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Miyazaki K, Asano N, Yamada T, Miyawaki K, Sakai R, Igarashi T, Nishikori M, Ohata K, Sunami K, Yoshida I, Yamamoto G, Takahashi N, Okamoto M, Yano H, Nishimura Y, Tamaru S, Nishikawa M, Izutsu K, Kinoshita T, Suzumiya J, Ohshima K, Kato K, Katayama N, Yamaguchi M. DA-EPOCH-R combined with high-dose methotrexate in patients with newly diagnosed stage II-IV CD5-positive diffuse large B-cell lymphoma: a single-arm, open-label, phase II study. Haematologica 2020; 105:2308-2315. [PMID: 33054055 PMCID: PMC7556618 DOI: 10.3324/haematol.2019.231076] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/21/2019] [Indexed: 11/21/2022] Open
Abstract
CD5-positive diffuse large B-cell lymphoma (CD5+ DLBCL) is characterized by poor prognosis and a high frequency of central nervous system relapse after standard immunochemotherapy. We conducted a phase II study to investigate the efficacy and safety of dose-adjusted (DA)- EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab) combined with high-dose methotrexate (HD-MTX) in newly diagnosed patients with CD5+ DLBCL. Previously untreated patients with stage II to IV CD5+ DLBCL according to the 2008 World Health Organization classification were eligible. Four cycles of DA-EPOCH-R followed by two cycles of HD-MTX and four additional cycles of DAEPOCH- R (DA-EPOCH-R/HD-MTX) were planned as the protocol treatment. The primary end point was 2-year progression-free survival (PFS). Between September 25, 2012, and November 11, 2015, we enrolled 47 evaluable patients. Forty-five (96%) patients completed the protocol treatment. There were no deviations or violations in the DA-EPOCH-R dose levels. The complete response rate was 91%, and the overall response rate was 94%. At a median follow up of 3.1 years (range, 2.0-4.9 years), the 2- year PFS was 79% [95% confidence interval (CI): 64-88]. The 2-year overall survival was 89% (95%CI: 76-95). Toxicity included grade 4 neutropenia in 46 (98%) patients, grade 4 thrombocytopenia 12 (26%) patients, and febrile neutropenia in 31 (66%) patients. No treatment-related death was noted during the study. DA-EPOCH-R/HD-MTX might be a first-line therapy option for stage II-IV CD5+ DLBCL and warrants further investigation. (Trial registered at: UMIN-CTR: UMIN000008507.).
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Affiliation(s)
- Kana Miyazaki
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Mie.
| | - Naoko Asano
- Department of Molecular Diagnostics, Nagano Prefectural Shinshu Medical Center, Suzaka
| | - Tomomi Yamada
- Department of Medical Innovation, Osaka University Hospital, Suita
| | - Kohta Miyawaki
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka
| | - Rika Sakai
- Department of Medical Oncology, Kanagawa Cancer Center, Yokohama
| | | | - Momoko Nishikori
- Department of Hematology and Oncology, Kyoto University Graduate School of Medicine, Kyoto
| | - Kinya Ohata
- Department of Hematology, Kanazawa University, Kanazawa
| | - Kazutaka Sunami
- Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama
| | - Isao Yoshida
- Department of Hematologic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama
| | - Go Yamamoto
- Department of Hematology, Toranomon Hospital, Tokyo
| | - Naoki Takahashi
- Department of Hematology and Oncology, International Medical Center, Saitama Medical University, Hidaka
| | - Masataka Okamoto
- Department of Hematology, Fujita Health University School of Medicine, Toyoake
| | - Hiroki Yano
- Department of Hematology, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi
| | - Yuki Nishimura
- Clinical Research Support Center, Mie University Hospital, Tsu
| | - Satoshi Tamaru
- Clinical Research Support Center, Mie University Hospital, Tsu
| | | | - Koji Izutsu
- Department of Hematology, Toranomon Hospital, Tokyo; Department of Hematology, National Cancer Center Hospital, Tokyo
| | - Tomohiro Kinoshita
- Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya
| | - Junji Suzumiya
- Department of Oncology and Hematology, Shimane University Hospital, Izumo
| | - Koichi Ohshima
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Koji Kato
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka
| | - Naoyuki Katayama
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Mie
| | - Motoko Yamaguchi
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Mie
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Okello CD, Omoding A, Ddungu H, Mulumba Y, Orem J. Outcomes of treatment with CHOP and EPOCH in patients with HIV associated NHL in a low resource setting. BMC Cancer 2020; 20:798. [PMID: 32831073 PMCID: PMC7446121 DOI: 10.1186/s12885-020-07305-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/17/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The optimal chemotherapy regimen for treating HIV associated NHL in low resource settings is unknown. We conducted a retrospective study to describe survival rates, treatment response rates and adverse events in patients with HIV associated NHL treated with CHOP and dose adjusted-EPOCH regimens at the Uganda Cancer Institute. METHODS A retrospective study of patients diagnosed with HIV and lymphoma and treated at the Uganda Cancer Institute from 2016 to 2018 was done. RESULTS One hundred eight patients treated with CHOP and 12 patients treated with DA-EPOCH were analysed. Patients completing 6 or more cycles of chemotherapy were 51 (47%) in the CHOP group and 8 (67%) in the DA-EPOCH group. One year overall survival (OS) rate in patients treated with CHOP was 54.5% (95% CI, 42.8-64.8) and 80.2% (95% CI, 40.3-94.8) in those treated with DA-EPOCH. Factors associated with favourable survival were BMI 18.5-24.9 kg/m2, (p = 0.03) and completion of 6 or more cycles of chemotherapy, (p < 0.001). The overall response rate was 40% in the CHOP group and 59% in the DA-EPOCH group. Severe adverse events occurred in 19 (18%) patients in the CHOP group and 3 (25%) in the DA-EPOCH group; these were neutropenia (CHOP = 13, 12%; DA-EPOCH = 2, 17%), anaemia (CHOP = 12, 12%; DA-EPOCH = 1, 8%), thrombocytopenia (CHOP = 7, 6%; DA-EPOCH = 0), sepsis (CHOP = 1), treatment related death (DA-EPOCH = 1) and hepatic encephalopathy (CHOP = 1). CONCLUSION Treatment of HIV associated NHL with curative intent using CHOP and infusional DA-EPOCH is feasible in low resource settings and associated with > 50% 1 year survival.
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MESH Headings
- Adult
- Anemia/chemically induced
- Anemia/economics
- Anemia/epidemiology
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/economics
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/adverse effects
- Cyclophosphamide/economics
- Doxorubicin/administration & dosage
- Doxorubicin/adverse effects
- Doxorubicin/economics
- Drug Administration Schedule
- Etoposide/administration & dosage
- Etoposide/adverse effects
- Etoposide/economics
- Female
- HIV Infections/complications
- HIV Infections/immunology
- Hepatic Encephalopathy/chemically induced
- Hepatic Encephalopathy/economics
- Hepatic Encephalopathy/epidemiology
- Humans
- Infusions, Intravenous/economics
- Infusions, Intravenous/methods
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/economics
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/mortality
- Male
- Middle Aged
- Neutropenia/chemically induced
- Neutropenia/economics
- Neutropenia/epidemiology
- Prednisone/administration & dosage
- Prednisone/adverse effects
- Prednisone/economics
- Retrospective Studies
- Sepsis/chemically induced
- Sepsis/economics
- Sepsis/epidemiology
- Survival Rate
- Thrombocytopenia/chemically induced
- Thrombocytopenia/economics
- Thrombocytopenia/epidemiology
- Time Factors
- Treatment Outcome
- Uganda/epidemiology
- Vincristine/administration & dosage
- Vincristine/adverse effects
- Vincristine/economics
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Affiliation(s)
- Clement D Okello
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda.
| | - Abrahams Omoding
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
| | - Henry Ddungu
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
| | - Yusuf Mulumba
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
| | - Jackson Orem
- Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
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53
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Harker-Murray PD, Pommert L, Barth MJ. Novel Therapies Potentially Available for Pediatric B-Cell Non-Hodgkin Lymphoma. J Natl Compr Canc Netw 2020; 18:1125-1134. [PMID: 32755987 DOI: 10.6004/jnccn.2020.7608] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/22/2020] [Indexed: 11/17/2022]
Abstract
Burkitt lymphoma, diffuse large B-cell lymphoma (DLBCL), and primary mediastinal B-cell lymphoma are the most common aggressive pediatric mature B-cell non-Hodgkin lymphomas (B-NHLs). Despite excellent survival with current chemotherapy regimens, therapy for Burkitt lymphoma and DLBCL has a high incidence of short- and long-term toxicities. Patients who experience relapse generally have a very poor prognosis. Therefore, novel approaches using targeted therapies to reduce toxicities and improve outcomes in the relapse setting are needed. The addition of rituximab, a monoclonal antibody against CD20, to upfront therapy has improved survival outcomes for high-risk patients and may allow decreased total chemotherapy in those with low-risk disease. Antibody-drug conjugates have been combined with chemotherapy in relapsed/refractory (R/R) NHL, and multiple antibody-drug conjugates are in development. Additionally, bispecific T-cell-engaging antibody constructs and autologous CAR T-cells have been successful in the treatment of R/R acute leukemias and are now being applied to R/R B-NHL with some successes. PD-L1 and PD-L2 on tumor cells can be targeted with checkpoint inhibitors, which restore T-cell-mediated immunity and antitumor responses and can be added to conventional chemotherapy and immune-directed therapies to augment responses. Lastly, trials of small molecule inhibitors targeting cell signaling pathways in NHL subtypes are underway. This article reviews many of the targeted therapies under development that could be considered for future trials in R/R pediatric mature B-NHL.
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Affiliation(s)
| | - Lauren Pommert
- Pediatric Oncology, Midwest Children's Cancer Center, Milwaukee, Wisconsin; and
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Fedoriw Y, Selitsky S, Montgomery ND, Kendall SM, Richards KL, Du W, Tomoka T, Mulenga M, Parker JS, Dave SS, Gopal S. Identifying transcriptional profiles and evaluating prognostic biomarkers of HIV-associated diffuse large B-cell lymphoma from Malawi. Mod Pathol 2020; 33:1482-1491. [PMID: 32080349 DOI: 10.1038/s41379-020-0506-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/06/2020] [Accepted: 02/06/2020] [Indexed: 12/17/2022]
Abstract
Lymphoma incidence in sub-Saharan Africa (SSA) is increasing due to HIV and population aging. Diffuse Large B-cell lymphoma (DLBCL), the most common lymphoma in SSA and worldwide, is highly associated with HIV, but molecular studies of HIV-associated DLBCL are scarce globally. We describe profiling of DLBCL from Malawi, aiming to elucidate tumor biology and identify clinically meaningful biomarkers specifically for SSA. Between June 1, 2013 and June 1, 2016, 59 cases of DLBCL (32 HIV+/27 HIV-) enrolled in the Kamuzu Central Hospital Lymphoma Study were characterized, of which 54 (92%) were negative for Epstein-Barr virus. Gene expression profiling (GEP) by whole transcriptome sequencing was performed on the first 36 cases (22 HIV+/14 HIV-). Immunohistochemistry (IHC) and GEP results were compared with published data and correlated to clinical outcome and pathologic features. Unsupervised clustering strongly segregated DLBCL by HIV status (p = 0.0003, Chi-squared test), indicating a marked contribution of HIV to expression phenotype. Pathway analysis identified that HIV-associated tumors were enriched in hypoxia, oxidative stress, and metabolism related gene expression patterns. Cell-of-origin subtype, determined by sequencing and IHC, did not associate with differences in overall survival (OS), while Ki-67 proliferation index ≥80% was associated with inferior OS in HIV+ DLBCL only (p = 0.03) and cMYC/BCL2 co-expression by IHC was negatively prognostic across the entire cohort (p = 0.01). This study provides among the first molecular characterizations of DLBCL from SSA, demonstrates marked gene expression differences by HIV status, and identifies genomic and immunophenotypic characteristics that can inform future basic and clinical investigations.
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Affiliation(s)
- Yuri Fedoriw
- University of North Carolina, Chapel Hill, NC, USA.
| | | | | | - Sviatoslav M Kendall
- Duke Cancer Institute and Center for Genomic and Computational Biology, Durham, NC, USA
| | | | - Wei Du
- Cornell University, New York, NY, USA
| | - Tamiwe Tomoka
- UNC Project-Malawi, Lilongwe, Malawi.,University of Malawi College of Medicine, Lilongwe, Malawi
| | | | | | - Sandeep S Dave
- Duke Cancer Institute and Center for Genomic and Computational Biology, Durham, NC, USA
| | - Satish Gopal
- University of North Carolina, Chapel Hill, NC, USA.,UNC Project-Malawi, Lilongwe, Malawi
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55
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Eule C, Arora N, Li HC, Sadeghi N. Presentation and management of primary mediastinal large B-cell lymphoma: a retrospective cohort analysis. Acta Oncol 2020; 59:786-788. [PMID: 32233823 DOI: 10.1080/0284186x.2020.1744718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Corbin Eule
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nivedita Arora
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hsiao C. Li
- Division of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Parkland Health and Hospital System, Dallas, TX, USA
| | - Navid Sadeghi
- Division of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Parkland Health and Hospital System, Dallas, TX, USA
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56
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Jayachandran PK, Rajan AK, Karunakaran P, Mehra N, Selvarajan G, Kesana S, Dhanushkodi M, Radhakrishnan V, Sagar TG. Plasmablastic lymphoma - single centre experience with infusional EPOCH chemotherapy. Leuk Res 2020; 95:106391. [PMID: 32559556 DOI: 10.1016/j.leukres.2020.106391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Plasmablastic lymphoma (PBL) is a rare type of aggressive large B - cell non-Hodgkin Lymphoma (NHL) which was initially described in HIV positive individuals and later was also described in immune-competent individuals. It was included as a distinct entity in the WHO lymphoma classification in 2008. METHODS The clinical features, HIV status, treatment details, and outcomes of patients diagnosed with plasmablastic lymphoma from January 2012 to December 2018 were retrospectively collected from the patient records and analyzed. The survival analysis was done by Kaplan Meier analysis and the comparison was done by the Log Rank test. RESULTS The median age of 25 patients, included in the study was 41 years (Range 13-71 years). Males constituted 76 %. HIV positivity was 72 %. Stage IV disease was present in 76 %. Extranodal involvement was seen in 96 %. Out of 25 patients, seven did not receive any treatment and three received metronomic oral chemotherapy due to poor performance status at presentation. Fifteen patients received chemotherapy on a curative intent. Infusional EPOCH chemotherapy was given in 13 patients. CHOP and CHOEP chemotherapy was given in one patient each. The median number of cycles was 6 (Range: 3-8). The overall response rate of patients treated on a curative intent was 80 % (Complete response and partial response in 8 and 4 respectively). Three patients underwent high dose chemotherapy with autologous stem cell rescue at first remission. The median event-free survival (EFS) and median overall survival (OS) of the whole study population was 5.9 and 12.4 months respectively, with a median follow of 26.9 months. The median EFS was 13.8 months and the median OS was not reached in the curative-intent group. The factors adversely influencing the EFS and OS were Age > 40 years, high IPI, and non-curative intent of treatment. CONCLUSION Plasmablastic lymphoma commonly presents as stage 4 disease with extranodal involvement and is more common in immune-deficient individuals. Infusional EPOCH chemotherapy is a promising option that induces long term remission.
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Affiliation(s)
| | - Arun Kumar Rajan
- Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, TN, 600036 India
| | - Parathan Karunakaran
- Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, TN, 600036 India
| | - Nikita Mehra
- Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, TN, 600036 India
| | - Gangothri Selvarajan
- Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, TN, 600036 India
| | - Sivasree Kesana
- Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, TN, 600036 India
| | - Manikandan Dhanushkodi
- Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, TN, 600036 India
| | | | - Tenali Gnana Sagar
- Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, TN, 600036 India
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Schöder H, Polley MYC, Knopp MV, Hall N, Kostakoglu L, Zhang J, Higley HR, Kelloff G, Liu H, Zelenetz AD, Cheson BD, Wagner-Johnston N, Kahl BS, Friedberg JW, Hsi ED, Leonard JP, Schwartz LH, Wilson WH, Bartlett NL. Prognostic value of interim FDG-PET in diffuse large cell lymphoma: results from the CALGB 50303 Clinical Trial. Blood 2020; 135:2224-2234. [PMID: 32232481 PMCID: PMC7316220 DOI: 10.1182/blood.2019003277] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/24/2020] [Indexed: 12/28/2022] Open
Abstract
As part of a randomized, prospective clinical trial in large cell lymphoma, we conducted serial fluorodeoxyglucose positron emission tomography (FDG-PET) at baseline, after 2 cycles of chemotherapy (interim PET [i-PET]), and at end of treatment (EoT) to identify biomarkers of response that are predictive of remission and survival. Scans were interpreted in a core laboratory by 2 imaging experts, using the visual Deauville 5-point scale (5-PS), and by calculating percent change in FDG uptake (change in standardized uptake value [ΔSUV]). Visual scores of 1 through 3 and ΔSUV ≥66% were prospectively defined as negative. Of 524 patients enrolled in the parent trial, 169 agreed to enroll in the PET substudy and 158 were eligible for final analysis. In this selected population, all had FDG-avid disease at baseline; by 5-PS, 55 (35%) remained positive on i-PET and 28 (18%) on EoT PET. Median ΔSUV on i-PET was 86.2%. With a median follow-up of 5 years, ΔSUV, as continuous variable, was associated with progression-free survival (PFS) (hazard ratio [HR] = 0.99; 95% confidence interval [CI], 0.97-1.00; P = .02) and overall survival (OS) (HR, 0.98; 95% CI, 0.97-0.99; P = .03). ΔSUV ≥66% was predictive of OS (HR, 0.31; 95% CI, 0.11-0.85; P = .02) but not PFS (HR, 0.47; 95% CI, 0.19-1.13; P = .09). Visual 5-PS on i-PET did not predict outcome. ΔSUV, but not visual analysis, on i-PET predicted OS in DLBCL, although the low number of events limited the statistical analysis. These data may help guide future clinical trials using PET response-adapted therapy. This trial was registered at www.clinicaltrials.gov as #NCT00118209.
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Affiliation(s)
- Heiko Schöder
- Department Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Michael V Knopp
- Department Radiology, The Ohio State University, Columbus, OH
| | - Nathan Hall
- Department Radiology, Philadelphia VA Medical Center, Philadelphia, PA
| | - Lale Kostakoglu
- Department Radiology, Mt. Sinai Medical Center, New York, NY
| | - Jun Zhang
- Department Radiology, The Ohio State University, Columbus, OH
| | | | - Gary Kelloff
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Heshan Liu
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Andrew D Zelenetz
- Department Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bruce D Cheson
- Department Medicine, MedStar Georgetown University Hospital, Washington, DC
| | | | - Brad S Kahl
- Department Medicine, Washington University School of Medicine, St. Louis, MO
| | | | - Eric D Hsi
- Department Laboratory Medicine, Cleveland Clinic, Cleveland, OH
| | - John P Leonard
- Department Medicine, Weill Cornell Medical College, New York, NY
| | | | - Wyndham H Wilson
- Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Nancy L Bartlett
- Department Medicine, Washington University School of Medicine, St. Louis, MO
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Nelson B, Hong A, Iqbal F, Venkatesan R. An Advanced AIDS Patient With CD4 <20 and Plasmablastic Lymphoma Achieving Complete Response With the V-EPOCH Regimen. Cureus 2020; 12:e8641. [PMID: 32685310 PMCID: PMC7364388 DOI: 10.7759/cureus.8641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is a rare form of non-Hodgkin lymphoma that is highly aggressive and carries a poor prognosis. Although the standard chemotherapy choice for most diffuse large B-cell lymphomas (DLBCL) is R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), subtypes of DLBCL such as PBL are less responsive to this treatment regimen. The preferred regimens for PBL include infusional EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin hydrochloride), HyperCVAD (cyclophosphamide, vincristine sulfate, doxorubicin hydrochloride, and dexamethasone), or CODOX-M/IVAC (cyclophosphamide, vincristine, doxorubicin, high‐dose methotrexate/ifosfamide, etoposide, and high‐dose cytarabine). Recent studies have begun to investigate the addition of other agents to these regimens to improve survival. This case report is about a patient with a history of advanced acquired immunodeficiency syndrome (AIDS) with a cluster of differentiation 4 (CD4) count <20 who had CD20 negative plasmablastic lymphoma and was successfully treated with the combination of bortezomib and dose-adjusted EPOCH (V-EPOCH) and intrathecal chemotherapy, achieving complete response with optimal tolerance. To our knowledge, this is the first case to demonstrate a complete response with V-EPOCH for PBL in advanced AIDS with CD4 <20. We aim to highlight the importance of standardizing effective chemotherapeutic approaches to this cancer entity and augment the effectiveness of V-EPOCH therapy in the literature review.
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Affiliation(s)
- Blessie Nelson
- Department of Hematology and Oncology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Angelina Hong
- Department of Hematology and Oncology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Fatima Iqbal
- Department of Pathology and Laboratory Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Rohit Venkatesan
- Department of Hematology and Oncology, University of Texas MD Anderson Cancer Center, Galveston, USA
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Morales ASR, Joy JK, Zbona DM. Administration sequence for multi-agent oncolytic regimens. J Oncol Pharm Pract 2020; 26:933-942. [DOI: 10.1177/1078155219895070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The existence of a multitude of oncolytics regimens containing two or more agents (combination) outlines the need to define their most adequate sequence of administration. However, limited resources are currently available to specify a particular sequence, presenting challenges potentially impacting on patient safety, and Pharmacy & Infusion Nursing workflows. Methods A comprehensive literature search was performed leading to the compilation of a document containing drug administration sequencing instructions for our Nursing, Pharmacy, and Oncology providers to follow. Regimens prioritized in our literature review represented regimens selected as part of our approved Clinical Pathways, regimens inquiries from Pharmacy or Nursing, as well as less frequently used regimens. We stratified the regimens by tumor type and arranged them alphabetically by indication. Results A table was compiled containing all the supporting literature for the recommended drug administration sequences. If, in certain instances, no literature support was identified outlining rationale such as enhanced management of adverse effects, a specific institutional decision was made by our enterprise Medical Oncology Committee with recommendations from Pharmacy experts. The primary guiding principles for outlining our recommendations were the following: administration of vesicant agents first; administration of biologic agents first; administration of taxanes prior to platinum agents; and duration of infusion (shorter infusions prioritized). Conclusion This guideline is not exhaustive. The compilation provided here is intended to be utilized as guidance for oncolytics administration sequence. We will continue to review and incorporate treatment sequencing recommendations for additional regimens.
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Affiliation(s)
| | - Jamie K Joy
- Cancer Treatment Centers of America Global, Boca Raton, FL, USA
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60
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Kasi PM, Grothey A. Should we optimize cytotoxic therapy by dosing to neutropenia? Lessons from TAS-102. Ann Oncol 2020; 31:15-16. [PMID: 31912790 DOI: 10.1016/j.annonc.2019.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 01/26/2023] Open
Affiliation(s)
- P M Kasi
- Division of Hematology, Oncology and Bone Marrow Transplantation, Department of Internal Medicine, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - A Grothey
- West Cancer Center and Research Institute, OneOncology, Germantown, Tennessee, USA.
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61
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Dholaria B, Vanegas YAM, Diehl N, Spaulding AC, Visscher S, Tun HW, Ailawadhi S, Vishnu P. Cost Analysis of R-CHOP Versus Dose-Adjusted R-EPOCH in Treatment of Diffuse Large B-Cell Lymphoma with High-Risk Features. Clin Hematol Int 2020; 2:117-124. [PMID: 34595452 PMCID: PMC8432333 DOI: 10.2991/chi.d.200410.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/07/2020] [Indexed: 11/12/2022] Open
Abstract
Dose-adjusted rituximab, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin (DA.R-EPOCH) is used for upfront treatment of high-risk diffuse large B cell lymphoma (DLBCL). In this study, we compared the outcomes in patients with high-risk DLBCL who received frontline rituximab, cycophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) or DA.R-EPOCH immunochemotherapy. Outcomes and treatment-related cost were analyzed. DLBCL with one of the following features were included in the study: MYC ± BCL2 or BCL6 rearrangement by FISH or MYC overexpression by immunohistochemistry, Ki67 index ≥ 80% or nongerminal center immunophenotype, tumor measuring ≥5 cm and NCCN- IPI score ≥4. A total of 80 patients were treated with R-CHOP (n = 52, 65%) or DA.R-EPOCH (n = 28, 35%), with a median follow-up of 11.2 months (range: 0.7–151.3 months). The hazard ratios (HRs) for progression-free survival and overall survival were 0.79 [95% confidence interval (CI) 0.28%–2.29%, p = 0.67] and 0.86 (95% CI 0.26%–2.78%, p = 0.80), respectively for DA.R-EPOCH compared to R-CHOP. The total mean cost was USD106,940 ± USD39,351 and USD58,509 ± 24,588 for DA.R-EPOCH and R-CHOP respectively (p < 0.001). In our analysis, DA.R-EPOCH resulted comparable clinical outcomes and increased treatment-related expenses compared to R-CHOP in high-risk DLBCL.
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Affiliation(s)
- Bhagirathbhai Dholaria
- Department of Hematology-Oncology, Pierce Ave, Preston Research Building, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Hematology and Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Yenny Alejandra Moreno Vanegas
- Department of Hematology and Oncology, Mayo Clinic Florida, Jacksonville, FL, USA.,Department of Internal Medicine, St. Elizabeth Medical Center, Boston, MA, USA
| | - Nancy Diehl
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Aaron C Spaulding
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA
| | - Sue Visscher
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Han W Tun
- Department of Hematology and Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Sikander Ailawadhi
- Department of Hematology and Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Prakash Vishnu
- Department of Hematology and Oncology, Mayo Clinic Florida, Jacksonville, FL, USA.,Harrison Health Partners Hematology and Oncology, Bremerton, WA, USA
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62
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Barreca M, Stathis A, Barraja P, Bertoni F. An overview on anti-tubulin agents for the treatment of lymphoma patients. Pharmacol Ther 2020; 211:107552. [PMID: 32305312 DOI: 10.1016/j.pharmthera.2020.107552] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/14/2020] [Indexed: 01/19/2023]
Abstract
Anti-tubulin agents constitute a large class of compounds with broad activity both in solid tumors and hematologic malignancies, due to the interference with microtubule dynamics. Since microtubules play crucial roles in the regulation of the mitotic spindles, the interference with their function usually leads to a block in cell division with arrest at the metaphase/anaphase junction of mitosis, followed to apoptosis. This explains the reason why tubulin-binding agents (TBAs) proved to be extremely active in patients with cancer. Several anti-tubulin agents are indicated in the treatment of patients with lymphomas both alone and in combination chemotherapy regimens. The article reviews the literature on classic and more recent anti-tubulin agents, providing an insight into their mechanisms of action and their use in the treatment of lymphoma.
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Affiliation(s)
- Marilia Barreca
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Palermo, Italy; Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland,; Faculty of Biomedical Sciences, USI, Lugano, Switzerland
| | - Paola Barraja
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Palermo, Italy
| | - Francesco Bertoni
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland,; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland,.
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63
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Inhibition of Aurora A Kinase in Combination with Chemotherapy Induces Synthetic Lethality and Overcomes Chemoresistance in Myc-Overexpressing Lymphoma. Target Oncol 2020; 14:563-575. [PMID: 31429028 DOI: 10.1007/s11523-019-00662-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Aberrant Myc expression plays a critical role in various tumors, including non-Hodgkin lymphoma (NHL). Myc-positive lymphoma is clinically aggressive, more resistant to chemotherapy, and associated with high mortality. OBJECTIVE The current study aimed to show inhibition of aurora A kinase (AURKA) may overcome resistance to chemotherapy and improve outcomes in Myc-overexpressing lymphoma. METHODS Myc-overexpressing lymphoma cell lines were evaluated by trypan blue, annexin V/propidium iodide staining, and western blotting for cytotoxicity, cell cycle, apoptosis, and Myc-associated protein expression, respectively, in the presence of cyclophosphamide with or without MLN8237, an AURKA inhibitor. Immunofluorescence for apoptosis-inducing factor (AIF) and acridine orange staining were used to analyze levels of autophagy. EµMyc genetically modified mouse model and xenograft models bearing Myc-overexpressing lymphoma cells were used to determine the efficacy of cyclophosphamide, MLN8237, or the combination in chemosensitive and chemoresistant tumors. RESULTS In our in vitro experiments using chemoresistant lymphoma cells, MLN8237 and cyclophosphamide showed synergistic effects. Mice bearing lymphoma xenograft had rapid disease progression with median survival of ~ 35 days when treated with cyclophosphamide alone. In contrast, the combination of cyclophosphamide and MLN8237 induced complete tumor regression in all mice, which led to improvement in survival compared with the single agent control (p = 0.022). Kinome analysis of tumors treated with MLN8237 showed global suppression of various kinases. CONCLUSION Our data demonstrate that AURKA inhibition induces synthetic lethality and overcomes chemoresistance in Myc-overexpressing lymphoma. The combination of MLN8237 and conventional chemotherapy showed promising safety and anti-tumor activities in preclinical models of Myc-positive NHL.
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64
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Becker S, Kiecke C, Schäfer E, Sinzig U, Deuper L, Trigo-Mourino P, Griesinger C, Koch R, Rydzynska Z, Chapuy B, von Bonin F, Kube D, Venkataramani V, Bohnenberger H, Leha A, Flach J, Dierks S, Bastians H, Maruschak B, Bojarczuk K, Taveira MDO, Trümper L, Wulf GM, Wulf GG. Destruction of a Microtubule-Bound MYC Reservoir during Mitosis Contributes to Vincristine's Anticancer Activity. Mol Cancer Res 2020; 18:859-872. [PMID: 32161139 DOI: 10.1158/1541-7786.mcr-19-1203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/11/2020] [Accepted: 03/09/2020] [Indexed: 11/16/2022]
Abstract
Tightly regulated activity of the transcription factor MYC is essential for orderly cell proliferation. Upon deregulation, MYC elicits and promotes cancer progression. Proteasomal degradation is an essential element of MYC regulation, initiated by phosphorylation at Serine62 (Ser62) of the MB1 region. Here, we found that Ser62 phosphorylation peaks in mitosis, but that a fraction of nonphosphorylated MYC binds to the microtubules of the mitotic spindle. Consequently, the microtubule-destabilizing drug vincristine decreases wild-type MYC stability, whereas phosphorylation-deficient MYC is more stable, contributing to vincristine resistance and induction of polyploidy. PI3K inhibition attenuates postmitotic MYC formation and augments the cytotoxic effect of vincristine. IMPLICATIONS: The spindle's function as a docking site for MYC during mitosis may constitute a window of specific vulnerability to be exploited for cancer treatment.
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Affiliation(s)
- Sabrina Becker
- Department of Hematology and Medical Oncology, University Medicine Goettingen, Goettingen, Germany
| | - Christina Kiecke
- Department of Hematology and Medical Oncology, University Medicine Goettingen, Goettingen, Germany
| | - Eva Schäfer
- Department of Hematology and Medical Oncology, University Medicine Goettingen, Goettingen, Germany
| | - Ursula Sinzig
- Department of Hematology and Medical Oncology, University Medicine Goettingen, Goettingen, Germany
| | - Lena Deuper
- Department of Hematology and Medical Oncology, University Medicine Goettingen, Goettingen, Germany
| | - Pablo Trigo-Mourino
- Max-Planck Institute for Biophysical Chemistry, Goettingen, Germany.,Analytical Research and Development, Merck & Co., Inc., Kenilworth, New Jersey
| | | | - Raphael Koch
- Department of Hematology and Medical Oncology, University Medicine Goettingen, Goettingen, Germany
| | - Zuzanna Rydzynska
- Department of Hematology and Medical Oncology, University Medicine Goettingen, Goettingen, Germany
| | - Bjoern Chapuy
- Department of Hematology and Medical Oncology, University Medicine Goettingen, Goettingen, Germany
| | - Frederike von Bonin
- Department of Hematology and Medical Oncology, University Medicine Goettingen, Goettingen, Germany
| | - Dieter Kube
- Department of Hematology and Medical Oncology, University Medicine Goettingen, Goettingen, Germany
| | - Vivek Venkataramani
- Department of Hematology and Medical Oncology, University Medicine Goettingen, Goettingen, Germany
| | | | - Andreas Leha
- Department of Medical Statistics, University Medicine Goettingen, Goettingen, Germany
| | - Johanna Flach
- Department of Hematology and Medical Oncology, University Medicine Goettingen, Goettingen, Germany
| | - Sascha Dierks
- Department of Hematology and Medical Oncology, University Medicine Goettingen, Goettingen, Germany
| | - Holger Bastians
- Department of Experimental Oncology, University Medicine Goettingen, Goettingen, Germany
| | - Brigitte Maruschak
- Institute for Neuropathology, University Medicine Goettingen, Goettingen, Germany
| | - Kamil Bojarczuk
- Department of Hematology and Medical Oncology, University Medicine Goettingen, Goettingen, Germany.,Department of Experimental Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | - Lorenz Trümper
- Department of Hematology and Medical Oncology, University Medicine Goettingen, Goettingen, Germany
| | - Gerburg M Wulf
- Department of Medicine, BIDMC/Harvard Medical School, Boston, Massachusetts
| | - Gerald G Wulf
- Department of Hematology and Medical Oncology, University Medicine Goettingen, Goettingen, Germany.
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Wang HY, Yao ZH, Yao SN, Chu JF, Yan Z, Wang K, Liu YY. [Feasibility of PEG-rhG-CSF in the first-line treatment of diffuse large B-cell lymphoma receiving dose-adjusted EPOCH plus rituximab]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 41:167-170. [PMID: 32135637 PMCID: PMC7357936 DOI: 10.3760/cma.j.issn.0253-2727.2020.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Indexed: 11/08/2022]
Affiliation(s)
- H Y Wang
- Department of internal Medicine, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
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66
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Tahir Z, Peters J, Leahy K, Batalini F. Double-hit monomorphic B-cell lymphoma after liver transplantation. BMJ Case Rep 2020; 13:13/1/e231831. [PMID: 31900295 DOI: 10.1136/bcr-2019-231831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We report the first case of double-hit (MYC and BCL-6) monomorphic post-transplant lymphoproliferative disorder in a patient status post liver transplantation. Our patient is a 71-year-old man with a past medical history of Budd-Chiari syndrome complicated by cirrhosis and hepatocellular carcinoma. He underwent a deceased donor liver transplantation 2 years prior to presentation and was maintained on tacrolimus and mycophenolate mofetil for immunosuppression. He presented with a 3-week history of classical B-symptoms. Initial workup was notable for elevated lactate dehydrogenase. Abdomen ultrasound revealed multiple hypoechoic lesions, raising suspicion for a post-transplant lymphoproliferative disorder. Biopsy showed pleomorphic large neoplastic cells throughout, consistent with a diagnosis of diffuse large B-cell lymphoma. Cytogenetics then revealed rearrangements in both MYC and BCL-6, consistent with double-hit lymphoma. His immunosuppressive regimen was subsequently tapered and he was started on DA-EPOCH-R (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab) regimen.
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Affiliation(s)
- Zabreen Tahir
- Medicine, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Julia Peters
- Medicine, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kathleen Leahy
- Medicine, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Felipe Batalini
- Medicine, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA .,Medicine, Harvard Medical School, Boston, Massachusetts, USA
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67
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Prabhash K, Rajendra A, Noronha V, Bagal B, Niyogi D, Shet T, Purandare N, Tibdewal A. Twin trouble. CANCER RESEARCH, STATISTICS, AND TREATMENT 2020. [DOI: 10.4103/crst.crst_103_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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68
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Zuze T, Ellis GK, Kasonkanji E, Kaimila B, Nyasosela R, Nyirenda R, Tomoka T, Mulenga M, Chikasema M, Tewete B, Mtangwanika A, Chiyoyola S, Chimzimu F, Kampani C, Mhango W, Nicholas S, Randall C, Montgomery ND, Fedoriw G, Westmoreland KD, Painschab MS, Gopal S. Modified EPOCH for high-risk non-Hodgkin lymphoma in sub-Saharan Africa. Cancer Med 2020; 9:77-83. [PMID: 31705618 PMCID: PMC6943163 DOI: 10.1002/cam4.2631] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/30/2019] [Accepted: 10/09/2019] [Indexed: 12/21/2022] Open
Abstract
Aggressive non-Hodgkin lymphoma (NHL) is among the most common cancers in sub-Saharan Africa (SSA), where CHOP is standard treatment and outcomes are poor. To address this, we treated 17 newly diagnosed adult patients in Malawi with Burkitt (n = 8), plasmablastic (n = 8), and primary effusion lymphoma (n = 1) with a modified EPOCH regimen between 2016 and 2019. Twelve patients (71%) were male and the median age was 40 years (range 16-63). Eleven (65%) were HIV infected, median CD4 count was 218 cells/µL (range 9-460), and nine (82%) had suppressed HIV RNA < 400 copies/mL. Patients received a median of six cycles (range 2-8) and median follow-up was 14 months (range 2-34) among patients still alive. Grade 3/4 neutropenia was observed in 26% of cycles and in 65% of patients. Sixteen (94%) responded to EPOCH and 10 (59%) achieved a complete response. One-year overall survival (OS) was 62% (95% confidence interval [CI], 42%-91%). Five patients (29%) died from progressive NHL and three (18%) from treatment-related complications. These data suggest EPOCH with setting-appropriate modifications may be a practical, safe, and effective option for improving high-risk NHL outcomes in Malawi and comparable settings, which deserves further prospective evaluation.
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Affiliation(s)
| | | | | | - Bongani Kaimila
- UNC Project‐MalawiLilongweMalawi
- University of Malawi College of MedicineBlantyreMalawi
| | | | | | - Tamiwe Tomoka
- UNC Project‐MalawiLilongweMalawi
- University of Malawi College of MedicineBlantyreMalawi
- University of North CarolinaChapel HillNCUSA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Satish Gopal
- UNC Project‐MalawiLilongweMalawi
- University of Malawi College of MedicineBlantyreMalawi
- University of North CarolinaChapel HillNCUSA
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Weis TM, Marini BL, Nachar VR, Brown AM, Phillips TJ, Brown J, Wilcox RA, Kaminski MS, Devata S, Perissinotti AJ. Impact of a vincristine dose cap on the incidence of neuropathies with DA-EPOCH-R for the treatment of aggressive lymphomas. Leuk Lymphoma 2019; 61:1126-1132. [DOI: 10.1080/10428194.2019.1703969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Taylor M. Weis
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Bernard L. Marini
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Victoria R. Nachar
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Anna M. Brown
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Tycel J. Phillips
- Department of Internal Medicine, Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Julia Brown
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Ryan A. Wilcox
- Department of Internal Medicine, Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mark S. Kaminski
- Department of Internal Medicine, Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sumana Devata
- Department of Internal Medicine, Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Anthony J. Perissinotti
- Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, Ann Arbor, MI, USA
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70
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Mechanistic Insights into Chemoresistance Mediated by Oncogenic Viruses in Lymphomas. Viruses 2019; 11:v11121161. [PMID: 31888174 PMCID: PMC6950054 DOI: 10.3390/v11121161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 12/17/2022] Open
Abstract
Viral lymphomagenesis induced by infection with oncogenic viruses, such as Kaposi’s sarcoma associated herpesvirus (KSHV), Epstein–Barr virus (EBV) and human T-cell leukemia virus (HTLV-1), represents a group of aggressive malignancies with a diverse range of pathological features. Combined chemotherapy remains the standard of care for these virus-associated lymphomas; however, frequent chemoresistance is a barrier to achieving successful long-term disease-free survival. There is increasing evidence that indicates virus-associated lymphomas display more resistance to cytotoxic chemotherapeutic agents than that observed in solid tumors. Although the tumor microenvironment and genetic changes, such as key oncogene mutations, are closely related to chemoresistance, some studies demonstrate that the components of oncogenic viruses themselves play pivotal roles in the multidrug chemoresistance of lymphoma cells. In this review, we summarize recent advances in the understanding of the mechanisms through which oncogenic viruses mediate lymphoma cell chemoresistance, with a particular focus on KSHV and EBV, two major oncogenic viruses. We also discuss the current challenges to overcome these obstacles in the treatment of virus-associated lymphomas.
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71
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Zhang F, Li L, Zhang L, Li X, Fu X, Wang X, Wu J, Sun Z, Kong F, Ren L, Zhang M. Prognostic analysis of CD5 expression in double-hit diffuse large B-cell lymphoma and effectiveness comparison in patients treated with dose-adjusted EPOCH plus rituximab/R-CHOP regimens. BLOOD AND LYMPHATIC CANCER-TARGETS AND THERAPY 2019; 9:33-43. [PMID: 31692510 PMCID: PMC6707937 DOI: 10.2147/blctt.s216292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/11/2019] [Indexed: 12/11/2022]
Abstract
Objectives To compare the efficacy of rituximab, dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin (DA-EPOCH-R) with traditional rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) regimens in CD5+ double-hit lymphoma (DHL) and to evaluate prognostic factors. Methods We retrospectively studied 139 patients with newly diagnosed DHL/THL diffuse large B-cell lymphoma (including 20 cases CD5+ and 119 cases CD5−), 87 cases were MYC/BCL2 DHL, 30 cases were MYC/BCL6 DHL, 22 cases were THL. MYC, BCL2 and BCL6 rearrangements were examined by fluorescence in-situ hybridization. CD5 is detected by immunohistochemistry (IHC). Results The objective response rate (ORR) difference between CD5+ and CD5− was significant (80.0% vs 63.8%, P=0.003). The median follow-up time was 18 months (range: 4–39 months). Progression-free survival (PFS) of CD5+ group was significantly worse than that of CD5- (28.1% vs 59.0%, P=0.028), while no significant difference was observed in overall survival (OS) (32.1% vs 59.9%, P=0.057). Compared with the two regimens, the 2-year survival rate of DA-EPOCH-R group was significantly superior than that of R-CHOP (63.6% vs 45.4%, P=0.034 for PFS; 67.4% vs 47.8%, P=0.038 for OS). Besides, CD5+ patients receiving DA-EPOCH-R had survival benefits compared with R-CHOP in PFS (85.7% vs 23.0%, P=0.029), but there was no statistical difference in OS (87.7% vs 34.4.0%, P=0.064). However, in DA-EPOCH-R protocol, there was no significant difference between CD5+ DHL (MYC/BCl2 and MYC/BCL6) and triple-hit lymphoma (P=0.776 for PFS; P=0.728 for OS). Multivariate analysis showed that CD5+ treatment regimen and disease stage were independent prognostic factors. Conclusion Our retrospective study shows that CD5+ has a poorer prognosis than CD5− patients. Based on its improved lifetime and good tolerance on CD5+ patients, which is expected to become the first-line treatment for high-risk DLBCL types based on more clinical research.
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Affiliation(s)
- Fangwen Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China.,Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China
| | - Ling Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China.,Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China
| | - Lei Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China.,Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China
| | - Xin Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China.,Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China
| | - Xiaorui Fu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China.,Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China
| | - Xinhua Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China.,Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China
| | - Jingjing Wu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China.,Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China
| | - Zhenchang Sun
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China.,Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China
| | - Fei Kong
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China.,Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China
| | - Liangliang Ren
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China.,Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China.,Department of Oncology, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450052, People's Republic of China
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72
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Weis TM, Perissinotti AJ, Nachar VR, Brown AM, Phillips TJ, Marini BL. Dosing Vincristine in Dose-Adjusted EPOCH-R: To Cap or Not to Cap? J Clin Oncol 2019; 37:2952. [PMID: 31532723 DOI: 10.1200/jco.19.01259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Taylor M Weis
- Taylor M. Weis, PharmD; Anthony J. Perissinotti, PharmD; Victoria R. Nachar, PharmD; Anna M. Brown, PharmD; Tycel J. Phillips, MD; and Bernard L. Marini, PharmD, University of Michigan, Ann Arbor, MI
| | - Anthony J Perissinotti
- Taylor M. Weis, PharmD; Anthony J. Perissinotti, PharmD; Victoria R. Nachar, PharmD; Anna M. Brown, PharmD; Tycel J. Phillips, MD; and Bernard L. Marini, PharmD, University of Michigan, Ann Arbor, MI
| | - Victoria R Nachar
- Taylor M. Weis, PharmD; Anthony J. Perissinotti, PharmD; Victoria R. Nachar, PharmD; Anna M. Brown, PharmD; Tycel J. Phillips, MD; and Bernard L. Marini, PharmD, University of Michigan, Ann Arbor, MI
| | - Anna M Brown
- Taylor M. Weis, PharmD; Anthony J. Perissinotti, PharmD; Victoria R. Nachar, PharmD; Anna M. Brown, PharmD; Tycel J. Phillips, MD; and Bernard L. Marini, PharmD, University of Michigan, Ann Arbor, MI
| | - Tycel J Phillips
- Taylor M. Weis, PharmD; Anthony J. Perissinotti, PharmD; Victoria R. Nachar, PharmD; Anna M. Brown, PharmD; Tycel J. Phillips, MD; and Bernard L. Marini, PharmD, University of Michigan, Ann Arbor, MI
| | - Bernard L Marini
- Taylor M. Weis, PharmD; Anthony J. Perissinotti, PharmD; Victoria R. Nachar, PharmD; Anna M. Brown, PharmD; Tycel J. Phillips, MD; and Bernard L. Marini, PharmD, University of Michigan, Ann Arbor, MI
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Malenda A, Kołkowska‐Leśniak A, Puła B, Długosz‐Danecka M, Chełstowska M, Końska A, Giza A, Lech‐Marańda E, Jurczak W, Warzocha K. Outcomes of treatment with dose‐adjusted EPOCH‐R or R‐CHOP in primary mediastinal large B‐cell lymphoma. Eur J Haematol 2019; 104:59-66. [DOI: 10.1111/ejh.13337] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 09/21/2019] [Accepted: 10/01/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Agata Malenda
- Department of Hematology Institute of Hematology and Transfusion Medicine Warsaw Poland
| | | | - Bartosz Puła
- Department of Hematology Institute of Hematology and Transfusion Medicine Warsaw Poland
| | | | - Monika Chełstowska
- Department of Hematology Institute of Hematology and Transfusion Medicine Warsaw Poland
| | - Agnieszka Końska
- Department of Hematology Institute of Hematology and Transfusion Medicine Warsaw Poland
| | - Agnieszka Giza
- Department of Hematology Jagiellonian University Cracow Poland
| | - Ewa Lech‐Marańda
- Department of Hematology Institute of Hematology and Transfusion Medicine Warsaw Poland
- Department of Hematology and Transfusion Medicine Centre of Postgraduate Medicine Warsaw Poland
| | | | - Krzysztof Warzocha
- Department of Hematology Institute of Hematology and Transfusion Medicine Warsaw Poland
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Atwal M, Swan RL, Rowe C, Lee KC, Lee DC, Armstrong L, Cowell IG, Austin CA. Intercalating TOP2 Poisons Attenuate Topoisomerase Action at Higher Concentrations. Mol Pharmacol 2019; 96:475-484. [PMID: 31399497 PMCID: PMC6744389 DOI: 10.1124/mol.119.117259] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/02/2019] [Indexed: 12/18/2022] Open
Abstract
Topoisomerase II (TOP2) poisons are effective cytotoxic anticancer agents that stabilize the normally transient TOP2-DNA covalent complexes formed during the enzyme reaction cycle. These drugs include etoposide, mitoxantrone, and the anthracyclines doxorubicin and epirubicin. Anthracyclines also exert cell-killing activity via TOP2-independent mechanisms, including DNA adduct formation, redox activity, and lipid peroxidation. Here, we show that anthracyclines and another intercalating TOP2 poison, mitoxantrone, stabilize TOP2-DNA covalent complexes less efficiently than etoposide, and at higher concentrations they suppress the formation of TOP2-DNA covalent complexes, thus behaving as TOP2 poisons at low concentration and inhibitors at high concentration. We used induced pluripotent stem cell (iPSC)-derived human cardiomyocytes as a model to study anthracycline-induced damage in cardiac cells. Using immunofluorescence, our study is the first to demonstrate the presence of topoisomerase IIβ (TOP2B) as the only TOP2 isoform in iPSC-derived cardiomyocytes. In these cells, etoposide robustly induced TOP2B covalent complexes, but we could not detect doxorubicin-induced TOP2-DNA complexes, and doxorubicin suppressed etoposide-induced TOP2-DNA complexes. In vitro, etoposide-stabilized DNA cleavage was attenuated by doxorubicin, epirubicin, or mitoxantrone. Clinical use of anthracyclines is associated with cardiotoxicity. The observations in this study have potentially important clinical consequences regarding the effectiveness of anticancer treatment regimens when TOP2-targeting drugs are used in combination. These observations suggest that inhibition of TOP2B activity, rather than DNA damage resulting from TOP2 poisoning, may play a role in doxorubicin cardiotoxicity. SIGNIFICANCE STATEMENT: We show that anthracyclines and mitoxantrone act as topoisomerase II (TOP2) poisons at low concentration but attenuate TOP2 activity at higher concentration, both in cells and in in vitro cleavage experiments. Inhibition of type II topoisomerases suppresses the action of other drugs that poison TOP2. Thus, combinations containing anthracyclines or mitoxantrone and etoposide may reduce the activity of etoposide as a TOP2 poison and thus reduce the efficacy of drug combinations.
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Affiliation(s)
- Mandeep Atwal
- Institute for Cell and Molecular Biosciences, Newcastle University, Newcastle upon Tyne, United Kingdom (M.A., R.L.S., C.R., K.C.L., I.G.C., C.A.A.) and Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, United Kingdom (D.C.L., L.A.)
| | - Rebecca L Swan
- Institute for Cell and Molecular Biosciences, Newcastle University, Newcastle upon Tyne, United Kingdom (M.A., R.L.S., C.R., K.C.L., I.G.C., C.A.A.) and Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, United Kingdom (D.C.L., L.A.)
| | - Chloe Rowe
- Institute for Cell and Molecular Biosciences, Newcastle University, Newcastle upon Tyne, United Kingdom (M.A., R.L.S., C.R., K.C.L., I.G.C., C.A.A.) and Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, United Kingdom (D.C.L., L.A.)
| | - Ka C Lee
- Institute for Cell and Molecular Biosciences, Newcastle University, Newcastle upon Tyne, United Kingdom (M.A., R.L.S., C.R., K.C.L., I.G.C., C.A.A.) and Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, United Kingdom (D.C.L., L.A.)
| | - David C Lee
- Institute for Cell and Molecular Biosciences, Newcastle University, Newcastle upon Tyne, United Kingdom (M.A., R.L.S., C.R., K.C.L., I.G.C., C.A.A.) and Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, United Kingdom (D.C.L., L.A.)
| | - Lyle Armstrong
- Institute for Cell and Molecular Biosciences, Newcastle University, Newcastle upon Tyne, United Kingdom (M.A., R.L.S., C.R., K.C.L., I.G.C., C.A.A.) and Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, United Kingdom (D.C.L., L.A.)
| | - Ian G Cowell
- Institute for Cell and Molecular Biosciences, Newcastle University, Newcastle upon Tyne, United Kingdom (M.A., R.L.S., C.R., K.C.L., I.G.C., C.A.A.) and Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, United Kingdom (D.C.L., L.A.)
| | - Caroline A Austin
- Institute for Cell and Molecular Biosciences, Newcastle University, Newcastle upon Tyne, United Kingdom (M.A., R.L.S., C.R., K.C.L., I.G.C., C.A.A.) and Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, United Kingdom (D.C.L., L.A.)
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75
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Philippe L, Lancar R, Laurent C, Algarte-Genin M, Chassagne-Clément C, Fabiani B, Pierre Chenard M, Lazure T, Parrens M, Charlotte F, Delattre C, Gibault L, Capron F, Goubin-Versini I, Petitjean B, Boué F, Mounier N, Costello R, Costagliola D, Prevot S, Besson C. In situ BCL2 expression is an independent prognostic factor in HIV-associated DLBCL, a LYMPHOVIR cohort study. Br J Haematol 2019; 188:413-423. [PMID: 31468517 DOI: 10.1111/bjh.16176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/04/2019] [Indexed: 12/13/2022]
Abstract
The prognostic value of cell of origin (COO) classification and BCL2 expression is not well established in diffuse large B-cell lymphoma (DLBCL) patients with human immunodeficiency virus (HIV) infection in the recent era. Phenotypic patterns were determined by immunohistochemistry (IHC) of pathological samples from patients with HIV-associated DLBCL prospectively enrolled in the French AIDS and Viral Hepatitis CO16 Lymphovir cohort between 2008 and 2015. Molecular subgroup classification into germinal centre B-cell (GCB) and non-GCB subtypes was determined using the Hans algorithm. Among 52 samples of systemic DLBCL subjected to centralized pathological analysis, 25 of the 42 tested for BCL2 expression were positive. Samples were further classified into GCB (n = 19) and non-GCB (n = 16) subtypes and 17 remained unclassified. In multivariable analysis, BCL2 expression was an independent pejorative prognostic biomarker [4-year progression-free survival (PFS): 52% for BCL2+ vs. 88% for BCL2- , P = 0·02] and tended to reduce 4-year overall survival (OS) (63% for BCL2+ vs. 88% for BCL2- , P = 0·06). The difference between CGB and non-GCB subtypes on PFS and OS did not reach significance (4-year PFS: 79% for GCB vs. 53% for non-GCB, P = 0·24 and 4-year OS: 78% for GCB vs. 69% for non-GCB, P = 0·34). BCL2 expression determined by IHC is an independent pejorative prognostic biomarker in HIV-associated DLBCL in the recent era. This supports the investigation of new therapeutic strategies in patients with BCL2 expression.
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Affiliation(s)
- Laure Philippe
- Unit of Haematology-Oncology, Centre Hospitalier Versailles, Le Chesnay, France.,Université Versailles Saint Quentin en Yvelines, Paris-Saclay University, Communauté Paris-Saclay, Saint-Quentin en Yvelines, France
| | - Remi Lancar
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Sorbonne Université, Paris, France
| | - Camille Laurent
- Department of Pathology, Institut Universitaire du Cancer-Oncopole, CHU Toulouse, Toulouse, France.,INSERM, U.1037, Centre de Recherche en Cancérologie de Toulouse-Purpan, Toulouse, France
| | - Michele Algarte-Genin
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Sorbonne Université, Paris, France
| | | | - Bettina Fabiani
- Department of Pathology, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Marie Pierre Chenard
- Department of Pathology, Hôpital de Hautepierre, University Hospital of Strasbourg, Strasbourg, France
| | - Thierry Lazure
- Faculté de médecine Paris Sud, Université Paris Sud, Le Kremlin-Bicêtre, France.,Department of Pathology, AP-HP, Hôpitaux Paris Sud, Paris Sud University, Le Kremlin-Bicetre, France
| | - Marie Parrens
- Department of Pathology, Haut-Lévêque Hospital, Southern Hospital Group, Bordeaux University Hospital, Pessac, France
| | - Frederic Charlotte
- Department of Pathology, Hopital Pitie-Salpetriere and Sorbonne University, Paris, France
| | | | - Laure Gibault
- Department of Pathology, Hôpital Européen Georges Pompidou, AP-HP, and Université Paris Descartes, Paris, France
| | - Frederique Capron
- Department of Pathology, Faculté de médecine Pierre-et-Marie-Curie, Hopital Pitié-Salpêtrière, AP-HP, Paris, France
| | | | - Bruno Petitjean
- Department of Pathology, René DUBOS Hospital, Cergy-Pontoise, France
| | - François Boué
- Faculté de médecine Paris Sud, Université Paris Sud, Le Kremlin-Bicêtre, France.,Clinical Immunology Unit, AP-HP, Hôpitaux Paris Sud Site Béclère, Clamart, France
| | - Nicolas Mounier
- Department of Onco-Haematology, Archet Hospital, Nice, France
| | - Regis Costello
- Department of Haematology, AP-HM, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Dominique Costagliola
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Sorbonne Université, Paris, France
| | - Sophie Prevot
- Faculté de médecine Paris Sud, Université Paris Sud, Le Kremlin-Bicêtre, France.,Department of Pathology, AP-HP, Hôpitaux Paris Sud, Paris Sud University, Le Kremlin-Bicetre, France
| | - Caroline Besson
- Unit of Haematology-Oncology, Centre Hospitalier Versailles, Le Chesnay, France.,Université Versailles Saint Quentin en Yvelines, Paris-Saclay University, Communauté Paris-Saclay, Saint-Quentin en Yvelines, France.,INSERM U1018, Centre pour la Recherche en Epidémiologie et Santé des Populations (CESP), Equipe "Générations et Santé" Gustave Roussy, Villejuif, France
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76
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Keshvani N, Hon M, Gupta A, Brown TJ, Roy L, Marley E, Lindsey S, Johnson DH, Sadeghi N, Li HC. Reducing Hospitalizations: Institution of Outpatient Infusional EPOCH-Based Chemotherapy at a Safety Net Hospital. J Oncol Pract 2019; 15:e644-e651. [DOI: 10.1200/jop.18.00738] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) -based chemotherapy is traditionally administered inpatient because of its complex 96-hour protocol and number of involved medications. These routine admissions are costly, disruptive, and isolating to patients. Here, we describe our experience transitioning from inpatient to outpatient ambulatory EPOCH-based chemotherapy in a safety-net hospital, associated cost savings, and patient perceptions. METHODS AND MATERIALS: Guidelines for chemotherapy administration and educational materials were developed by a multidisciplinary team of physicians, nurses, and pharmacists. Data were collected via chart review and costs via the finance department. Patient satisfaction with chemotherapy at home compared with hospitalization was measured on a Likert-type scale via direct-to-patient survey. RESULTS: From January 30, 2017, through January 30, 2018, 87 cycles of EPOCH-based chemotherapy were administered to 23 patients. Sixty-one ambulatory cycles (70%) were administered to 18 patients. Of 26 cycles administered in the hospital, 18 (69%) were the first cycle of treatment. Rates of inappropriate prophylactic antimicrobial prescription and laboratory testing were lower in the outpatient setting. Eight of nine patients surveyed preferred home chemotherapy to inpatient chemotherapy. Per-cycle drug costs were 57.6% lower in outpatients as a result of differences in the acquisition cost in the outpatient setting. In total, the transition to ambulatory EPOCH-based chemotherapy yielded 1-year savings of $502,030 and an estimated 336 days of avoided hospital confinement. CONCLUSION: Multiday ambulatory EPOCH-based regimens were successfully and safely administered in our safety-net hospital. Outpatient therapy was associated with significant savings through avoided hospitalizations and reductions in drug acquisition cost and improved patient satisfaction.
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Affiliation(s)
- Neil Keshvani
- University of Texas Southwestern Medical Center, Dallas, TX
- Parkland Health and Hospital System, Dallas, TX
| | - Mary Hon
- University of Texas Southwestern Medical Center, Dallas, TX
- Parkland Health and Hospital System, Dallas, TX
| | - Arjun Gupta
- University of Texas Southwestern Medical Center, Dallas, TX
- Parkland Health and Hospital System, Dallas, TX
| | - Timothy J. Brown
- University of Texas Southwestern Medical Center, Dallas, TX
- Parkland Health and Hospital System, Dallas, TX
| | - Lonnie Roy
- Parkland Health and Hospital System, Dallas, TX
| | | | | | - David H. Johnson
- University of Texas Southwestern Medical Center, Dallas, TX
- Parkland Health and Hospital System, Dallas, TX
| | - Navid Sadeghi
- University of Texas Southwestern Medical Center, Dallas, TX
- Parkland Health and Hospital System, Dallas, TX
| | - Hsiao C. Li
- University of Texas Southwestern Medical Center, Dallas, TX
- Parkland Health and Hospital System, Dallas, TX
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77
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The Use of Optimal Treatment for DLBCL Is Improving in All Age Groups and Is a Key Factor in Overall Survival, but Non-Clinical Factors Influence Treatment. Cancers (Basel) 2019; 11:cancers11070928. [PMID: 31269764 PMCID: PMC6678990 DOI: 10.3390/cancers11070928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 06/17/2019] [Accepted: 06/28/2019] [Indexed: 12/12/2022] Open
Abstract
Introduction: Diffuse large B cell lymphoma (DLBCL) is an aggressive form of non-Hodgkin lymphoma for which a cure is usually the therapeutic goal of optimal treatment. Using a large population-based cohort we sought to examine the factors associated with optimal DLBCL treatment and survival. Methods: DLBCL cases were identified through the population-based Victorian Cancer Registry, capturing new diagnoses for two time periods: 2008–2009 and 2012–2013. Treatment was pre-emptively classified as ‘optimal’ or ‘suboptimal’, according to compliance with current treatment guidelines. Univariable and multivariable logistic regression models were fitted to determine factors associated with treatment and survival. Results: Altogether, 1442 DLBCL cases were included. Based on multivariable analysis, delivery of optimal treatment was less likely for those aged ≥80 years (p < 0.001), women (p = 0.012), those with medical comorbidity (p < 0.001), those treated in a non-metropolitan hospital (p = 0.02) and those who were ex-smokers (p = 0.02). Delivery of optimal treatment increased between 2008–2009 and the 2012–2013 (from 60% to 79%, p < 0.001). Delivery of optimal treatment was independently associated with a lower risk of death (hazard ratio (HR) = 0.60 (95% confidence interval (CI) 0.45–0.81), p = 0.001). Conclusion: Delivery of optimal treatment for DLBCL is associated with hospital location and category, highlighting possible demographic variation in treatment patterns. Together with an increase in the proportion of patients receiving optimal treatment in the more recent time period, this suggests that treatment decisions in DLBCL may be subject to non-clinical influences, which may have implications when evaluating equity of treatment access. The positive association with survival emphasizes the importance of delivering optimal treatment in DLBCL.
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78
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Godfrey JK, Nabhan C, Karrison T, Kline JP, Cohen KS, Bishop MR, Stadler WM, Karmali R, Venugopal P, Rapoport AP, Smith SM. Phase 1 study of lenalidomide plus dose-adjusted EPOCH-R in patients with aggressive B-cell lymphomas with deregulated MYC and BCL2. Cancer 2019; 125:1830-1836. [PMID: 30707764 DOI: 10.1002/cncr.31877] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/12/2018] [Accepted: 10/12/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dual translocation of MYC and BCL2 or the dual overexpression of these proteins in patients with aggressive B-cell lymphomas (termed double-hit lymphoma [DHL] and double-expressor lymphoma [DEL], respectively) have poor outcomes after chemoimmunotherapy with the combination of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Retrospective reports have suggested improved outcomes with dose-intensified regimens. In the current study, the authors conducted a phase 1 study to evaluate the feasibility, toxicity, and preliminary efficacy of adding lenalidomide to dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin with rituximab (DA-EPOCH-R) in patients with DHL and DEL. METHODS The primary objective of the current study was to determine the maximum tolerated dose of lenalidomide in combination with DA-EPOCH-R. A standard 3+3 design was used with lenalidomide administered on days 1 to 14 of each 21-day cycle (dose levels of 10 mg, 15 mg, and 20 mg). Patients attaining a complete response after 6 cycles of induction therapy proceeded to maintenance lenalidomide (10 mg daily for 14 days every 21 days) for 12 additional cycles. RESULTS A total of 15 patients were enrolled, 10 of whom had DEL and 5 of whom had DHL. Two patients experienced dose-limiting toxicities at a lenalidomide dose of 20 mg, consisting of grade 4 sepsis. The maximum tolerated dose of lenalidomide was determined to be 15 mg. The most common nonhematologic grade ≥3 adverse events included thromboembolism (4 patients; 27%) and hypokalemia (2 patients; 13%) (toxicities were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.0]). The preliminary efficacy of the regimen was encouraging, especially in the DEL cohort, in which all 10 patients achieved durable and complete metabolic responses with a median follow-up of 24 months. CONCLUSIONS The combination of lenalidomide with DA-EPOCH-R appears to be safe and feasible in patients with DHL and DEL. These encouraging results have prompted an ongoing phase 2 multicenter study.
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Affiliation(s)
- James K Godfrey
- Division of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Chadi Nabhan
- Cardinal Health Specialty Solutions, Waukegan, Illinois
| | - Theodore Karrison
- Department of Health Studies, University of Chicago, Chicago, Illinois
| | - Justin P Kline
- Division of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Kenneth S Cohen
- Division of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Michael R Bishop
- Division of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Walter M Stadler
- Division of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Reem Karmali
- Division of Hematology and Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois
| | - Parameswaran Venugopal
- Division of Hematology, Oncology and Stem Cell Transplant, Rush University, Chicago, Illinois
| | - Aaron P Rapoport
- Blood and Marrow Transplant Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sonali M Smith
- Division of Hematology/Oncology, University of Chicago, Chicago, Illinois
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79
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Saito M, Miyashita K, Miura Y, Harada S, Ogasawara R, Izumiyama K, Mori A, Tanaka M, Morioka M, Kondo T. Successful Treatment of Gastrosplenic Fistula Arising from Diffuse Large B-Cell Lymphoma with Chemotherapy: Two Case Reports. Case Rep Oncol 2019; 12:376-383. [PMID: 31182954 PMCID: PMC6547279 DOI: 10.1159/000500505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/18/2019] [Indexed: 12/19/2022] Open
Abstract
Gastrosplenic fistula (GSF) is a rare condition arising from gastric or splenic lymphomas. Surgical resection is the most common treatment, as described in previous reports. We report two cases of GSF in diffuse large B-cell lymphoma (DLBCL) patients that were successfully treated with chemotherapy and irradiation without surgical resection. Case 1 was of a 63-year-old man who had primary gastric DLBCL with a large lesion outside the stomach wall, leading to a spontaneous fistula in the spleen. Case 2 was of a 59-year-old man who had primary splenic DLBCL, which proliferated and infiltrated directly into the stomach. In both cases, chemotherapy comprising rituximab + dose-adjusted EPOCH regimen (etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin) was administered. Case 1 had significant bleeding from the lesion of the stomach during the treatment cycle; however, endoscopic hemostasis was achieved. Case 2 developed a fistula between the stomach and the spleen following therapeutic chemotherapy; however, no complications related to the fistula were observed thereafter. In both cases, irradiation was administered, and complete remission was achieved.
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Affiliation(s)
- Makoto Saito
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | | | - Yosuke Miura
- Department of Internal Medicine, Megumino Hospital, Eniwa, Japan
| | - Shinpei Harada
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Reiki Ogasawara
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Koh Izumiyama
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Akio Mori
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Masanori Tanaka
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Masanobu Morioka
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Takeshi Kondo
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
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80
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Liang JH, Wang L, Zhu HY, Qian J, Liao H, Wu JZ, Xia Y, Wu W, Cao L, Fan L, Li JY, Xu W. Dose-adjusted EPOCH regimen as first-line treatment for non-Hodgkin lymphoma-associated hemophagocytic lymphohistiocytosis: a single-arm, open-label, phase II trial. Haematologica 2019; 105:e29-e32. [PMID: 31073069 DOI: 10.3324/haematol.2019.220301] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jin-Hua Liang
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital; Key Laboratory of Hematology of Nanjing Medical University; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing
| | - Li Wang
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital; Key Laboratory of Hematology of Nanjing Medical University; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing
| | - Hua-Yuan Zhu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital; Key Laboratory of Hematology of Nanjing Medical University; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing
| | - Jun Qian
- Department of Hematology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu
| | - Hui Liao
- Department of Hematology, Air Force Hospital of Eastern Theater Command, Nanjing, Jiangsu, China
| | - Jia-Zhu Wu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital; Key Laboratory of Hematology of Nanjing Medical University; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing
| | - Yi Xia
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital; Key Laboratory of Hematology of Nanjing Medical University; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing
| | - Wei Wu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital; Key Laboratory of Hematology of Nanjing Medical University; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing
| | - Lei Cao
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital; Key Laboratory of Hematology of Nanjing Medical University; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing
| | - Lei Fan
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital; Key Laboratory of Hematology of Nanjing Medical University; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing
| | - Jian-Yong Li
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital; Key Laboratory of Hematology of Nanjing Medical University; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing
| | - Wei Xu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital; Key Laboratory of Hematology of Nanjing Medical University; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing
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Bartlett NL, Wilson WH, Jung SH, Hsi ED, Maurer MJ, Pederson LD, Polley MYC, Pitcher BN, Cheson BD, Kahl BS, Friedberg JW, Staudt LM, Wagner-Johnston ND, Blum KA, Abramson JS, Reddy NM, Winter JN, Chang JE, Gopal AK, Chadburn A, Mathew S, Fisher RI, Richards KL, Schöder H, Zelenetz AD, Leonard JP. Dose-Adjusted EPOCH-R Compared With R-CHOP as Frontline Therapy for Diffuse Large B-Cell Lymphoma: Clinical Outcomes of the Phase III Intergroup Trial Alliance/CALGB 50303. J Clin Oncol 2019; 37:1790-1799. [PMID: 30939090 DOI: 10.1200/jco.18.01994] [Citation(s) in RCA: 239] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Alliance/CALGB 50303 (NCT00118209), an intergroup, phase III study, compared dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-EPOCH-R) with standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) as frontline therapy for diffuse large B-cell lymphoma. PATIENTS AND METHODS Patients received six cycles of DA-EPOCH-R or R-CHOP. The primary objective was progression-free survival (PFS); secondary clinical objectives included response rate, overall survival (OS), and safety. RESULTS Between 2005 and 2013, 524 patients were registered; 491 eligible patients were included in the final analysis. Most patients (74%) had stage III or IV disease; International Prognostic Index (IPI) risk groups included 26% IPI 0 to 1, 37% IPI 2, 25% IPI 3, and 12% IPI 4 to 5. At a median follow-up of 5 years, PFS was not statistically different between the arms (hazard ratio, 0.93; 95% CI, 0.68 to 1.27; P = .65), with a 2-year PFS rate of 78.9% (95% CI, 73.8% to 84.2%) for DA-EPOCH-R and 75.5% (95% CI, 70.2% to 81.1%) for R-CHOP. OS was not different (hazard ratio, 1.09; 95% CI, 0.75 to 1.59; P = .64), with a 2-year OS rate of 86.5% (95% CI, 82.3% to 91%) for DA-EPOCH-R and 85.7% (95% CI, 81.4% to 90.2%) for R-CHOP. Grade 3 and 4 adverse events were more common (P < .001) in the DA-EPOCH-R arm than the R-CHOP arm, including infection (16.9% v 10.7%, respectively), febrile neutropenia (35.0% v 17.7%, respectively), mucositis (8.4% v 2.1%, respectively), and neuropathy (18.6% v 3.3%, respectively). Five treatment-related deaths (2.1%) occurred in each arm. CONCLUSION In the 50303 study population, the more intensive, infusional DA-EPOCH-R was more toxic and did not improve PFS or OS compared with R-CHOP. The more favorable results with R-CHOP compared with historical controls suggest a potential patient selection bias and may preclude generalizability of results to specific risk subgroups.
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Affiliation(s)
| | - Wyndham H Wilson
- 2 National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | | | | | | | | | | | - Bruce D Cheson
- 6 MedStar Georgetown University Hospital, Washington, DC
| | - Brad S Kahl
- 1 Washington University School of Medicine, St Louis, MO
| | | | - Louis M Staudt
- 2 National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Kristie A Blum
- 8 The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | | | | | | - Amy Chadburn
- 14 Cornell University Medical College, New York, NY
| | - Susan Mathew
- 14 Cornell University Medical College, New York, NY
| | | | | | - Heiko Schöder
- 17 Memorial Sloan Kettering Cancer Center, New York, NY
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82
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Kataoka T, Sakurashita H, Taogoshi T, Nishigakiuchi R, Murase T, Izumitani S, Saeki Y, Matsuo H. Comparison of Pegfilgrastim and Filgrastim for the Primary Prophylactic Effect for Preventing Febrile Neutropenia in Patients Undergoing Rituximab with Dose-adjusted EPOCH Chemotherapy. YAKUGAKU ZASSHI 2019; 139:629-633. [DOI: 10.1248/yakushi.18-00101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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83
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Atkins S, He F. Chemotherapy and Beyond: Infections in the Era of Old and New Treatments for Hematologic Malignancies. Infect Dis Clin North Am 2019; 33:289-309. [PMID: 30935703 DOI: 10.1016/j.idc.2019.01.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Treatment options for hematologic malignancies have been rapidly expanding in the past decade, resulting in better survival outcomes for many patients. Infection is an important cause of morbidity and mortality in this patient population. Cytotoxic chemotherapy has well-studied infectious risks related to the degree and duration of myelosuppression. Targeted therapies and immunotherapies have less clearly predictable infectious risk and diverse effects on immune function. This review discusses contemporary management of hematologic malignancies, followed by special discussion of novel agents, including signaling/small molecule inhibitors, monoclonal antibodies, immunomodulators, and immunotherapies, for treatment of hematologic malignancies with focus on infectious risk.
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Affiliation(s)
- Sarah Atkins
- Department of Internal Medicine, University of Minnesota, 420 Delaware Street Southeast, MMC 284, Minneapolis, MN 55455, USA
| | - Fiona He
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, 420 Delaware Street Southeast, MMC 480, Minneapolis, MN 55455, USA.
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84
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Dodero A, Guidetti A, Tucci A, Barretta F, Novo M, Devizzi L, Re A, Passi A, Pellegrinelli A, Pruneri G, Miceli R, Testi A, Pennisi M, Di Chio MC, Matteucci P, Carniti C, Facchetti F, Rossi G, Corradini P. Dose-adjusted EPOCH plus rituximab improves the clinical outcome of young patients affected by double expressor diffuse large B-cell lymphoma. Leukemia 2019; 33:1047-1051. [PMID: 30631117 PMCID: PMC6756077 DOI: 10.1038/s41375-018-0320-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/05/2018] [Accepted: 11/06/2018] [Indexed: 01/15/2023]
Affiliation(s)
- A Dodero
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - A Guidetti
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy. .,Department of Oncology and Hemato-Oncology, University of Milano, Milano, Italy.
| | - A Tucci
- Department of Hematology, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - F Barretta
- Department of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - M Novo
- Department of Hematology, Azienda Ospedaliero Universitaria Citta' della Salute e della Scienza di Torino, Torino, Italy
| | - L Devizzi
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - A Re
- Department of Hematology, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - A Passi
- Department of Hematology, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - A Pellegrinelli
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - G Pruneri
- Department of Oncology and Hemato-Oncology, University of Milano, Milano, Italy.,Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - R Miceli
- Department of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - A Testi
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - M Pennisi
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - M C Di Chio
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - P Matteucci
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - C Carniti
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - F Facchetti
- Department of Pathology, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - G Rossi
- Department of Hematology, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - P Corradini
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.,Department of Oncology and Hemato-Oncology, University of Milano, Milano, Italy
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85
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Roswarski J, Roschewski M, Melani C, Pittaluga S, Lucas A, Steinberg SM, Jaffe ES, Waldmann TA, Wilson WH. Phase 1/2 study of alemtuzumab with dose-adjusted EPOCH in untreated aggressive T and NK cell lymphomas. Leuk Lymphoma 2019; 60:2062-2066. [PMID: 30626252 DOI: 10.1080/10428194.2018.1562184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To evaluate the feasibility and clinical efficacy of the combination of alemtuzumab with dose-adjusted etoposide/cyclophosphamide/doxorubicin/vincristine/prednisone (DA-EPOCH) as upfront therapy for untreated aggressive T and NK cell lymphomas, a phase 1/2 trial was conducted. Thirty patients were treated with the study regimen, consisting of alemtuzumab on day 1 of a 21 day cycle with standard dosing of DA-EPOCH for 6-8 cycles. Alemtuzumab 30 mg IV was used for the phase 2 component. Of 30 treated patients, 17 had a complete response (CR) and eight had a partial response (83.3% overall response rate). The median overall survival and progression-free survival were 20.2 and 6.6 months, respectively. There were five treatment-related deaths on study mainly due to infectious complications, including one case each of disseminated toxoplasmosis and pneumonia and two cases of sepsis. Alemtuzumab with DA-EPOCH is of limited clinical utility due to unacceptable toxicity, despite the high rate of CR.
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Affiliation(s)
- Joseph Roswarski
- a Center for Cancer Research, National Cancer Institute , Bethesda , MD , USA.,b Tripler Army Medical Center , Honolulu , HI , USA
| | - Mark Roschewski
- a Center for Cancer Research, National Cancer Institute , Bethesda , MD , USA
| | - Christopher Melani
- a Center for Cancer Research, National Cancer Institute , Bethesda , MD , USA
| | - Stefania Pittaluga
- c Laboratory of Pathology , National Cancer Institute , Bethesda , MD , USA
| | - Andrea Lucas
- a Center for Cancer Research, National Cancer Institute , Bethesda , MD , USA
| | - Seth M Steinberg
- a Center for Cancer Research, National Cancer Institute , Bethesda , MD , USA
| | - Elaine S Jaffe
- c Laboratory of Pathology , National Cancer Institute , Bethesda , MD , USA
| | - Thomas A Waldmann
- a Center for Cancer Research, National Cancer Institute , Bethesda , MD , USA
| | - Wyndham H Wilson
- a Center for Cancer Research, National Cancer Institute , Bethesda , MD , USA
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86
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Complications Associated With Dose-adjusted EPOCH-rituximab Therapy for Non-Hodgkin Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:781-787. [DOI: 10.1016/j.clml.2018.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/05/2018] [Accepted: 08/21/2018] [Indexed: 12/21/2022]
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87
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Burt R, Warcel D, Fielding AK. Blinatumomab, a bispecific B-cell and T-cell engaging antibody, in the treatment of B-cell malignancies. Hum Vaccin Immunother 2018; 15:594-602. [PMID: 30380973 PMCID: PMC6605719 DOI: 10.1080/21645515.2018.1540828] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 10/22/2018] [Indexed: 01/28/2023] Open
Abstract
Blinatumomab (Blincyto, Amgen), a bi-specific antibody, is a first-in-class, targeted immunotherapy agent for treatment of B-cell malignancies with a novel mechanism of action which involves in-vivo engagement of the patient's T cells with CD19-expressing tumour cells. Clinical trials have demonstrated its efficacy in relapsed B-cell Acute Lymphoblastic Leukaemia (B-ALL) and B-cell Non-Hodgkin's Lymphoma including in patients who are refractory to chemotherapy. This review summarises the development and design of Blinatumomab, the outcome of clinical studies demonstrating its efficacy and how to manage the administration, practically, including relevant toxicities. We compare and contrast it to other emerging agents for treatment of B-cell malignancies.
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88
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Moore DC, Arnall JR, Plesca DC. Transitioning historically inpatient chemotherapy regimens for hematologic malignancies to the ambulatory care setting. Am J Health Syst Pharm 2018; 75:1824-1830. [PMID: 30131323 DOI: 10.2146/ajhp180060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Donald C Moore
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Justin R Arnall
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Dragos C Plesca
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Charlotte, NC
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89
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DA-EPOCH-R improves the outcome over that of R-CHOP regimen for DLBCL patients below 60 years, GCB phenotype, and those with high-risk IPI, but not for double expressor lymphoma. J Cancer Res Clin Oncol 2018; 145:117-127. [DOI: 10.1007/s00432-018-2771-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
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90
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Broccoli A, Zinzani PL. The unique biology and treatment of primary mediastinal B-cell lymphoma. Best Pract Res Clin Haematol 2018; 31:241-250. [DOI: 10.1016/j.beha.2018.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/11/2018] [Accepted: 07/02/2018] [Indexed: 01/03/2023]
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91
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Özdemir BC, Csajka C, Dotto GP, Wagner AD. Sex Differences in Efficacy and Toxicity of Systemic Treatments: An Undervalued Issue in the Era of Precision Oncology. J Clin Oncol 2018; 36:2680-2683. [PMID: 30004815 DOI: 10.1200/jco.2018.78.3290] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Berna C Özdemir
- Berna C. Özdemir, Lausanne University Hospital; and International Cancer Prevention Institute, Lausanne, Switzerland; Chantal Csajka, Lausanne University Hospital; and University of Lausanne, Lausanne, Switzerland; Gian-Paolo Dotto, International Cancer Prevention Institute; University of Lausanne, Lausanne, Switzerland; and Massachusetts General Hospital, Charlestown, MA; and Anna Dorothea Wagner, Lausanne University Hospital, Lausanne, Switzerland
| | - Chantal Csajka
- Berna C. Özdemir, Lausanne University Hospital; and International Cancer Prevention Institute, Lausanne, Switzerland; Chantal Csajka, Lausanne University Hospital; and University of Lausanne, Lausanne, Switzerland; Gian-Paolo Dotto, International Cancer Prevention Institute; University of Lausanne, Lausanne, Switzerland; and Massachusetts General Hospital, Charlestown, MA; and Anna Dorothea Wagner, Lausanne University Hospital, Lausanne, Switzerland
| | - Gian-Paolo Dotto
- Berna C. Özdemir, Lausanne University Hospital; and International Cancer Prevention Institute, Lausanne, Switzerland; Chantal Csajka, Lausanne University Hospital; and University of Lausanne, Lausanne, Switzerland; Gian-Paolo Dotto, International Cancer Prevention Institute; University of Lausanne, Lausanne, Switzerland; and Massachusetts General Hospital, Charlestown, MA; and Anna Dorothea Wagner, Lausanne University Hospital, Lausanne, Switzerland
| | - Anna Dorothea Wagner
- Berna C. Özdemir, Lausanne University Hospital; and International Cancer Prevention Institute, Lausanne, Switzerland; Chantal Csajka, Lausanne University Hospital; and University of Lausanne, Lausanne, Switzerland; Gian-Paolo Dotto, International Cancer Prevention Institute; University of Lausanne, Lausanne, Switzerland; and Massachusetts General Hospital, Charlestown, MA; and Anna Dorothea Wagner, Lausanne University Hospital, Lausanne, Switzerland
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92
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Zhang WH, Li GY, Ma YJ, Li ZC, Zhu Y, Chang J, Hao SG, Tao R. Reduced-dose EPOCH-R chemotherapy for elderly patients with advanced stage diffuse large B cell lymphoma. Ann Hematol 2018; 97:1809-1816. [DOI: 10.1007/s00277-018-3369-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 05/07/2018] [Indexed: 11/28/2022]
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93
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Melani C, Advani R, Roschewski M, Walters KM, Chen CC, Baratto L, Ahlman MA, Miljkovic MD, Steinberg SM, Lam J, Shovlin M, Dunleavy K, Pittaluga S, Jaffe ES, Wilson WH. End-of-treatment and serial PET imaging in primary mediastinal B-cell lymphoma following dose-adjusted EPOCH-R: a paradigm shift in clinical decision making. Haematologica 2018; 103:1337-1344. [PMID: 29748435 PMCID: PMC6068044 DOI: 10.3324/haematol.2018.192492] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/10/2018] [Indexed: 11/28/2022] Open
Abstract
Dose-adjusted-EPOCH-R obviates the need for radiotherapy in most patients with primary mediastinal B-cell lymphoma. End-of-treatment PET, however, does not accurately identify patients at risk of treatment failure, thereby confounding clinical decision making. To define the role of PET in primary mediastinal B-cell lymphoma following dose-adjusted-EPOCH-R, we extended enrollment and follow up on our published phase II trial and independent series. Ninety-three patients received dose-adjusted-EPOCH-R without radiotherapy. End-of-treatment PET was performed in 80 patients, of whom 57 received 144 serial scans. One nuclear medicine physician from each institution blindly reviewed all scans from their respective institution. End-of-treatment PET was negative (Deauville 1-3) in 55 (69%) patients with one treatment failure (8-year event-free and overall survival of 96.0% and 97.7%). Among 25 (31%) patients with a positive (Deauville 4-5) end-of-treatment PET, there were 5 (20%) treatment failures (8-year event-free and overall survival of 71.1% and 84.3%). Linear regression analysis of serial scans showed a significant decrease in SUVmax in positive end-of-treatment PET non-progressors compared to an increase in treatment failures. Among 6 treatment failures, the median end-of-treatment SUVmax was 15.4 (range, 1.9-21.3), and 4 achieved long-term remission with salvage therapy. Virtually all patients with a negative end-of-treatment PET following dose-adjusted-EPOCH-R achieved durable remissions and should not receive radiotherapy. Among patients with a positive end-of-treatment PET, only 5/25 (20%) had treatment-failure. Serial PET imaging distinguished end-of-treatment PET positive patients without treatment failure, thereby reducing unnecessary radiotherapy by 80%, and should be considered in all patients with an initial positive PET following dose-adjusted-EPOCH-R (clinicaltrials.gov identifier 00001337).
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Affiliation(s)
- Christopher Melani
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Mark Roschewski
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Clara C Chen
- Nuclear Medicine Division, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Lucia Baratto
- Nuclear Medicine and Molecular Imaging Division, Stanford University, CA
| | - Mark A Ahlman
- Nuclear Medicine Division, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Milos D Miljkovic
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jessica Lam
- Stanford Cancer Institute, Stanford University, CA
| | - Margaret Shovlin
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Stefania Pittaluga
- Laboratory of Pathology, Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elaine S Jaffe
- Laboratory of Pathology, Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Wyndham H Wilson
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Beygi S, Sadashiv S, Reilly JB, Khan C, Lister J. Frontline treatment of diffuse large B-cell lymphoma in elderly: a systematic review of clinical trials in post-rituximab era. Leuk Lymphoma 2018; 59:2847-2861. [PMID: 29616868 DOI: 10.1080/10428194.2018.1443332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Treatment of diffuse large B cell lymphoma (DLBCL) remains challenging in elderly population and systematic reviews are lacking in this area. Medline and Cochrane Register of Controlled Trials in addition to conference proceedings were searched for therapeutic clinical trials on frontline treatment of DLBCL in adults ≥60 in post-rituximab era. Forty-one out of 713 reviewed papers met our inclusion criteria. Six cycles of rituximab, cyclophosphamide, vincristine, prednisone (R-CHOP) administered every 21 d remain the standard treatment for fit elderly, with no role for maintenance rituximab. For individuals ≥80, the strongest evidence favors rituximab/ofatumumab-miniCHOP. Numerous alternative approaches including the use of liposomal anthracyclines, dose and regimen adjustment to frailty/comorbidity score, brief duration regimens, and consolidative radioimmunotherapy have produced promising outcomes and could be considered for R-CHOP inappropriate elderly. Phase III randomized trials studying the efficacy of liposomal vincristine, extended-exposure rituximab, and lenalidomide plus R-CHOP are ongoing.
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Affiliation(s)
- Sara Beygi
- a Allegheny Health Network, Department of Internal Medicine , Pittsburgh , PA , USA
| | - Santhosh Sadashiv
- b Allegheny Health Network, Division of Hematology and Cellular Therapy , West Penn Hospital , Pittsburgh , PA , USA
| | - James B Reilly
- c Allegheny Health Network, Department of Internal Medicine , Office of Graduate Medical Education , Pittsburgh , PA , USA
| | - Cyrus Khan
- b Allegheny Health Network, Division of Hematology and Cellular Therapy , West Penn Hospital , Pittsburgh , PA , USA
| | - John Lister
- b Allegheny Health Network, Division of Hematology and Cellular Therapy , West Penn Hospital , Pittsburgh , PA , USA
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95
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Liang JH, Lu L, Zhu HY, Li W, Fan L, Li JY, Xu W. The Prognostic Role of Circulating Epstein-Barr Virus DNA Copy Number in Angioimmunoblastic T-Cell Lymphoma Treated with Dose-Adjusted EPOCH. Cancer Res Treat 2018; 51:150-157. [PMID: 29621877 PMCID: PMC6334003 DOI: 10.4143/crt.2017.476] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/30/2018] [Indexed: 11/21/2022] Open
Abstract
Purpose Determine the frequency and prognostic value of circulating Epstein-Barr virus (EBV) DNA copy number in angioimmunoblastic T-cell lymphoma (AITL) patients who were treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin (DA-EPOCH) regimens. Materials and Methods Sixty newly-diagnosed AITL patients were retrospectively enrolled in the present study. All patients were treated with DA-EPOCH regimen. Results Twenty-two subjects (36.7%) had a EBV DNA-positive test at diagnosis. EBV DNA‒positive patients were associated with lower lymphocyte-monocyte ratio (p=0.024). Median follow-up was 40 months (range, 14 to 100 months). The overall response rate for all the 60 AITL patents were 71.7% (95% confidence interval [CI], 58.6 to 82.5) with 3-year progressive-free survival (PFS) rate of 30.9%±6.1% and overall survival (OS) rate of 60.1%±6.6%. Not only did PFS estimation differ between the EBV DNA‒positive and EBV DNA‒negative group (hazard ratio [HR], 2.24; 95% CI, 1.15 to 4.35; p=0.006), but also worse OS was observed in the pretreatment EBV DNA‒positive group than in the EBV DNA‒negative group (HR, 2.74; 95% CI, 1.22 to 6.19; p=0.006). EBV DNA test positivity was independent prognostic marker for both PFS (HR, 2.17; 95% CI, 1.17 to 4.00; p=0.014) and OS (HR, 3.24; 95% CI, 1.48 to 7.11; p=0.004) after adjusting International Prognostic Index and prognostic index for AITL score. Reduction in EBV copies was significantly associated with therapy-response. Conclusion Circulating EBV DNA level was an important prognostic and monitoring marker for AITL patients who treated with DA-EPOCH regimens which cannot improve outcomes for AITL patients.
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Affiliation(s)
- Jin-Hua Liang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Luo Lu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Hua-Yuan Zhu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Wang Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Lei Fan
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Jian-Yong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Wei Xu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
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96
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Poston JN, Dorer R, Aboulafia DM. The Diving Bell and the Butterfly Revisited: A Fatal Case of Locked-in Syndrome in a Man With Epstein-Barr Virus-Positive Diffuse Large B-Cell Lymphoma, Not Otherwise Specified. Clin Med Insights Blood Disord 2018; 11:1179545X18762799. [PMID: 29623003 PMCID: PMC5881979 DOI: 10.1177/1179545x18762799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 02/08/2018] [Indexed: 11/16/2022]
Abstract
Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) is a rare variant of DLBCL. The natural history of this subtype is poorly understood. Incomplete literature in the era of rituximab suggests that patients with EBV-positive DLBCL have similar outcomes to patients with EBV-negative DLBCL when treated with rituximab and anthracycline-based chemotherapy regimens; however, there are few prospective studies on this subtype and little is known about the risk of central nervous system (CNS) relapse with EBV-positive DLBCL. Herein, we describe the case of a 64-year-old man who presented with stage IIA EBV-positive DLBCL. His international age-adjusted International Prognostic Index (IPI) was 2. He achieved a complete response to 6 cycles of rituximab combined with chemotherapy consisting of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin. After 10 days of completion of chemotherapy, he had a fulminant neurologic decline manifested by diffuse weakness followed by a locked-in syndrome; he could only communicate by moving his eyes. He had been deemed at low risk for CNS relapse based on the application of the recently developed CNS-IPI score of 2 (1 point for age >60 years and 1 point for lactate dehydrogenase higher than normal) and consequently did not receive therapy for CNS prophylaxis. A limited postmortem autopsy revealed extensive lymphoma throughout the brain, particularly in the deep basal nuclei, midbrain, pons, centrum semiovale, and corpus callosum. This presentation of CNS relapse is rare and has not yet been described in EBV-positive DLBCL. We discuss some of the unique aspects of this case including the clinical manifestations of locked-in syndrome and its differential diagnosis and the uncertain benefits of CNS prophylaxis in this clinical context.
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Affiliation(s)
| | - Russell Dorer
- Department of Pathology and Laboratory Medicine, Virginia Mason Medical Center, Seattle, WA, USA
| | - David M Aboulafia
- Division of Hematology, University of Washington, Seattle, WA, USA
- Floyd & Delores Jones Cancer Institute, Virginia Mason Medical Center, Seattle, WA, USA
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97
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Ard KL, Kelly HR, Gandhi RT, Louissaint A. Case 9-2018: A 55-Year-Old Man with HIV Infection and a Mass on the Right Side of the Face. N Engl J Med 2018; 378:1143-1152. [PMID: 29562158 DOI: 10.1056/nejmcpc1800321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kevin L Ard
- From the Departments of Medicine (K.L.A., R.T.G.), Radiology (H.R.K.), and Pathology (A.L.), Massachusetts General Hospital, the Departments of Medicine (K.L.A., R.T.G.), Radiology (H.R.K.), and Pathology (A.L.), Harvard Medical School, and the Department of Radiology, Massachusetts Eye and Ear (H.R.K.) - all in Boston
| | - Hillary R Kelly
- From the Departments of Medicine (K.L.A., R.T.G.), Radiology (H.R.K.), and Pathology (A.L.), Massachusetts General Hospital, the Departments of Medicine (K.L.A., R.T.G.), Radiology (H.R.K.), and Pathology (A.L.), Harvard Medical School, and the Department of Radiology, Massachusetts Eye and Ear (H.R.K.) - all in Boston
| | - Rajesh T Gandhi
- From the Departments of Medicine (K.L.A., R.T.G.), Radiology (H.R.K.), and Pathology (A.L.), Massachusetts General Hospital, the Departments of Medicine (K.L.A., R.T.G.), Radiology (H.R.K.), and Pathology (A.L.), Harvard Medical School, and the Department of Radiology, Massachusetts Eye and Ear (H.R.K.) - all in Boston
| | - Abner Louissaint
- From the Departments of Medicine (K.L.A., R.T.G.), Radiology (H.R.K.), and Pathology (A.L.), Massachusetts General Hospital, the Departments of Medicine (K.L.A., R.T.G.), Radiology (H.R.K.), and Pathology (A.L.), Harvard Medical School, and the Department of Radiology, Massachusetts Eye and Ear (H.R.K.) - all in Boston
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98
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Fahrenbruch R, Kintzel P, Bott AM, Gilmore S, Markham R. Dose Rounding of Biologic and Cytotoxic Anticancer Agents: A Position Statement of the Hematology/Oncology Pharmacy Association. J Oncol Pract 2018; 14:e130-e136. [DOI: 10.1200/jop.2017.025411] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: To present a position statement from the Hematology/Oncology Pharmacy Association (HOPA) that pertains to dose rounding of biologic and cytotoxic anticancer agents. Methods: The HOPA Standards Committee organized a work group of oncology pharmacist specialists to examine the safety and value of dose rounding of biologic and cytotoxic anticancer agents. Primary literature that describes methods for dose rounding, with clinical or economic data, were analyzed. Relevant pharmacokinetic characteristics and aspects of product formulation were considered. Issues for institutional application were addressed. Results: Rounding of biologic and cytotoxic agents within 10% of the ordered dose is designated as acceptable for routine clinical care. Dose changes ≤ 10% are not expected to reduce the safety or effectiveness of therapy. The rounding amount—10%—is rational in the context of standard dose adjustments for patient tolerance and tumor response (≥ 20%), clinical trial deficiency criteria (> 10%), and the influence of interpatient pharmacokinetic variability. HOPA supports the use of the same threshold for dose rounding of anticancer drugs as that used for palliative and curative therapy. Potential exceptions to dose rounding are discussed. Conclusion: Dose rounding reduces waste and health care costs. HOPA recommends that each institution develop its own dose-rounding policy that addresses biologic and cytotoxic agents. Institutional guidelines for dose rounding of anticancer agents, including criteria for automatic dose rounding, the allowable percentage, and institutional processes for operationalizing and documenting dose rounding, should be determined by collaborative stakeholder consensus. Exceptions to dose rounding should be determined a priori. Additional studies that evaluate the impact of dose rounding on patient outcome are warranted.
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Affiliation(s)
- Rebecca Fahrenbruch
- University of Minnesota Health, Maple Grove; Fairview Pharmacy Services, Minneapolis, MN; Spectrum Health Hospitals, Grand Rapids, MI; Alaska Native Tribal Health Consortium, Anchorage, AK; The Johns Hopkins Hospital, Baltimore, MD; and Oregon Health and Science University Hospitals and Clinics, Portland, OR
| | - Polly Kintzel
- University of Minnesota Health, Maple Grove; Fairview Pharmacy Services, Minneapolis, MN; Spectrum Health Hospitals, Grand Rapids, MI; Alaska Native Tribal Health Consortium, Anchorage, AK; The Johns Hopkins Hospital, Baltimore, MD; and Oregon Health and Science University Hospitals and Clinics, Portland, OR
| | - Anne Marie Bott
- University of Minnesota Health, Maple Grove; Fairview Pharmacy Services, Minneapolis, MN; Spectrum Health Hospitals, Grand Rapids, MI; Alaska Native Tribal Health Consortium, Anchorage, AK; The Johns Hopkins Hospital, Baltimore, MD; and Oregon Health and Science University Hospitals and Clinics, Portland, OR
| | - Steven Gilmore
- University of Minnesota Health, Maple Grove; Fairview Pharmacy Services, Minneapolis, MN; Spectrum Health Hospitals, Grand Rapids, MI; Alaska Native Tribal Health Consortium, Anchorage, AK; The Johns Hopkins Hospital, Baltimore, MD; and Oregon Health and Science University Hospitals and Clinics, Portland, OR
| | - Ryan Markham
- University of Minnesota Health, Maple Grove; Fairview Pharmacy Services, Minneapolis, MN; Spectrum Health Hospitals, Grand Rapids, MI; Alaska Native Tribal Health Consortium, Anchorage, AK; The Johns Hopkins Hospital, Baltimore, MD; and Oregon Health and Science University Hospitals and Clinics, Portland, OR
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99
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Huang JJ, Xia Y, Wang Y, Liu PP, Bi XW, Sun P, Lin TY, Jiang WQ, Li ZM. A comparison of R-EPOCH and R-CHOP as a first-line regimen in de novo DLBCL patients with high Ki-67 expression in a single institution. Oncotarget 2018; 7:41242-41250. [PMID: 27183909 PMCID: PMC5173055 DOI: 10.18632/oncotarget.9271] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/31/2016] [Indexed: 01/22/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) patients with high Ki-67 expression receive limited benefits from R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) therapy. This study aims to compare the R-EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) and R-CHOP regimens as first-line therapy in DLBCL patients with high Ki-67 expression. Data from 44 untreated DLBCL patients with high Ki-67 expression receiving R-EPOCH therapy were matched with those from 132 untreated DLBCL patients with high Ki-67 expression receiving R-CHOP therapy based on the International Prognostic Index (IPI: age, Ann Arbor stage, performance status, LDH level, number of extranodal sites), gender, and Ki-67 expression. In the R-EPOCH group, 42/44 patients were eligible for response evaluation. A total of 35 patients (83.3%) achieved complete remission (CR); 6 patients (14.3%) achieved partial remission (PR); and one patient (2.4%) exhibited progressive disease (PD) after 2 cycles of therapy. Patients in the R-EPOCH group presented better survival outcomes than those in the R-CHOP group (3-year overall survival [OS]: 89.9% vs. 70.2%, p = 0.041; 3-year progression-free survival [PFS]: 86.6% vs. 59.7%, p = 0.024). The survival superiority of the R-EPOCH over the R-CHOP regimen persisted when considering only patients of low-to-intermediate IPI risk, but it was not observed in those of high IPI risk. Our data suggest that R-EPOCH could be superior to R-CHOP as a first-line regimen in DLBCL patients with high Ki-67 expression, especially in those of low-to-intermediate IPI risk.
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Affiliation(s)
- Jia-Jia Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yi Xia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yu Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Pan-Pan Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Xi-Wen Bi
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Peng Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Tong-Yu Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Wen-Qi Jiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Zhi-Ming Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
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100
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Dittus C, Grover N, Ellsworth S, Tan X, Park SI. Bortezomib in combination with dose-adjusted EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) induces long-term survival in patients with plasmablastic lymphoma: a retrospective analysis. Leuk Lymphoma 2018; 59:2121-2127. [PMID: 29303024 DOI: 10.1080/10428194.2017.1416365] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Plasmablastic lymphoma (PBL) is a rare and aggressive form of B-cell non-Hodgkin lymphoma. This subtype of lymphoma has a post-germinal center cell-of-origin called the plasmablast, and the immunophenotype is more consistent with that of a plasma cell than a lymphocyte. Because of these unique features, PBL is notoriously difficult to treat. Case reports and small reviews have evaluated the addition of agents directed against plasma cell disorders in combination with traditional lymphoma-directed regimens. We describe the largest case series to date, with the longest follow-up, evaluating bortezomib in combination with etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (V-EPOCH) for the treatment of PBL. Our results show that this is a safe and effective regimen with an overall and complete response rate of 100% and 2-year overall survival of 50%.
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Affiliation(s)
- Christopher Dittus
- a Division of Hematology and Oncology Medicine , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Natalie Grover
- b Division of Hematology and Oncology Medicine , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Steven Ellsworth
- c Division of Pathology and Cytopathology , Louisiana State University , Shreveport , LA , USA
| | - Xianming Tan
- d Lineberger Comprehensive Cancer Center , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Steven I Park
- e Levine Cancer Institute, Carolinas Healthcare System , Charlotte , NC , USA
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