered by the anti-CD20 monoclonal antibody rituximab. When carefully applied with appropriate supportive measures, these modern programs achieve a cure rate of approximately 90% in the average AYA patient, irrespective of clinical stage, which is the best result achievable in any aggressive lymphoid malignancy to date. The challenges ahead concern the following: optimization of management in underdeveloped countries, with reduction of diagnostic and referral-for-care intervals, and the applicability of currently curative regimens; the development of lower intensity but equally effective treatments for frail or immunocompromised patients at risk of death by complications; the identification of very high-risk patients through positron-emission tomography and minimal residual disease assays; and the assessment in these and the few refractory/relapsed ones of new monoclonals (ofatumumab, blinatumomab, inotuzumab ozogamicin) and new molecules targeting c-MYC and key proliferative steps of B-cell malignancies.
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Affiliation(s)
- Massimo Dozzo
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
| | | | - Pietro Maria Donisi
- Simple Departmental Operative Unit of Anatomic Pathology, Ospedale Ss. Giovanni e Paolo, Venice, Italy
| | | | - Elena Maino
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
| | | | - Piera Viero
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
| | - Renato Bassan
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
- Correspondence: Renato Bassan, Complex Operative Unit of Hematology, Ospedale dell’Angelo, Via Paccagnella 11, 30174 Mestre-Venice, Italy, Tel +39 41 965 7362, Fax +39 41 965 7361, Email
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57
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Havelange V, Pepermans X, Ameye G, Théate I, Callet-Bauchu E, Barin C, Penther D, Lippert E, Michaux L, Mugneret F, Dastugue N, Raphaël M, Vikkula M, Poirel HA. Genetic differences between paediatric and adult Burkitt lymphomas. Br J Haematol 2016; 173:137-44. [DOI: 10.1111/bjh.13925] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/09/2015] [Indexed: 01/31/2023]
Affiliation(s)
- Violaine Havelange
- Department of Haematology; Cliniques universitaires Saint-Luc - Université catholique de Louvain; Brussels Belgium
| | - Xavier Pepermans
- Centre for Human Genetics; Cliniques universitaires Saint-Luc - Université catholique de Louvain; Brussels Belgium
| | - Geneviève Ameye
- Centre for Human Genetics; Cliniques universitaires Saint-Luc - Université catholique de Louvain; Brussels Belgium
| | - Ivan Théate
- Department of Pathology; Cliniques universitaires Saint-Luc, Université catholique de Louvain; Brussels Belgium
| | | | - Carole Barin
- Laboratoire de Cytogénétique; CHU Bretonneau; Tours France
| | - Dominique Penther
- Laboratoire de génétique oncologique; Centre Henri Becquerel; Rouen France
| | - Eric Lippert
- Laboratoire d'hématologie; CHU Bordeaux; Pessac France
| | - Lucienne Michaux
- Centrum voor menselijke erfelijkheid; Katholieke Universiteit Leuven; Leuven Belgium
| | | | | | - Martine Raphaël
- Anatomie et cytologie pathologiques; CHU Bicêtre -Assistance Publique-Hôpitaux de Paris; INSERM U802; Université Paris-Sud 11; Le Kremlin-Bicêtre France
| | - Miikka Vikkula
- Human Molecular Genetics (GEHU); de Duve Institute - Université catholique de Louvain; Brussels Belgium
| | - Hélène A. Poirel
- Department of Haematology; Cliniques universitaires Saint-Luc - Université catholique de Louvain; Brussels Belgium
- Human Molecular Genetics (GEHU); de Duve Institute - Université catholique de Louvain; Brussels Belgium
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58
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Bekoz HS, Kantarcioglu B, Tecimer T, Uskent N, Cetiner M, Ferhanoglu B, Sargin D. Complete Remission of Burkitt Lymphoma After Surgical Excision: A Case Report. Indian J Hematol Blood Transfus 2016; 32:178-80. [PMID: 27408385 DOI: 10.1007/s12288-016-0650-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 01/19/2016] [Indexed: 01/22/2023] Open
Abstract
Burkitt lymphoma (BL) is a highly aggressive B cell non-Hodgkin lymphoma that has a high proliferation rate. The prognosis for BL is generally favorable, with cure rate of 75-90 % with modern chemoimmunotherapy regimens. Prompt administration of multiagent immunochemotherapy regimens is critical, because BL is almost always fatal if left untreated. Nevertheless here we report a case of BL that is still in complete remission after more than 4 years without any further treatment after surgical excision of the involved lymph node.
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Affiliation(s)
- Huseyin Saffet Bekoz
- Division of Hematology, Department of Internal Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Bulent Kantarcioglu
- Division of Hematology, Department of Internal Medicine, Istanbul Medipol University, Istanbul, Turkey ; Medipol Mega Hospital Complex, Hematology Clinic, TEM Avrupa Otoyolu Goztepe Cikisi No:1, 34214 Bagcilar, Istanbul Turkey
| | - Tulay Tecimer
- Department of Pathology, Acibadem University, Istanbul, Turkey
| | - Necdet Uskent
- Department of Hematology-Oncology, Anadolu Medical Center, Istanbul, Turkey
| | - Mustafa Cetiner
- Division of Hematology, Department of Internal Medicine, Koc University, Istanbul, Turkey
| | - Burhan Ferhanoglu
- Division of Hematology, Department of Internal Medicine, Koc University, Istanbul, Turkey
| | - Deniz Sargin
- Division of Hematology, Department of Internal Medicine, Istanbul Medipol University, Istanbul, Turkey
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59
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Migdady Y, Salhab M, Dang NH, Markham MJ, Olszewski AJ. Disparities in conditional net survival among non-Hodgkin lymphoma survivors: a population-based analysis. Leuk Lymphoma 2015; 57:676-84. [PMID: 26428541 DOI: 10.3109/10428194.2015.1102246] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We evaluated the association of baseline prognostic factors with conditional net survival among survivors of six subtypes non-Hodgkin lymphoma using the SEER program data from 2000-2012. Among 2-year survivors, further prognosis markedly improved in Burkitt's (BL) and diffuse large B-cell lymphoma (DLBCL), and became the same as for follicular lymphoma (5-year net survival ≥ 85%). Mantle cell lymphoma (MCL) demonstrated the worst prognosis of all studied histologies up to 5 years of survivorship. Age and stage lost prognostic significance in BL within 2 years from diagnosis. Racial disparities in net survival disappeared within 2 years for all subtypes, except in chronic lymphocytic leukemia, where black patients had persistently worse prognosis, and in MCL, where they had unexpectedly better prognosis than other races after 2 years. Many baseline factors may lose their initial prognostic value for lymphoma survivors, which should be considered when counseling patients about their prognosis and long-term surveillance.
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Affiliation(s)
- Yazan Migdady
- a Department of Medicine , University of Florida , Gainesville , FL , USA
| | - Mohammed Salhab
- b University of Massachusetts Medical School , Worcester , MA , USA ;,c Memorial Hospital of Rhode Island , Pawtucket , RI , USA
| | - Nam H Dang
- a Department of Medicine , University of Florida , Gainesville , FL , USA
| | - Merry J Markham
- a Department of Medicine , University of Florida , Gainesville , FL , USA
| | - Adam J Olszewski
- c Memorial Hospital of Rhode Island , Pawtucket , RI , USA ;,d The Warren Alpert Medical School of Brown University , Providence , RI , USA
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60
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Ginseng alleviates cyclophosphamide-induced hepatotoxicity via reversing disordered homeostasis of glutathione and bile acid. Sci Rep 2015; 5:17536. [PMID: 26625948 PMCID: PMC4667192 DOI: 10.1038/srep17536] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/02/2015] [Indexed: 12/19/2022] Open
Abstract
Cyclophosphamide (CP), a chemotherapeutic agent, is restricted due to its side effects, especially hepatotoxicity. Ginseng has often been clinically used with CP in China, but whether and how ginseng reduces the hepatotoxicity is unknown. In this study, the hepatoprotective effects and mechanisms under the combined usage were investigated. It was found that ginseng could ameliorate CP-induced elevations of ALP, ALT, ALS, MDA and hepatic deterioration, enhance antioxidant enzymes’ activities and GSH’s level. Metabolomics study revealed that 33 endogenous metabolites were changed by CP, 19 of which were reversed when ginseng was co-administrated via two main pathways, i.e., GSH metabolism and primary bile acids synthesis. Furthermore, ginseng could induce expression of GCLC, GCLM, GS and GST, which associate with the disposition of GSH, and expression of FXR, CYP7A1, NTCP and MRP 3, which play important roles in the synthesis and transport of bile acids. In addition, NRF 2, one of regulatory elements on the expression of GCLC, GCLM, GS, GST, NTCP and MRP3, was up-regulated when ginseng was co-administrated. In conclusion, ginseng could alleviate CP-induced hepatotoxicity via modulating the disordered homeostasis of GSH and bile acid, which might be mediated by inducing the expression of NRF 2 in liver.
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Chen BJ, Chang ST, Weng SF, Huang WT, Chu PY, Hsieh PP, Jung YC, Kuo CC, Chuang YT, Chuang SS. EBV-associated Burkitt lymphoma in Taiwan is not age-related. Leuk Lymphoma 2015; 57:644-53. [DOI: 10.3109/10428194.2015.1076928] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Bo-Jung Chen
- Department of Pathology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,
| | - Sheng-Tsung Chang
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan,
- Department of Nursing, National Tainan Institute of Nursing, Tainan, Taiwan,
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan,
| | - Wan-Ting Huang
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan,
- College of Medicine, Kaohsiung and Chang Gung University, Kaohsiung, Taiwan,
| | - Pei-Yi Chu
- Department of Pathology, St. Martin De Porres Hospital, Chiayi, Taiwan,
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan,
| | - Pin-Pen Hsieh
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,
- National Defense Medical Center, Taipei, Taiwan,
| | - Yun-Chih Jung
- Department of Pathology, Sin-Lau Christian Hospital, Tainan, Taiwan,
| | - Chun-Chi Kuo
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan,
| | - Yu-Ting Chuang
- Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan, and
| | - Shih-Sung Chuang
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan,
- Department of Pathology, College of Medicine, Taipei Medical University and National Taiwan University, Taipei, Taiwan
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62
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Peripheral blood lymphocyte to monocyte ratio identifies high-risk adult patients with sporadic Burkitt lymphoma. Ann Hematol 2015; 94:1645-54. [PMID: 26082333 DOI: 10.1007/s00277-015-2427-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 06/09/2015] [Indexed: 01/29/2023]
Abstract
Adult sporadic Burkitt lymphoma (BL) is a rare subtype of lymphoma. In this retrospective study, we investigated the prognostic value of pretreatment lymphocyte to monocyte ratio (LMR) in a cohort of 62 patients. Using LMR <2.6 as the optimal cutoff point, 24 patients (38.7 %) had LMR <2.6. The complete response rates in high-LMR group and low-LMR group were 90.9 and 65.0 %, respectively (P = 0.019). At a median follow-up time of 41 months, the 3-year progression-free survival (PFS) rate and overall survival (OS) rates were 76 and 80 %, respectively. In a multivariate Cox regression model, it was found that the presence of bone marrow infiltration and low LMR were independently adverse prognostic factors for both PFS and OS. In the whole group, the addition of rituximab to treatment did not benefit patients significantly in PFS and OS. In subgroup analysis, in patients with high LMR, addition of rituximab can significantly improve survival outcomes (P = 0.046). In conclusion, we firstly found that low LMR (<2.60) was an independently adverse prognostic factor in adult patients with sporadic BL. Intensive chemotherapy could cure the majority of patients in our study, and the pretreatment LMR might predict the value of rituximab in this age population.
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63
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Burkhardt B, Lenz G. XI. Management of paediatric and adult non-Hodgkin lymphoma: what lessons can each teach the other? Hematol Oncol 2015; 33 Suppl 1:62-6. [PMID: 26062057 DOI: 10.1002/hon.2219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Is there anything that we can learn from each other regarding paediatric and adult non-Hodgkin Lymphoma (NHL) management? Do we treat the same patients? Are there differences in lymphoma biology in the different age groups? Are the procedures of decision making and the infrastructure comparable? Is the weighing of toxicity and outcome aspects in the benefit and risk assessments prior to treatment decisions comparable? Interestingly, the proportional distribution of the NHL subtypes and the spectrum of NHL occurring in children and adolescents differs significantly from that in adults. This observation might motivate biological studies aiming to elucidate the pathomechanisms of lymphomagenesis. Concerning NHL diagnosis and staging, the comparison of outcome data reported for paediatric and adult patient series is often impaired by the use of different staging systems. However, the impact of reference laboratories supporting correct subtyping and the advantages of population-based patient recruitment are experiences that might be transferable between paediatric and adult oncologists. Interestingly, the process of implementing new drugs into current treatment strategies and making these drugs available to patients varies substantially across patient's age groups. The far lower absolute number of patients, especially of relapsed patients, and the favorable outcome with current standard treatment may contribute to the marked differences in the kinetic of implementing new compounds comparing adult with paediatric NHL patients. Also, the basis for the conduction of cooperative clinical trials with pharmaceutical companies needs to be strengthened in paediatric clinical trial groups. In conclusion, both paediatric and adult oncologists benefit from the interdisciplinary discussion with each other, not only concerning results and experiences in clinical trials but also with respect to critical aspects of infrastructure.
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Affiliation(s)
- Birgit Burkhardt
- NHL-BFM Study Center and Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Georg Lenz
- Translational Oncology, Department of Medicine A, University Hospital Münster, Münster, Germany
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