151
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Dinner S, Gurbuxani S, Jain N, Stock W. Acute Lymphoblastic Leukemia in Adults. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00066-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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152
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Kanakry JA, Ambinder RF. Virus-Associated Lymphoma. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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153
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Khan A, Brahim A, Ruiz M, Nagovski N. Relapsed/refractory Burkitt lymphoma and HIV infection. Int J STD AIDS 2017; 29:695-703. [PMID: 29264956 DOI: 10.1177/0956462417748239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The care of patients with HIV and Burkitt lymphoma poses a challenge to clinicians. Due to the limited treatment options that exist for relapsed/refractory Burkitt lymphoma, there is a need for the development of new therapies. This review aims to discuss evidence for current management strategies including chemotherapy and stem cell transplant, and highlight gaps in knowledge that will need to be addressed in the future.
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Affiliation(s)
- Alina Khan
- Memorial Cancer Institute, Memorial Hospital West, Pembroke Pines, FL, USA
| | - Amanda Brahim
- Memorial Cancer Institute, Memorial Hospital West, Pembroke Pines, FL, USA
| | - Marco Ruiz
- Memorial Cancer Institute, Memorial Hospital West, Pembroke Pines, FL, USA
| | - Neil Nagovski
- Memorial Cancer Institute, Memorial Hospital West, Pembroke Pines, FL, USA
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154
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Rezahosseini O, Hanaei S, Hamadani M, Keshavarz-Fathi M, Rezaei N. The promising role of monoclonal antibodies for immunotherapy of the HIV-associated cancer, non-Hodgkin lymphoma. Int Rev Immunol 2017; 37:165-173. [PMID: 29257907 DOI: 10.1080/08830185.2017.1405396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Association between HIV/AIDS and some of the cancers such as lymphomais is well known. Relative risk for developing non-Hodgkin lymphoma (NHL) increases 60-200 folds in HIV-infected individuals. Diffuse large B cell lymphoma (DLBCL), primary effusion lymphoma (PEL), Burkitt's lymphoma (BL) and Plasmablastic Lymphoma (PBL) are among the most frequent subtypes. During the last century, scientists found that the immune system could potentially detect and destroy cancer cells. Therefore, they started a new field of study, which is named immunotherapy. There are different immunotherapeutic methods, among which therapeutic antibodies, such as Brentuximabvedotin (Adcetris), Ibritumomabtiuxetan (Zevalin) and rituximab (Rituxan), used for treatment of NHLs showed promising results. In this article, we will review the immunotherapeutic option, monoclonal antibodies, for treatment of HIV-associated NHLs as well as their recent clinical status. We will also discuss the selective monoclonal antibody for each subtype of NHLs.
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Affiliation(s)
- Omid Rezahosseini
- a Cancer Immunology Project (CIP) , Universal Scientific Education and Research Network (USERN) , Tehran , Iran.,b Department of Infectious and Tropical diseases , Imam Khomeini Hospital Complex, Tehran University of Medical Sciences , Tehran , Iran
| | - Sara Hanaei
- a Cancer Immunology Project (CIP) , Universal Scientific Education and Research Network (USERN) , Tehran , Iran.,c Research Center for Immunodeficiencies , Children's Medical Center, Tehran University of Medical Sciences , Tehran , Iran.,d School of Medicine , Tehran University of Medical Sciences , Tehran , Iran
| | - Mehdi Hamadani
- e Division of Hematology & Oncology , Medical College of Wisconsin , Milwaukee , WI , USA.,f Cancer Immunology Project (CIP) , Universal Scientific Education and Research Network (USERN) , Milwaukee , WI , USA
| | - Mahsa Keshavarz-Fathi
- a Cancer Immunology Project (CIP) , Universal Scientific Education and Research Network (USERN) , Tehran , Iran.,c Research Center for Immunodeficiencies , Children's Medical Center, Tehran University of Medical Sciences , Tehran , Iran.,d School of Medicine , Tehran University of Medical Sciences , Tehran , Iran.,g Students' Scientific Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Nima Rezaei
- c Research Center for Immunodeficiencies , Children's Medical Center, Tehran University of Medical Sciences , Tehran , Iran.,h Department of Immunology, School of Medicine , Tehran University of Medical Sciences , Tehran , Iran.,i Cancer Immunology Project (CIP) , Universal Scientific Education and Research Network (USERN) , Sheffield , UK
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155
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Treatment of sporadic Burkitt lymphoma in adults, a retrospective comparison of four treatment regimens. Ann Hematol 2017; 97:255-266. [PMID: 29209924 PMCID: PMC5754407 DOI: 10.1007/s00277-017-3167-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/03/2017] [Indexed: 11/25/2022]
Abstract
Burkitt lymphoma is an aggressive B cell malignancy accounting for 1–2% of all adult lymphomas. Treatment with dose-intensive, multi-agent chemotherapy is effective but associated with considerable toxicity. In this observational study, we compared real-world efficacy, toxicity, and costs of four frequently employed treatment strategies for Burkitt lymphoma: the Lymphome Malins B (LMB), the Berlin-Frankfurt-Münster (BFM), the HOVON, and the CODOX-M/IVAC regimens. We collected data from 147 adult patients treated in eight referral centers. Following central pathology assessment, 105 of these cases were accepted as Burkitt lymphoma, resulting in the following treatment groups: LMB 36 patients, BFM 19 patients, HOVON 29 patients, and CODOX-M/IVAC 21 patients (median age 39 years, range 14–74; mean duration of follow-up 47 months). There was no significant difference between age, sex ratio, disease stage, or percentage HIV-positive patients between the treatment groups. Five-year progression-free survival (69%, p = 0.966) and 5-year overall survival (69%, p = 0.981) were comparable for all treatment groups. Treatment-related toxicity was also comparable with only hepatotoxicity seen more frequently in the CODOX/M-IVAC group (p = 0.004). Costs were determined by the number of rituximab gifts and the number of inpatients days. Overall, CODOX-M/IVAC had the most beneficial profile with regards to costs, treatment duration, and percentage of patients completing planned treatment. We conclude that the four treatment protocols for Burkitt lymphoma yield nearly identical results with regards to efficacy and safety but differ in treatment duration and costs. These differences may help guide future choice of treatment.
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156
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Chen AI, Leonard JT, Okada CY, Gay ND, Chansky K, Fan G, Dunlap JB, Raess PW, Braziel RM, Stentz A, Maziarz RT. Outcomes of DA-EPOCH-R induction plus autologous transplant consolidation for double hit lymphoma. Leuk Lymphoma 2017; 59:1884-1889. [PMID: 29199519 DOI: 10.1080/10428194.2017.1406085] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
High-grade B cell lymphoma with MYC and BCL2 rearrangements (double hit) has a poor prognosis with standard R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). We report here a treatment algorithm of DA-EPOCH-R (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, rituximab) followed by BEAM (carmustine, etoposide, cytarabine, melphalan) autologous transplant in 36 cases of previously untreated double hit lymphoma (DHL) from 2010 to 2015. A high risk International Prognostic Index (IPI) was present in 42% of cases. At median follow-up of 38 months, the 2-year progression free survival (PFS) and overall survival (OS) were 69% (95% CI 54-84%) and 71% (95% CI 56-86%). Eight cases were refractory to induction with 1-year OS 20%, and no factors were predictive for primary refractory disease. Of 28 responders, 17 proceeded to transplant while 11 were observed, primarily due to age and co-morbidities. By 24-week landmark analysis after diagnosis, the 2-year PFS and OS were both 94% (95% CI 83-100%) vs 79% (95% CI 52-100%) for transplant vs observation (p = .59 for both PFS and OS). There was no significant benefit to consolidative transplant in our series, and primary refractory DHL needs novel approaches.
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Affiliation(s)
- Andy I Chen
- a Center for Hematologic Malignancies, Oregon Health & Science University , Portland , OR , USA
| | - Jessica T Leonard
- a Center for Hematologic Malignancies, Oregon Health & Science University , Portland , OR , USA
| | - Craig Y Okada
- a Center for Hematologic Malignancies, Oregon Health & Science University , Portland , OR , USA
| | - Nathan D Gay
- a Center for Hematologic Malignancies, Oregon Health & Science University , Portland , OR , USA
| | - Kari Chansky
- a Center for Hematologic Malignancies, Oregon Health & Science University , Portland , OR , USA.,b Cancer Research and Biostatistics , Seattle , WA , USA
| | - Guang Fan
- a Center for Hematologic Malignancies, Oregon Health & Science University , Portland , OR , USA.,c Department of Pathology , Oregon Health & Science University , Portland , OR , USA
| | - Jennifer B Dunlap
- a Center for Hematologic Malignancies, Oregon Health & Science University , Portland , OR , USA.,c Department of Pathology , Oregon Health & Science University , Portland , OR , USA
| | - Philipp W Raess
- a Center for Hematologic Malignancies, Oregon Health & Science University , Portland , OR , USA.,c Department of Pathology , Oregon Health & Science University , Portland , OR , USA
| | - Rita M Braziel
- a Center for Hematologic Malignancies, Oregon Health & Science University , Portland , OR , USA.,c Department of Pathology , Oregon Health & Science University , Portland , OR , USA
| | - Alex Stentz
- a Center for Hematologic Malignancies, Oregon Health & Science University , Portland , OR , USA
| | - Richard T Maziarz
- a Center for Hematologic Malignancies, Oregon Health & Science University , Portland , OR , USA
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157
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Rogers KA, Huang Y, Ruppert AS, Salem G, Stephens DM, Heerema NA, Andritsos LA, Awan FT, Byrd JC, Flynn JM, Maddocks KJ, Jones JA. A single-institution retrospective cohort study of first-line R-EPOCH chemoimmunotherapy for Richter syndrome demonstrating complex chronic lymphocytic leukaemia karyotype as an adverse prognostic factor. Br J Haematol 2017; 180:259-266. [PMID: 29193006 DOI: 10.1111/bjh.15035] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/26/2017] [Indexed: 01/23/2023]
Abstract
Richter Syndrome, an aggressive lymphoma occurring in patients with chronic lymphocytic leukaemia (CLL), has a generally poor prognosis and anthracycline-based chemoimmunotherapy regimens designed to treat de novo diffuse large B-cell lymphoma achieve modest clinical benefit. R-EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) has demonstrated greater activity against aggressive B-cell histologies but has not been studied in Richter Syndrome. We conducted a retrospective cohort study of 46 Richter Syndrome patients treated with first-line R-EPOCH at our institution between 1 January 2006 and 31 May 2014. The median progression-free survival (PFS) was 3·5 months [95% confidence interval (CI): 2·0-7·6] and median overall survival (OS) was 5·9 months (95% CI: 3·2-10·3). Toxicity was high and 30% of patients died without progression or response. Patients with a complex CLL karyotype had significantly shorter PFS and OS (P = 0·005 and P = 0·002, respectively). Multivariable analysis identified complex CLL karyotype as the most significant predictor of decreased survival [Hazard ratio (HR) 2·72, 95% CI: 1·14-6·52, P = 0·025], adjusting for number of prior CLL treatments (P = 0·036). Richter Syndrome patients with complex CLL karyotype experience poor survival with R-EPOCH treatment and novel approaches are needed for these patients. In contrast, survival of patients without a complex CLL karyotype was similar to patients with de novo diffuse large B-cell lymphoma.
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Affiliation(s)
- Kerry A Rogers
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Ying Huang
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Amy S Ruppert
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Galena Salem
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | | | - Nyla A Heerema
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | | | - Farrukh T Awan
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - John C Byrd
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Joseph M Flynn
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Kami J Maddocks
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Jeffrey A Jones
- Division of Hematology, The Ohio State University, Columbus, OH, USA
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158
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Uldrick TS, Ison G, Rudek MA, Noy A, Schwartz K, Bruinooge S, Schenkel C, Miller B, Dunleavy K, Wang J, Zeldis J, Little RF. Modernizing Clinical Trial Eligibility Criteria: Recommendations of the American Society of Clinical Oncology-Friends of Cancer Research HIV Working Group. J Clin Oncol 2017; 35:3774-3780. [PMID: 28968173 PMCID: PMC5793223 DOI: 10.1200/jco.2017.73.7338] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose People with HIV are living longer as a result of effective antiretroviral therapy. Cancer has become a leading cause of morbidity and mortality in this patient population. However, studies of novel cancer therapeutics have historically excluded patients with HIV. Critical review of eligibility criteria related to HIV is required to accelerate development of and access to effective therapeutics for HIV-infected patients with cancer and make studies more generalizable to this patient population. Methods From January through April 2016, the HIV Working Group conducted a series of teleconferences; a review of 46 New Drug Applications from registration studies of unique agents studied in adults with cancer that led to the initial US Food and Drug Administration approval of that agent from 2011 to 2015; and a review of HIV-related eligibility criteria from National Cancer Institute-sponsored studies. Results were discussed and refined at a multistakeholder workshop held May 12, 2016. The HIV Working Group developed recommendations for eligibility criteria that focus on pharmacologic and immunologic considerations in this patient population and that balance patient safety, access to appropriate investigational agents, and study integrity. Results Exclusion of patients with HIV remains common in most studies of novel cancer agents. Models for HIV-related eligibility criteria in National Cancer Institute-sponsored studies are instructive. HIV infection itself should no longer be an exclusion criterion for most studies. Eligibility criteria related to HIV infection that address concurrent antiretroviral therapy and immune status should be designed in a manner that is appropriate for a given cancer. Conclusion Expanding clinical trial eligibility to be more inclusive of patients with HIV is justified in most cases and may accelerate the development of effective therapies in this area of unmet clinical need.
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Affiliation(s)
- Thomas S Uldrick
- Thomas S. Uldrick and Richard F. Little, National Cancer Institute, Bethesda; Gwynn Ison and Barry Miller, US Food and Drug Administration, Silver Spring; Michelle A. Rudek, Johns Hopkins University, Baltimore, MD; Ariela Noy, Memorial Sloan Kettering Cancer Center and Weill Medical College, New York, NY; Karl Schwartz, Patients Against Lymphoma, Riegelsville, PA; Suanna Bruinooge and Caroline Schenkel, ASCO, Alexandria, VA; Kieron Dunleavy, George Washington University, Washington, DC; Judy Wang, Florida Cancer Specialists and Research Institute, Sarasota, FL; and Jerome Zeldis, Sorrento Therapeutics, San Diego, CA
| | - Gwynn Ison
- Thomas S. Uldrick and Richard F. Little, National Cancer Institute, Bethesda; Gwynn Ison and Barry Miller, US Food and Drug Administration, Silver Spring; Michelle A. Rudek, Johns Hopkins University, Baltimore, MD; Ariela Noy, Memorial Sloan Kettering Cancer Center and Weill Medical College, New York, NY; Karl Schwartz, Patients Against Lymphoma, Riegelsville, PA; Suanna Bruinooge and Caroline Schenkel, ASCO, Alexandria, VA; Kieron Dunleavy, George Washington University, Washington, DC; Judy Wang, Florida Cancer Specialists and Research Institute, Sarasota, FL; and Jerome Zeldis, Sorrento Therapeutics, San Diego, CA
| | - Michelle A Rudek
- Thomas S. Uldrick and Richard F. Little, National Cancer Institute, Bethesda; Gwynn Ison and Barry Miller, US Food and Drug Administration, Silver Spring; Michelle A. Rudek, Johns Hopkins University, Baltimore, MD; Ariela Noy, Memorial Sloan Kettering Cancer Center and Weill Medical College, New York, NY; Karl Schwartz, Patients Against Lymphoma, Riegelsville, PA; Suanna Bruinooge and Caroline Schenkel, ASCO, Alexandria, VA; Kieron Dunleavy, George Washington University, Washington, DC; Judy Wang, Florida Cancer Specialists and Research Institute, Sarasota, FL; and Jerome Zeldis, Sorrento Therapeutics, San Diego, CA
| | - Ariela Noy
- Thomas S. Uldrick and Richard F. Little, National Cancer Institute, Bethesda; Gwynn Ison and Barry Miller, US Food and Drug Administration, Silver Spring; Michelle A. Rudek, Johns Hopkins University, Baltimore, MD; Ariela Noy, Memorial Sloan Kettering Cancer Center and Weill Medical College, New York, NY; Karl Schwartz, Patients Against Lymphoma, Riegelsville, PA; Suanna Bruinooge and Caroline Schenkel, ASCO, Alexandria, VA; Kieron Dunleavy, George Washington University, Washington, DC; Judy Wang, Florida Cancer Specialists and Research Institute, Sarasota, FL; and Jerome Zeldis, Sorrento Therapeutics, San Diego, CA
| | - Karl Schwartz
- Thomas S. Uldrick and Richard F. Little, National Cancer Institute, Bethesda; Gwynn Ison and Barry Miller, US Food and Drug Administration, Silver Spring; Michelle A. Rudek, Johns Hopkins University, Baltimore, MD; Ariela Noy, Memorial Sloan Kettering Cancer Center and Weill Medical College, New York, NY; Karl Schwartz, Patients Against Lymphoma, Riegelsville, PA; Suanna Bruinooge and Caroline Schenkel, ASCO, Alexandria, VA; Kieron Dunleavy, George Washington University, Washington, DC; Judy Wang, Florida Cancer Specialists and Research Institute, Sarasota, FL; and Jerome Zeldis, Sorrento Therapeutics, San Diego, CA
| | - Suanna Bruinooge
- Thomas S. Uldrick and Richard F. Little, National Cancer Institute, Bethesda; Gwynn Ison and Barry Miller, US Food and Drug Administration, Silver Spring; Michelle A. Rudek, Johns Hopkins University, Baltimore, MD; Ariela Noy, Memorial Sloan Kettering Cancer Center and Weill Medical College, New York, NY; Karl Schwartz, Patients Against Lymphoma, Riegelsville, PA; Suanna Bruinooge and Caroline Schenkel, ASCO, Alexandria, VA; Kieron Dunleavy, George Washington University, Washington, DC; Judy Wang, Florida Cancer Specialists and Research Institute, Sarasota, FL; and Jerome Zeldis, Sorrento Therapeutics, San Diego, CA
| | - Caroline Schenkel
- Thomas S. Uldrick and Richard F. Little, National Cancer Institute, Bethesda; Gwynn Ison and Barry Miller, US Food and Drug Administration, Silver Spring; Michelle A. Rudek, Johns Hopkins University, Baltimore, MD; Ariela Noy, Memorial Sloan Kettering Cancer Center and Weill Medical College, New York, NY; Karl Schwartz, Patients Against Lymphoma, Riegelsville, PA; Suanna Bruinooge and Caroline Schenkel, ASCO, Alexandria, VA; Kieron Dunleavy, George Washington University, Washington, DC; Judy Wang, Florida Cancer Specialists and Research Institute, Sarasota, FL; and Jerome Zeldis, Sorrento Therapeutics, San Diego, CA
| | - Barry Miller
- Thomas S. Uldrick and Richard F. Little, National Cancer Institute, Bethesda; Gwynn Ison and Barry Miller, US Food and Drug Administration, Silver Spring; Michelle A. Rudek, Johns Hopkins University, Baltimore, MD; Ariela Noy, Memorial Sloan Kettering Cancer Center and Weill Medical College, New York, NY; Karl Schwartz, Patients Against Lymphoma, Riegelsville, PA; Suanna Bruinooge and Caroline Schenkel, ASCO, Alexandria, VA; Kieron Dunleavy, George Washington University, Washington, DC; Judy Wang, Florida Cancer Specialists and Research Institute, Sarasota, FL; and Jerome Zeldis, Sorrento Therapeutics, San Diego, CA
| | - Kieron Dunleavy
- Thomas S. Uldrick and Richard F. Little, National Cancer Institute, Bethesda; Gwynn Ison and Barry Miller, US Food and Drug Administration, Silver Spring; Michelle A. Rudek, Johns Hopkins University, Baltimore, MD; Ariela Noy, Memorial Sloan Kettering Cancer Center and Weill Medical College, New York, NY; Karl Schwartz, Patients Against Lymphoma, Riegelsville, PA; Suanna Bruinooge and Caroline Schenkel, ASCO, Alexandria, VA; Kieron Dunleavy, George Washington University, Washington, DC; Judy Wang, Florida Cancer Specialists and Research Institute, Sarasota, FL; and Jerome Zeldis, Sorrento Therapeutics, San Diego, CA
| | - Judy Wang
- Thomas S. Uldrick and Richard F. Little, National Cancer Institute, Bethesda; Gwynn Ison and Barry Miller, US Food and Drug Administration, Silver Spring; Michelle A. Rudek, Johns Hopkins University, Baltimore, MD; Ariela Noy, Memorial Sloan Kettering Cancer Center and Weill Medical College, New York, NY; Karl Schwartz, Patients Against Lymphoma, Riegelsville, PA; Suanna Bruinooge and Caroline Schenkel, ASCO, Alexandria, VA; Kieron Dunleavy, George Washington University, Washington, DC; Judy Wang, Florida Cancer Specialists and Research Institute, Sarasota, FL; and Jerome Zeldis, Sorrento Therapeutics, San Diego, CA
| | - Jerome Zeldis
- Thomas S. Uldrick and Richard F. Little, National Cancer Institute, Bethesda; Gwynn Ison and Barry Miller, US Food and Drug Administration, Silver Spring; Michelle A. Rudek, Johns Hopkins University, Baltimore, MD; Ariela Noy, Memorial Sloan Kettering Cancer Center and Weill Medical College, New York, NY; Karl Schwartz, Patients Against Lymphoma, Riegelsville, PA; Suanna Bruinooge and Caroline Schenkel, ASCO, Alexandria, VA; Kieron Dunleavy, George Washington University, Washington, DC; Judy Wang, Florida Cancer Specialists and Research Institute, Sarasota, FL; and Jerome Zeldis, Sorrento Therapeutics, San Diego, CA
| | - Richard F Little
- Thomas S. Uldrick and Richard F. Little, National Cancer Institute, Bethesda; Gwynn Ison and Barry Miller, US Food and Drug Administration, Silver Spring; Michelle A. Rudek, Johns Hopkins University, Baltimore, MD; Ariela Noy, Memorial Sloan Kettering Cancer Center and Weill Medical College, New York, NY; Karl Schwartz, Patients Against Lymphoma, Riegelsville, PA; Suanna Bruinooge and Caroline Schenkel, ASCO, Alexandria, VA; Kieron Dunleavy, George Washington University, Washington, DC; Judy Wang, Florida Cancer Specialists and Research Institute, Sarasota, FL; and Jerome Zeldis, Sorrento Therapeutics, San Diego, CA
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Ganesan P, Ganesan TS, Atreya H, Kannan K, Radhakrishnan V, Dhanushkodi M, Joshua TLA, Sundersingh S, Sagar TG. DA-EPOCH-R in Aggressive CD 20 Positive B Cell Lymphomas: Real-World Experience. Indian J Hematol Blood Transfus 2017; 34:454-459. [PMID: 30127552 DOI: 10.1007/s12288-017-0901-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/30/2017] [Indexed: 02/04/2023] Open
Abstract
Recent reports have shown that excellent survival outcomes can be achieved in adult Burkitt's lymphoma with the use of DA-EPOCH-R regimen. When compared to earlier intense pediatric-type protocols, this regimen is less toxic. There are limited reports available on the use of this regimen outside the context of clinical trials. We analyzed the outcomes of patients who were treated with the DA-EPOCH-R regimen [Burkitt's lymphoma (BL), primary mediastinal B cell lymphoma (PMBCL) and HIV-positive patients with diffuse large B cell lymphoma (DLBCL)] at our center over a 3 year period. Baseline characters, responses, and toxicity data was captured from records. Event-free survival (EFS-from therapy initiation till occurrence of event (non-achievement of complete response or relapse) and overall survival (OS-from therapy initiation till death due to any cause) were estimated using Kaplan-Meier method. Among 41 patients [median age 40 years (18-76)], the following diagnoses were included-HIV negative patients (N = 29): BL (N = 24), PMBCL (N = 5); HIV positive patients (N = 12): BL (N = 8), and DLBCL (N = 4). Among those with BL, majority had stage III/IV disease (N = 21/32, 65%). At the completion of planned therapy, 33 had achieved CR (81%). One patient died due to toxicity. The actuarial EFS and OS at 2 years were 80 and 77% respectively for all patients. The OS at 2 years was 100% for PMBCL, 80% for BL and 50% for HIV-positive DLBCL. Majority of the failures in BL were in patients with advanced disease. DA-EPOCH-R can be used in real-world setting and allows treatment of older patients with BL.
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Affiliation(s)
- Prasanth Ganesan
- 1Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, 600020 India
| | - Trivadi S Ganesan
- 1Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, 600020 India
| | - Harshvardhan Atreya
- 1Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, 600020 India
| | | | | | | | | | - Shirley Sundersingh
- 2Department of Pathology, Cancer Institute (WIA), Chennai, Tamilnadu 600020 India
| | - Tenali Gnana Sagar
- 1Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, 600020 India
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160
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Adolescent and young adult lymphoma: collaborative efforts toward optimizing care and improving outcomes. Blood Adv 2017; 1:1945-1958. [PMID: 29296842 DOI: 10.1182/bloodadvances.2017008748] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/12/2017] [Indexed: 01/10/2023] Open
Abstract
Lymphomas are responsible for approximately 20% to 25% of annual cancer diagnoses in the adolescent and young adult (AYA) population. In 2006, the National Cancer Institute and the Lance Armstrong Foundation developed a joint Adolescent and Young Adult Oncology Progress Review Group (AYAO-PRG) to formally address the unique cancer burden of patients age 15 to 39 years. As part of their recommendations, the AYAO-PRG identified 5 imperatives for improving outcomes of AYAs with cancer. Broadly, the recommended areas of focus included research, awareness and education, investigational infrastructure, care delivery, and advocacy. In response to the challenges highlighted by the AYAO-PRG, the Lymphoma Research Foundation held the first AYA Lymphoma Research Foundation Symposium on 2 October 2015. At this symposium, clinicians and basic scientists from both pediatric and adult disciplines gave presentations describing the state of the science and proposed a collaborative research agenda built on the imperatives proposed by the AYAO-PRG. The following review presents an in-depth discussion of lymphoma management across pediatric and adult oncologic disciplines, focusing on Hodgkin lymphoma, mature B-cell lymphomas, and anaplastic large cell lymphoma.
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161
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Maeda Y, Nishimori H, Yoshida I, Hiramatsu Y, Uno M, Masaki Y, Sunami K, Masunari T, Nawa Y, Yamane H, Gomyo H, Takahashi T, Yano T, Matsuo K, Ohshima K, Nakamura S, Yoshino T, Tanimoto M. Dose-adjusted EPOCH chemotherapy for untreated peripheral T-cell lymphomas: a multicenter phase II trial of West-JHOG PTCL0707. Haematologica 2017; 102:2097-2103. [PMID: 28971899 PMCID: PMC5709109 DOI: 10.3324/haematol.2017.167742] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 09/20/2017] [Indexed: 01/20/2023] Open
Abstract
The standard CHOP therapy for peripheral T-cell lymphoma has resulted in unsatisfactory outcomes and it is still not clear what is the optimal front-line therapy. We conducted a multicenter phase II study of dose-adjusted etoposide, doxorubicin, and cyclophosphamide with vincristine and prednisone (EPOCH) for untreated peripheral T-cell lymphoma patients. In this prospective study, 41 patients were treated with dose-adjusted-EPOCH as initial therapy: peripheral T-cell lymphoma-not otherwise specified, n=21; angioimmunoblastic T-cell lymphoma, n=17; anaplastic lymphoma kinase-positive anaplastic large cell lymphoma, n=2; and anaplastic lymphoma kinase-negative anaplastic large cell lymphoma, n=1. Median patient age was 64 years (range: 32–79 years). According to the International Prognostic Index criteria, 51.2% were at high-intermediate or high risk. The overall response and complete response rates were 78.0% [95% confidence interval (CI): 62.4–89.4%] and 61.0% (95%CI: 44.5–75.8%), respectively. At the median follow up of 24.0 months, the 2-year progression-free survival and overall survival were 53.3% (95%CI: 36.4–67.5%) and 73.2% (95%CI: 56.8–84.1%), respectively. The younger patients (≤ 60 years old) had a high response rate (overall response 94.1% and complete response 70.6%) and survival rate (progression-free survival 62.5% and overall survival 82.4%). The most common grade ≥ 3 adverse events were neutropenia (74.5%), anemia (40.8%), thrombocytopenia (22.0%), and febrile neutropenia (9.0%). Dose-adjusted-EPOCH had a high response rate with a tolerable toxicity profile. Our results indicate that dose-adjusted-EPOCH is a reasonable first-line approach for peripheral T-cell lymphoma patients and may improve outcomes.
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Affiliation(s)
- Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | - Hisakazu Nishimori
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | - Isao Yoshida
- Department of Hematologic Oncology, Shikoku Cancer Center, Ehime, Japan
| | - Yasushi Hiramatsu
- Department of Hematology and Oncology, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan
| | - Masatoshi Uno
- Department of Internal Medicine, Kaneda Hospital, Okayama, Japan
| | - Yasufumi Masaki
- Department of Hematology and Immunology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Kazutaka Sunami
- Department of Hematology, National Hospital Organization Okayama Medical Center, Japan
| | - Taro Masunari
- Department of Hematology, Chugoku Central Hospital, Hiroshima, Japan
| | - Yuichiro Nawa
- Department of Hematology, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Hiromichi Yamane
- Department of Internal Medicine, Sumitomo Besshi Hospital, Ehime, Japan
| | - Hiroshi Gomyo
- Department of Hematology, Hyogo Cancer Center, Hyogo, Japan
| | - Tsutomu Takahashi
- Department of Hematology and Oncology, Shimane University Hospital, Japan
| | - Tomofumi Yano
- Department of Hematology, Okayama Rosai Hospital, Nagoya, Japan
| | - Keitaro Matsuo
- Division of Molecular and Clinical Epidemiology, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Koichi Ohshima
- Department of Pathology, School of Medicine, Kurume University, Fukuoka, Japan
| | - Shigeo Nakamura
- Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Mitsune Tanimoto
- Department of Hematology and Oncology, Okayama University Hospital, Japan
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162
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Weagel EG, Meng W, Townsend MH, Velazquez EJ, Brog RA, Boyer MW, Weber KS, Robison RA, O'Neill KL. Biomarker analysis and clinical relevance of TK1 on the cell membrane of Burkitt's lymphoma and acute lymphoblastic leukemia. Onco Targets Ther 2017; 10:4355-4367. [PMID: 28919785 PMCID: PMC5593407 DOI: 10.2147/ott.s141239] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
TK1 is an enzyme involved in DNA synthesis and repair. TK1 is usually found elevated in cancer patients’ serum, which makes it a useful tumor proliferation biomarker that strongly correlates with cancer stage, metastatic capabilities, and recurrence risk. In this study, we show that TK1 is upregulated and localizes on the plasma membrane of Burkitt’s lymphoma, acute promyelocytic leukemia, T cell leukemia, and acute lymphoblastic leukemia (ALL). Using flow cytometry, we confirmed that TK1 localizes on the surface of Raji, HL60, and Jurkat cell lines and on ALL clinical samples. Using fluorescent microscopy, we found a strong association of TK1 with the plasma membrane in Raji, HL60, and Jurkat cell lines. These findings were also confirmed by scanning electron microscopy. Our study also shows that this phenomenon does not occur on normal resting or proliferating lymphocytes. In addition, we show that membrane TK1 is found in all oligomeric forms ranging from monomer to tetramer and exhibits enzymatic activity. These findings suggest TK1 as a possible target for immunotherapy with the potential to be utilized in the treatment of hematological cancers.
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Affiliation(s)
- Evita G Weagel
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo
| | - Wei Meng
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo
| | - Michelle H Townsend
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo
| | - Edwin J Velazquez
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo
| | - Rachel A Brog
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo
| | - Michael W Boyer
- Division of Hematology and Hematologic Malignancies, Department of Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - K Scott Weber
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo
| | - Richard A Robison
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo
| | - Kim L O'Neill
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo
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163
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Ayoub F, Forde JJ, Patel N, Markham M. Primary gastric Burkitt lymphoma: a rare cause of life-threatening haematemesis. BMJ Case Rep 2017; 2017:bcr-2017-220313. [PMID: 28830898 DOI: 10.1136/bcr-2017-220313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lymphomas are the second most common gastric malignancy following gastric adenocarcinoma. The majority of gastric lymphomas are either mucosa-associated lymphoid tissue lymphomas or diffuse large B-cell lymphomas. Primary gastric Burkitt lymphoma is a subtype of non-Hodgkin's lymphoma and represents an aggressive and rare malignancy with only a small number of cases reported worldwide. Clinical and radiological presentation is non-specific and mimics other gastric lymphomas. Diagnosis is established with pathological evaluation. Due to the paucity of cases, treatment of this condition is not well studied and is extrapolated from paediatric and adult literature of Burkitt lymphoma not isolated to the stomach. We present the case of a male patient with primary gastric Burkitt lymphoma who initially presented with life-threatening haematemesis, later achieving complete remission with treatment. We discuss the epidemiology, presentation and management of gastric Burkitt lymphoma.
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Affiliation(s)
- Fares Ayoub
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Justin J Forde
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Niraj Patel
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Merry Markham
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, Florida, USA
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164
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Abstract
PURPOSE OF REVIEW The era of modern HIV therapeutics is well underway. The cancer and infectious disease epidemiology of HIV disease has markedly altered as populations are availed to the benefits of antiretroviral therapy (ARV). The types of cancers occurring among those with HIV infection has broadened but the case burden in absolute numbers is very low relative to the background population. There are fewer incident cases of the AIDS-defining cancers (aggressive B-cell lymphomas, Kaposi's sarcoma, and cervical cancer). There is an increased risk for certain non-AIDS-defining cancers, but these occur somewhat sporadically relative to clinical trial enrollment. The changing epidemiology of cancer in HIV poses challenges as well as opportunities for participation of persons with HIV in cancer therapy clinical trials. RECENT FINDINGS There are excellent examples of cancer trials that inform cancer therapy for patients with HIV infection. Examples include those from HIV-specific trials and from trials mainly focused on the background population that included patients with HIV infection. SUMMARY Interpretation of clinical trials to guide therapy for those with HIV infection and cancer largely depends on data that does not include HIV-infected patients. The ability to extend clinical trial findings to populations not included in clinical trials remains problematic for a variety of populations, including those with HIV or AIDS. Careful prioritization of studies designed to bridge this gap is needed. However, there are published studies that serve as excellent examples bridging these gaps and the portfolio of cancer therapy trials underway will inform HIV and cancer better than at any time in the past.
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165
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Adult high-grade B-cell lymphoma with Burkitt lymphoma signature: genomic features and potential therapeutic targets. Blood 2017; 130:1819-1831. [PMID: 28801451 DOI: 10.1182/blood-2017-02-767335] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/22/2017] [Indexed: 12/15/2022] Open
Abstract
The adult high-grade B-cell lymphomas sharing molecular features with Burkitt lymphoma (BL) are highly aggressive lymphomas with poor clinical outcome. High-resolution structural and functional genomic analysis of adult Burkitt lymphoma (BL) and high-grade B-cell lymphoma with BL gene signature (adult-molecularly defined BL [mBL]) revealed the MYC-ARF-p53 axis as the primary deregulated pathway. Adult-mBL had either unique or more frequent genomic aberrations (del13q14, del17p, gain8q24, and gain18q21) compared with pediatric-mBL, but shared commonly mutated genes. Mutations in genes promoting the tonic B-cell receptor (BCR)→PI3K pathway (TCF3 and ID3) did not differ by age, whereas effectors of chronic BCR→NF-κB signaling were associated with adult-mBL. A subset of adult-mBL had BCL2 translocation and mutation and elevated BCL2 mRNA and protein expression, but had a mutation profile similar to mBL. These double-hit lymphomas may have arisen from a tumor precursor that acquired both BCL2 and MYC translocations and/or KMT2D (MLL2) mutation. Gain/amplification of MIR17HG and its paralogue loci was observed in 50% of adult-mBL. In vitro studies suggested miR-17∼92's role in constitutive activation of BCR signaling and sensitivity to ibrutinib. Overall integrative analysis identified an interrelated gene network affected by copy number and mutation, leading to disruption of the p53 pathway and the BCR→PI3K or NF-κB activation, which can be further exploited in vivo by small-molecule inhibitors for effective therapy in adult-mBL.
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166
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Martijn HA, Njuguna F, Olbara G, Langat S, Skiles J, Martin S, Vik T, van de Ven PM, Kaspers GJ, Mostert S. Influence of health insurance status on paediatric non-Hodgkin's lymphoma treatment in Kenya. BMJ Paediatr Open 2017; 1:e000149. [PMID: 29637157 PMCID: PMC5862191 DOI: 10.1136/bmjpo-2017-000149] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Non-Hodgkin's lymphoma (NHL) is the most common childhood malignancy in sub-Saharan Africa. Survival rates for NHL are higher than 80% in high-income countries.This study explores treatment outcomes of children with NHL in Kenya, a sub-Saharan low-income country, and the association between health insurance status at diagnosis and treatment outcomes. DESIGN This was a retrospective medical records study. All children diagnosed with NHL in 2010, 2011 and 2012 were included. Data on treatment outcomes and health insurance status at diagnosis were collected. RESULTS Of all 63 patients with NHL, 35% abandoned treatment, 22% had progressive or relapsed disease, 14% died and 29% had event-free survival. Most patients (73%) had no health insurance at diagnosis. Treatment outcomes in children with or without health insurance at diagnosis differed significantly (p=0.005). The most likely treatment outcome in children with health insurance at diagnosis was event-free survival (53%), whereas in children without health insurance at diagnosis it was abandonment of treatment (44%). Crude HR for treatment failure was 3.1 (95% CI 1.41 to 6.60, p=0.005) for uninsured versus insured children. The event-free survival estimate was significantly higher in children with health insurance at diagnosis than in patients without health insurance at diagnosis (p=0.003). Stage of disease at diagnosis was identified as a confounder of this association (adjusted HR=2.4, 95% CI 0.95 to 6.12, p=0.063). CONCLUSIONS Survival of children with NHL in Kenya is much lower compared with high-income countries. Abandonment of treatment is the most common cause of treatment failure. Health insurance at diagnosis was associated with better treatment outcomes and survival.
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Affiliation(s)
- Hugo A Martijn
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Gilbert Olbara
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Sandra Langat
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Jodi Skiles
- Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Stephen Martin
- Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Terry Vik
- Department of Pediatrics, Division of Hemato-Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Gertjan Jl Kaspers
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Saskia Mostert
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands
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167
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Kwok M, Wu SP, Mo C, Summers T, Roschewski M. Circulating Tumor DNA to Monitor Therapy for Aggressive B-Cell Lymphomas. Curr Treat Options Oncol 2017; 17:47. [PMID: 27461036 DOI: 10.1007/s11864-016-0425-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OPINION STATEMENT The goal of therapy for aggressive B-cell lymphomas such as diffuse large B-cell lymphoma (DLBCL) and Burkitt lymphoma (BL) is to achieve cure. Combination chemotherapy with rituximab cures most patients, but those with recurrent disease have a poor prognosis. Medical imaging scans such as computed tomography (CT) and positron emission tomography (PET) are the principal methods to assess response and monitor for disease relapse after therapy but are fundamentally limited by risks of radiation, cost, and a lack of tumor specificity. Novel sequencing-based DNA monitoring methods are capable of quantifying small amounts of circulating tumor DNA (ctDNA) before, during, and after therapy for mature B-cell lymphomas. Detection of ctDNA encoding clonal rearranged variable-diversity-joining (VDJ) receptor gene sequences has demonstrated improved analytical sensitivity and enhanced tumor specificity compared to imaging scans in DLBCL, offering broad clinical applicability across a range of aggressive B-cell lymphomas. Molecular monitoring of ctDNA has vaulted into the spotlight as a promising non-invasive tool with immediate clinical impact on monitoring for recurrence after therapy prior to clinical symptoms. As these clinical observations are validated, ctDNA monitoring needs to be investigated as a tool for response-adapted therapy and as a marker of minimal residual disease upon completion of therapy in aggressive B-cell lymphomas. Molecular monitoring of ctDNA holds tremendous promise that may ultimately transform our ability to monitor disease in aggressive B-cell lymphomas.
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MESH Headings
- Biomarkers, Tumor
- DNA, Neoplasm/blood
- DNA, Neoplasm/genetics
- Diagnostic Imaging
- Disease Progression
- Genetic Testing/methods
- Genetic Testing/standards
- Genomics/methods
- Genomics/standards
- High-Throughput Nucleotide Sequencing
- Humans
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/therapy
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/therapy
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/genetics
- Treatment Outcome
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Affiliation(s)
- Mary Kwok
- Hematology-Oncology Department, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, 4954 N. Palmer Road, Bethesda, MD, 20889, USA
| | - S Peter Wu
- Internal Medicine Department, Perlmutter Cancer Center, New York University Langone Medical Center, 560 E 34th Street, New York, NY, 10016, USA
| | - Clifton Mo
- Hematology-Oncology Department, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, 4954 N. Palmer Road, Bethesda, MD, 20889, USA
| | - Thomas Summers
- Pathology Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20895, USA
| | - Mark Roschewski
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Bldg 10, Room 4N/115, Bethesda, MD, 20892, USA.
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168
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Absalon MJ, Khoury RA, Phillips CL. Post-transplant lymphoproliferative disorder after solid-organ transplant in children. Semin Pediatr Surg 2017; 26:257-266. [PMID: 28964482 DOI: 10.1053/j.sempedsurg.2017.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The post-transplant lymphoproliferative disorders (PTLD) are a diverse group of potentially life-threatening conditions affecting organ transplant recipients. PTLD arises in the setting of an attenuated host immunologic system that is manipulated to allow a foreign graft but then fails to provide adequate immune surveillance of transformed malignant or premalignant lymphocytes. The diversity of biological behavior and clinical presentation makes for a challenging clinical situation for those involved in the care of children with PTLD occurring after solid-organ transplantation. This review details a large transplant center's multidisciplinary approach to monitoring for PTLD and systematic approach to intervention, which has been essential for early recognition and successful treatment.
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Affiliation(s)
- Michael J Absalon
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7018, Cincinnati, Ohio 45229.
| | - Ruby A Khoury
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7018, Cincinnati, Ohio 45229
| | - Christine L Phillips
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7018, Cincinnati, Ohio 45229
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169
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Armitage JO, Gascoyne RD, Lunning MA, Cavalli F. Non-Hodgkin lymphoma. Lancet 2017; 390:298-310. [PMID: 28153383 DOI: 10.1016/s0140-6736(16)32407-2] [Citation(s) in RCA: 338] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/09/2016] [Accepted: 09/22/2016] [Indexed: 12/12/2022]
Abstract
Lymphomas can affect any organ in the body, present with a wide range of symptoms, and be seen by primary care physicians and physicians from most specialties. They are traditionally divided into Hodgkin's lymphoma (which accounts for about 10% of all lymphomas) and non-Hodgkin lymphoma, which is the topic of this Seminar. Non-Hodgkin lymphoma represents a wide spectrum of illnesses that vary from the most indolent to the most aggressive malignancies. They arise from lymphocytes that are at various stages of development, and the characteristics of the specific lymphoma subtype reflect those of the cell from which they originated. Since this topic was last reviewed in The Lancet in 2012, advances in understanding the biology and genetics of non-Hodgkin lymphoma and the availability of new diagnostic methods and therapies have improved our ability to manage patients with this disorder.
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Affiliation(s)
| | - Randy D Gascoyne
- British Columbia Cancer Agency and British Columbia Cancer Research Centre, Vancouver, BC, Canada
| | | | - Franco Cavalli
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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170
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Moghaddasi M, Nabovvati M, Razmeh S. Bilateral Cavernous Sinus Thrombosis as First Manifestation of Primary Burkitt Lymphoma of the Thyroid Gland. Neurol Int 2017; 9:7133. [PMID: 28713532 PMCID: PMC5505089 DOI: 10.4081/ni.2017.7133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/19/2017] [Accepted: 05/27/2017] [Indexed: 11/23/2022] Open
Abstract
Cavernous sinus thrombosis (CST) is a rare condition that is usually associated with infections, pregnancy, vasculitis and some types of medication, such as the contraceptive pill and paraneoplastic. Primary Burkitt lymphoma (PBL) of the thyroid gland is very uncommon and the clinical description of such cases has been largely limited to case reports. In this paper, we present a case of CST as the first manifestation of PBL of the thyroid gland. To the best of our knowledge, our patient is the first case report of PBL of the thyroid gland that presents with bilateral CST.
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Affiliation(s)
| | | | - Saeed Razmeh
- Department of Neurology, Iran University of Medical Sciences, Tehran, Iran
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171
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Lai C, Roschewski M, Melani C, Pittaluga S, Shovlin M, Steinberg SM, Dunleavy K, Pack S, Jaffe ES, Wilson WH. MYC gene rearrangement in diffuse large B-cell lymphoma does not confer a worse prognosis following dose-adjusted EPOCH-R. Leuk Lymphoma 2017. [PMID: 28641474 DOI: 10.1080/10428194.2017.1339882] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Catherine Lai
- a Myeloid Malignancies Section, Hematology Branch, National Heart, Lung, and Blood Institute , National Institutes of Health , Bethesda , MD , USA
| | - Mark Roschewski
- b Lymphoid Malignancies Branch , Center for Cancer Research, National Cancer Institute , Bethesda , MD , USA
| | - Christopher Melani
- b Lymphoid Malignancies Branch , Center for Cancer Research, National Cancer Institute , Bethesda , MD , USA
| | - Stefania Pittaluga
- c Laboratory of Pathology , Clinical Center, National Cancer Institute, National Institutes of Health , Bethesda , MD , USA
| | - Margaret Shovlin
- b Lymphoid Malignancies Branch , Center for Cancer Research, National Cancer Institute , Bethesda , MD , USA
| | - Seth M Steinberg
- d Biostatistics and Data Management Section , Office of the Clinical Director, Center for Cancer Research, National Cancer Institute , Bethesda , MD , USA
| | - Kieron Dunleavy
- b Lymphoid Malignancies Branch , Center for Cancer Research, National Cancer Institute , Bethesda , MD , USA
| | - Svetlana Pack
- c Laboratory of Pathology , Clinical Center, National Cancer Institute, National Institutes of Health , Bethesda , MD , USA
| | - Elaine S Jaffe
- c Laboratory of Pathology , Clinical Center, National Cancer Institute, National Institutes of Health , Bethesda , MD , USA
| | - Wyndham H Wilson
- b Lymphoid Malignancies Branch , Center for Cancer Research, National Cancer Institute , Bethesda , MD , USA
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172
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How I treat patients with aggressive lymphoma at high risk of CNS relapse. Blood 2017; 130:867-874. [PMID: 28611025 DOI: 10.1182/blood-2017-03-737460] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/11/2017] [Indexed: 12/25/2022] Open
Abstract
Central nervous system (CNS) relapses are an uncommon yet devastating complication of non-Hodgkin lymphomas. The identification of patients at high risk of secondary CNS relapse is therefore paramount. Retrospective data indicate prophylactic CNS-directed therapies may reduce the risk of CNS involvement; however, no consensus exists about dose, timing, or route of therapy. In addition, prophylaxis is not without risk of treatment-related complications and morbidity. Here, we present a series of case vignettes highlighting our approach to common dilemmas encountered in routine clinical practice. We review the method of assessing CNS relapse risk, factors that increase the likelihood of relapse including histologic subtype, MYC rearrangement, protein expression, and extranodal involvement, and review our clinical practice based on available evidence in administering CNS-directed prophylaxis.
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173
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Schmitz N, Nickelsen M, Savage KJ. Central Nervous System Prophylaxis for Aggressive B-cell Lymphoma: Who, What, and When? Hematol Oncol Clin North Am 2017; 30:1277-1291. [PMID: 27888881 DOI: 10.1016/j.hoc.2016.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Central nervous system (CNS) relapse of aggressive B-cell lymphoma is a rare but serious complication with poor survival. Different approaches have been used to define risks factors for CNS relapse and establish prophylactic measures. Although patients with low or intermediate risk of CNS relapse should not undergo special diagnostic or therapeutic measures, CNS MRI as well as cytology and flow cytometry of the cerebrospinal fluid are suggested for high-risk patients (and patients with testicular involvement) at diagnosis, and prophylactic high-dose methotrexate in patients without proven CNS involvement. Future risk and treatment models may include molecular features and new treatment options.
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Affiliation(s)
- Norbert Schmitz
- Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, Hamburg D-20099, Germany.
| | - Maike Nickelsen
- Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, Hamburg D-20099, Germany
| | - Kerry J Savage
- Department of Medical Oncology, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, British Columbia V5Z 4E6, Canada.
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174
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Abstract
Because of its rarity and high curability, progress in advancing therapeutics in Burkitt lymphoma (BL) has been difficult. Over recent years, several new mutations that cooperate with MYC have been identified, and this has paved the way for testing novel agents in the disease. One of the challenges of most standard approaches typically used is severe treatment-related toxicity that often leads to discontinuation of therapy. To that point, there has been recent success developing intermediate intensity approaches that are well tolerated in all patient groups and maintain high cure rates in a multicenter setting.
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Affiliation(s)
- Kieron Dunleavy
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA.
| | - Richard F Little
- HIV and Stem Cell Therapeutics, Cancer Therapeutic Evaluation Program (CTEP), National Cancer Institute, Bethesda, MD 20892, USA
| | - Wyndham H Wilson
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
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175
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Xiao J, Du S, Dai G, Gao G, Yang D, Zhao H. Efficacy and tolerability of chemotherapy in Chinese patients with AIDS-related Burkitt lymphoma and diffuse large B-cell lymphoma: An observational study. Sci Rep 2017; 7:1905. [PMID: 28507339 PMCID: PMC5432515 DOI: 10.1038/s41598-017-02086-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 04/05/2017] [Indexed: 02/08/2023] Open
Abstract
We evaluated the efficacy and tolerability of chemotherapy in HIV-infected patients with diffuse large B-cell lymphoma (DLBCL) receiving CHOP ± R (n = 17) or Burkitt lymphoma (BL) receiving CODOX-M/IVAC ± R (n = 15). The study was conducted in Beijing Ditan Hospital from January 2009 to August 2015. The following grade 4 adverse effects were observed in BL and DLBCL patients, respectively: neutropenia (80% versus 47.1%), anaemia (46.7% versus 5.9%), thrombocytopenia (53.3% versus 11.8%), bacterial pneumonia (33.3% versus 5.9%), and sepsis (20% versus 5.9%) (p < 0.05). In the BL group, 10 (66.7%) patients died from treatment-related or tumour-related causes, 5 (33.3%) achieved complete response, 1 achieved partial response (6.7%), and 7 developed progressive disease. The 1-year overall survival and progression-free survival rates were 33.3%. Of the DLBCL patients, 3 (17.6%) died from treatment-related causes, 14 (82.4%) achieved complete response, and 3 had progressive disease. The 1-year overall survival and progression-free survival rates were 82.4%. The strongest risk factor for death was relapse between chemotherapy cycles (adjusted hazard ratio = 47.3; 95%CI, 4.2-528.6, p = 0.002). Initiating antiretroviral therapy before chemotherapy failed to improve overall survival. DLBCL patients demonstrated good responses and survival outcomes, while BL patients could not tolerate chemotherapy due to more severe toxicity, and showed poor responses and survival outcomes.
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Affiliation(s)
- Jiang Xiao
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Shuxu Du
- Beijing Shijitan Hospital, Capital Medical University, Beijing, 100020, China
| | - Guorui Dai
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Guiju Gao
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Di Yang
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Hongxin Zhao
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China.
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Abstract
Lymphomas may be broadly divided into non-Hodgkin (90%) and Hodgkin (10%) types. Most lymphomas (90%) are of B cell origin but can also be T cell or natural killer cell. Clinical management of indolent and aggressive lymphomas is different. Aggressive lymphomas are more dangerous if left untreated yet a higher cell proliferation rate also renders them more chemosensitive, so they are managed with curative intent. Indolent lymphomas are, for the most part, incurable, such that quality of life must be balanced against toxicity of treatment in deciding when and how to treat.
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177
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Rytting ME, Jabbour EJ, O'Brien SM, Kantarjian HM. Acute lymphoblastic leukemia in adolescents and young adults. Cancer 2017; 123:2398-2403. [DOI: 10.1002/cncr.30624] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 01/17/2017] [Accepted: 01/17/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Michael E. Rytting
- Department of Pediatrics-Patient Care, Children's Cancer Hospital; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Elias J. Jabbour
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Susan M. O'Brien
- Chao Family Comprehensive Cancer Center; University of California at Irvine; Orange California
| | - Hagop M. Kantarjian
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
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178
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Affiliation(s)
- Mark N Polizzotto
- aKirby Institute for Infection and Immunity, University of New South Wales bSt Vincent's Hospital Sydney, Sydney, Australia cClinical AIDS Research and Education (CARE) Center, University of California Los Angeles, Los Angeles, California, USA
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179
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Dozzo M, Carobolante F, Donisi PM, Scattolin A, Maino E, Sancetta R, Viero P, Bassan R. Burkitt lymphoma in adolescents and young adults: management challenges. Adolesc Health Med Ther 2017; 8:11-29. [PMID: 28096698 PMCID: PMC5207020 DOI: 10.2147/ahmt.s94170] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
About one-half of all Burkitt lymphoma (BL) patients are younger than 40 years, and one-third belong to the adolescent and young adult (AYA) subset, defined by an age between 15 and 25-40 years, based on selection criteria used in different reports. BL is an aggressive B-cell neoplasm displaying highly characteristic clinico-diagnostic features, the biologic hallmark of which is a translocation involving immunoglobulin and c-MYC genes. It presents as sporadic, endemic, or epidemic disease. Endemicity is pathogenetically linked to an imbalance of the immune system which occurs in African children infected by malaria parasites and Epstein-Barr virus, while the epidemic form strictly follows the pattern of infection by HIV. BL shows propensity to extranodal involvement of abdominal organs, bone marrow, and central nervous system, and can cause severe metabolic and renal impairment. Nevertheless, BL is highly responsive to specifically designed short-intensive, rotational multiagent chemotherapy programs, empowered by the anti-CD20 monoclonal antibody rituximab. When carefully applied with appropriate supportive measures, these modern programs achieve a cure rate of approximately 90% in the average AYA patient, irrespective of clinical stage, which is the best result achievable in any aggressive lymphoid malignancy to date. The challenges ahead concern the following: optimization of management in underdeveloped countries, with reduction of diagnostic and referral-for-care intervals, and the applicability of currently curative regimens; the development of lower intensity but equally effective treatments for frail or immunocompromised patients at risk of death by complications; the identification of very high-risk patients through positron-emission tomography and minimal residual disease assays; and the assessment in these and the few refractory/relapsed ones of new monoclonals (ofatumumab, blinatumomab, inotuzumab ozogamicin) and new molecules targeting c-MYC and key proliferative steps of B-cell malignancies.
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Affiliation(s)
- Massimo Dozzo
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
| | | | - Pietro Maria Donisi
- Simple Departmental Operative Unit of Anatomic Pathology, Ospedale Ss. Giovanni e Paolo, Venice, Italy
| | | | - Elena Maino
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
| | | | - Piera Viero
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
| | - Renato Bassan
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
- Correspondence: Renato Bassan, Complex Operative Unit of Hematology, Ospedale dell’Angelo, Via Paccagnella 11, 30174 Mestre-Venice, Italy, Tel +39 41 965 7362, Fax +39 41 965 7361, Email
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180
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Lange J, Lenz G, Burkhardt B. Mature aggressive B-cell lymphoma across age groups - molecular advances and therapeutic implications. Expert Rev Hematol 2016; 10:123-135. [PMID: 27936978 DOI: 10.1080/17474086.2017.1271318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Mature B-cell lymphoma represents the most common type of Non-Hodgkin lymphoma, and different subtypes prevail at different patient ages. Areas covered: We review recent data on differences and commonalities in mature B-cell lymphoma occurring in adult and pediatric patients, with a special emphasis on molecular advances and therapeutic implications. To this end, we will discuss knowledge on diffuse large B-cell lymphoma and Burkitt lymphoma/leukemia, which are the most frequent subtypes in adult and pediatric patients, respectively, and on primary mediastinal B-cell lymphoma, which is a subtype of mature B-cell lymphoma occurring mainly in adolescents and young adults with a female predominance. Expert commentary: Molecular profiling has revealed molecular alterations that can be used to further classify the subtypes of mature B-cell lymphoma. These new subgroups frequently respond differentially to targeted therapeutic strategies. Future clinical trials utilizing new drugs will address this issue by combining clinical data and response assessment with a molecular workup of the corresponding lymphomas.
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Affiliation(s)
- Jonas Lange
- a Pediatric Hematology and Oncology , University Hospital Muenster , Muenster , Germany.,b Translational Oncology, Department of Medicine A , University Hospital Muenster, Muenster, Germany; Cluster of Excellence EXC 1003, Cells in Motion , Muenster , Germany
| | - Georg Lenz
- b Translational Oncology, Department of Medicine A , University Hospital Muenster, Muenster, Germany; Cluster of Excellence EXC 1003, Cells in Motion , Muenster , Germany
| | - Birgit Burkhardt
- a Pediatric Hematology and Oncology , University Hospital Muenster , Muenster , Germany
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181
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Sandlund JT, Martin MG. Non-Hodgkin lymphoma across the pediatric and adolescent and young adult age spectrum. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:589-597. [PMID: 27913533 PMCID: PMC6142492 DOI: 10.1182/asheducation-2016.1.589] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The non-Hodgkin lymphomas (NHLs) occurring in children and adolescents and young adults (AYA) are characterized by various age-related differences in tumor biology and survival. Children generally present with high-grade lymphomas, such as Burkitt lymphoma, diffuse large B-cell lymphoma, lymphoblastic lymphoma, and anaplastic large cell lymphoma, whereas low-grade histologic subtypes, such as follicular lymphoma, occur more frequently with increasing age. Treatment outcome for children with NHL is generally superior to that observed in adults. Factors contributing to this discrepancy include psychosocial factors, patient factors, and differences in tumor biology and therapy. These factors will be reviewed, with particular attention to the biological features of diffuse large B-cell lymphoma and anaplastic large cell lymphoma and corresponding therapeutic challenges. Novel targeting agents have been developed, which have been shown to be active in some patients. There is clearly a need for treatment protocols with eligibility criteria that cover the full span of the pediatric and AYA age range and that incorporate detailed molecular characterization of the tumors.
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Affiliation(s)
- John T. Sandlund
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Pediatrics, University of Tennessee College of Medicine, Memphis TN
| | - Mike G. Martin
- Department of Medicine, University of Tennessee College of Medicine, Memphis, TN; and
- The West Cancer Center, Memphis TN
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182
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Approach to the diagnosis and treatment of high-grade B-cell lymphomas with MYC and BCL2 and/or BCL6 rearrangements. Blood 2016; 129:280-288. [PMID: 27821509 DOI: 10.1182/blood-2016-02-636316] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 10/25/2016] [Indexed: 12/19/2022] Open
Abstract
High-grade B-cell lymphomas (HGBLs) with MYC and BCL2 and/or BCL6 rearrangements, so-called "double-hit" lymphomas (HGBL-DH), are aggressive lymphomas that form a separate provisional entity in the 2016 revised World Health Organization Classification of Lymphoid Tumors. Fluorescence in situ hybridization (FISH) will be required to identify HGBL-DH and will reclassify a subset of diffuse large B-cell lymphomas (DLBCLs) and HGBLs with features intermediate between DLBCL and Burkitt lymphoma into this new category. Identifying patients with HGBL-DH is important because it may change clinical management. This poses a challenge for centers that may not be ready to handle the additional workload and financial burden associated with the increase in requests for FISH testing. Herein, we review the mechanisms of deregulation of these oncogenes. We identify the factors associated with a poor prognosis and those that can guide diagnostic testing. Restricting FISH analysis to the 10% of DLBCL patients who have a germinal center B-cell phenotype and coexpress MYC and BCL2 proteins would be cost-effective and would identify the subset of patients who are at highest risk of experiencing a relapse following conventional therapy. These patients may benefit from intensified chemotherapy regimens or, ideally, should enroll in clinical trials investigating novel regimens.
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183
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Paul S, Kantarjian H, Jabbour EJ. Adult Acute Lymphoblastic Leukemia. Mayo Clin Proc 2016; 91:1645-1666. [PMID: 27814839 DOI: 10.1016/j.mayocp.2016.09.010] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 09/26/2016] [Accepted: 09/26/2016] [Indexed: 02/08/2023]
Abstract
Conventional cytotoxic chemotherapy used to treat acute lymphoblastic leukemia (ALL) results in high cure rates in pediatric patients but is suboptimal in the treatment of adult patients. The 5-year overall survival is approximately 90% in children and 30% to 40% in adults and elderly patients. Adults with ALL tend to have higher risk factors at diagnosis, more comorbidities, and increasing age that often requires dose reductions. Major advancements have been made in redefining the pathologic classification of ALL, identifying new cytogenetic-molecular abnormalities, and developing novel targeted agents in order to improve survival. The addition of new monoclonal antibodies and tyrosine kinase inhibitors to conventional chemotherapy in the frontline setting has resulted in increased rates of complete remission and overall survival. These new developments are changing the treatment of adult ALL from a "one therapy fits all" approach to individualized treatment based on patient's cytogenetic and molecular profile.
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Affiliation(s)
- Shilpa Paul
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hagop Kantarjian
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elias J Jabbour
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX.
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184
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Contejean A, Lemiale V, Resche-Rigon M, Mokart D, Pène F, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Rabbat A, Perez P, Meert AP, Benoit D, Hamidfar R, Darmon M, Jourdain M, Renault A, Schlemmer B, Azoulay E. Increased mortality in hematological malignancy patients with acute respiratory failure from undetermined etiology: a Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologique (Grrr-OH) study. Ann Intensive Care 2016; 6:102. [PMID: 27783381 PMCID: PMC5080277 DOI: 10.1186/s13613-016-0202-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 10/11/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Acute respiratory failure (ARF) is the most frequent complication in patients with hematological malignancies and is associated with high morbidity and mortality. ARF etiologies are numerous, and despite extensive diagnostic workflow, some patients remain with undetermined ARF etiology. METHODS This is a post-hoc study of a prospective multicenter cohort performed on 1011 critically ill hematological patients. Relationship between ARF etiology and hospital mortality was assessed using a multivariable regression model adjusting for confounders. RESULTS This study included 604 patients with ARF. All patients underwent noninvasive diagnostic tests, and a bronchoscopy and bronchoalveolar lavage (BAL) was performed in 155 (25.6%). Definite diagnoses were classified into four exclusive etiological categories: pneumonia (44.4%), non-infectious diagnoses (32.6%), opportunistic infection (10.1%) and undetermined (12.9%), with corresponding hospital mortality rates of 40, 35, 55 and 59%, respectively. Overall hospital mortality was 42%. By multivariable analysis, factors associated with hospital mortality were invasive pulmonary aspergillosis (OR 7.57 (95% CI 3.06-21.62); p < 0.005), use of invasive mechanical ventilation (OR 1.65 (95% CI 1.07-2.55); p = 0.02), a SOFA score >7 (OR 3.32 (95% CI 2.15-5.15); p < 0.005) and an undetermined ARF etiology (OR 2.92 (95% CI 1.71-5.07); p < 0.005). CONCLUSIONS In patients with hematological malignancies and ARF, up to 13% remain with undetermined ARF etiology despite comprehensive diagnostic workup. Undetermined ARF etiology is independently associated with hospital mortality. Studies to guide second-line diagnostic strategies are warranted. ClinicalTrials.Gov NCT01172132.
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Affiliation(s)
| | | | | | - Djamel Mokart
- Réanimation, Institut Paoli Calmettes, Marseille, France.,Medical Intensive Care Unit, Hôpital Saint-Louis, ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology And Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université Paris Diderot Sorbonne, 1, Avenue Claude Vellefaux, 75010, Paris, France
| | - Frédéric Pène
- Réanimation médicale, Hôpital Cochin, APHP, Paris, France
| | - Achille Kouatchet
- Service de Reanimation Médicale et Médecine Hyperbare, CHU Angers, Angers, France
| | - Julien Mayaux
- Service de Pneumologie et Réanimation, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France
| | - François Vincent
- Réanimation polyvalente, Hôpital Avicenne, APHP, Bobigny, France
| | - Martine Nyunga
- Réanimation polyvalente, Hôpital V.Provo, Roubaix, France
| | - Fabrice Bruneel
- Réanimation polyvalente, Hôpital de Versailles, Le Chesnay, France
| | - Antoine Rabbat
- Réanimation médicale, Hôpital Cochin, APHP, Paris, France
| | - Pierre Perez
- Réanimation médicale, Hôpital Brabois, Nancy, France
| | - Anne-Pascale Meert
- Service des Soins Intensifs Medico-Chirurgicaux et Oncologie Thoracique, Institut Jules Bordet, Brussels, Belgium
| | | | | | - Michael Darmon
- Réanimation polyvalente, CHU de Saint-Etienne, Saint-Piest-en-Jarrez, France
| | | | - Anne Renault
- Réanimation et Urgences Médicales, CHU de la Cavale Blanche, Brest, France
| | | | - Elie Azoulay
- Réanimation médicale, Hôpital Saint Louis, APHP, Paris, France. .,Medical Intensive Care Unit, Hôpital Saint-Louis, ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology And Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université Paris Diderot Sorbonne, 1, Avenue Claude Vellefaux, 75010, Paris, France.
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185
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Haberl S, Haferlach T, Stengel A, Jeromin S, Kern W, Haferlach C. MYC rearranged B-cell neoplasms: Impact of genetics on classification. Cancer Genet 2016; 209:431-439. [PMID: 27810071 DOI: 10.1016/j.cancergen.2016.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/11/2016] [Accepted: 08/21/2016] [Indexed: 12/12/2022]
Abstract
A cohort comprising 156 patients with B-cell neoplasms harboring an MYC rearrangement was analyzed with respect to phenotypic presentation, molecular markers (TP53, MYC and ID3) and additional cytogenetic abnormalities (concomitantly occurring BCL2, BCL6 and/or CCND1 rearrangements; double, triple or quadruple hit lymphomas = multiple hit lymphomas). MYC translocations occurred as single hit (only MYC rearranged, 63%) or multiple hit lymphoma (37%) and presented as acute leukemia (AL) (14%), Burkitt lymphoma (30%), chronic lymphocytic leukemia (CLL) (21%) or other mature B-cell neoplasms (35%). Multiple hit lymphomas more frequently showed a complex karyotype compared to single hit lymphomas (62% vs. 28%, p < 0.001). Single hit Burkitt lymphomas presented with specific characteristics, by translocation of MYC to an immunoglobulin locus, predominantly a non-complex karyotype (23% vs. 67%, p = 0.012) and a significantly higher ID3 and TP53 mutation frequency (ID3mut: 49% vs. 0%, p = 0.002; TP53mut: 69% vs. 33%, p = 0.045). Additionally, MYC rearranged CLL presented as outstanding group by often showing a non-complex karyotype (85%), absence of ID3 mutations, a high frequency of SF3B1 mutations, and a frequent involvement of non-immunoglobulin loci as MYC-partner genes (61%). Consequently, genetic characteristics distinguish different subgroups of MYC rearranged B-cell neoplasms and therefore may contribute to a new classification system.
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186
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Naik P, Wang J, Brazeau MJ, Rosario D. An Atypical Presentation of Sporadic Jejunal Burkitt's Lymphoma. Case Rep Gastrointest Med 2016; 2016:3605813. [PMID: 27672459 PMCID: PMC5031818 DOI: 10.1155/2016/3605813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 06/04/2016] [Accepted: 06/27/2016] [Indexed: 11/18/2022] Open
Abstract
Burkitt's lymphoma is a very aggressive type of B-cell NHL with replication approaching 100%. Primary gastrointestinal lymphoma is rare. In our case, a 24-year-old male initially presented with symptomatic anemia. He was initially evaluated with colonoscopy and EGD, both of which were unremarkable. A capsule endoscopy was then performed to further evaluate his significant anemia which revealed friable inflamed ulcerated mass in the jejunum. A push enteroscopy was then performed to obtain tissue from the jejunal mass. Biopsy results and immunohistochemical stains were consistent with Burkitt's lymphoma. PET/CT scan revealed only jejunal involvement. Treatment consisted of bowel resection prior to chemotherapy due to concern for perforation with chemotherapy. Patient achieved complete remission after the treatment.
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Affiliation(s)
- Pratik Naik
- Department of Internal Medicine, William Beaumont Army Medical Center (WBAMC), 5005 North Piedras Street, El Paso, TX 79920, USA
| | - James Wang
- Division of Gastroenterology, Department of Internal Medicine, William Beaumont Army Medical Center (WBAMC), 5005 North Piedras Street, El Paso, TX 79920, USA
| | - Michael J. Brazeau
- Department of Internal Medicine, William Beaumont Army Medical Center (WBAMC), 5005 North Piedras Street, El Paso, TX 79920, USA
| | - Domingo Rosario
- Department of Pathology, William Beaumont Army Medical Center (WBAMC), 5005 North Piedras Street, El Paso, TX 79920, USA
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187
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Sissolak G, Seftel M, Uldrick TS, Esterhuizen TM, Mohamed N, Kotze D. Burkitt's Lymphoma and B-Cell Lymphoma Unclassifiable With Features Intermediate Between Diffuse Large B-Cell Lymphoma and Burkitt's Lymphoma in Patients With HIV: Outcomes in a South African Public Hospital. J Glob Oncol 2016; 3:218-226. [PMID: 28717763 PMCID: PMC5493215 DOI: 10.1200/jgo.2015.002378] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose Burkitt’s lymphoma (BL) is a common HIV-associated lymphoma in South Africa. B-cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt’s lymphoma (BL/DLBCL) also occurs in HIV infection. Outcomes of HIV-infected patients with BL or BL/DLBCL in a resource-constrained setting are not defined. Methods We performed a retrospective study of HIV-positive patients with BL or BL/DLBCL treated from 2004 to 2012 with curative intent at a publically funded academic medical center in South Africa. Differences between BL and BL/DLBCL, survival outcomes, and factors associated with survival were analyzed. Results There were 35 patients with either HIV-associated BL (24) or BL/DLBCL (11) who met study criteria. Median CD4+ T-lymphocyte count at lymphoma diagnosis was 188 cells/μL (range, 10 to 535 cells/μL). Patients with BL/DLBCL were significantly older and had less bone marrow involvement and lower baseline serum lactase dehydrogenase than patients with BL. Eighty-nine percent of patients presented with advanced disease, and 25% had baseline CNS involvement. Chemotherapy regimens consisted of cytoreduction with low-dose cyclophosphamide, vincristine, and prednisone followed by induction with vincristine, methotrexate, cyclophosphamide, doxorubicin and prednisone (LMB 86; 57%); hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate, and cytarabine (hyper-CVAD; 20%); cyclophosphamide, doxorubicin, vincristine, and prednisone and high-dose methotrexate with leucovorin rescue on day 10 with accompanying prophylactic IT chemotherapy (Stanford regimen; 14%); and cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP-like; 9%) regimens. Twenty-three patients received CNS treatment or prophylaxis, and 31 received concurrent combination antiretroviral therapy. Two-year overall survival was 38% (95% CI, 22% to 54%) and 2-year event-free survival was 23% (95% CI, 11% to 38%), with no difference between histologic subtypes. Common causes of death were infection (41%) and CNS disease progression or systemic relapse (41%). Conclusion Cure of HIV-associated BL and BL/DLBCL with intensive regimens is possible in resource-limited settings, but lower toxicity regimens, improved CNS prophylaxis, and increased resources for supportive care are required.
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Affiliation(s)
- Gerhard Sissolak
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
| | - Matthew Seftel
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
| | - Thomas S Uldrick
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
| | - Tonya M Esterhuizen
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
| | - Nooroudien Mohamed
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
| | - Danie Kotze
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
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188
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Clinical approach to diffuse large B cell lymphoma. Blood Rev 2016; 30:477-491. [PMID: 27596109 DOI: 10.1016/j.blre.2016.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 05/26/2016] [Accepted: 06/20/2016] [Indexed: 12/19/2022]
Abstract
Diffuse large B cell lymphoma (DLBCL) is the most common subtype of lymphoma. We now recognize that DLBCL corresponds to a biologically heterogeneous family of diseases. Given the potential for cure for most DLBCL patients, appropriate diagnostic and staging evaluation and therapy are essential. Here we review areas of consensus as well as controversy in the evaluation, treatment and monitoring of patients with DLBCL and its related subtypes.
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189
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Olszewski AJ, Fallah J, Castillo JJ. Human immunodeficiency virus-associated lymphomas in the antiretroviral therapy era: Analysis of the National Cancer Data Base. Cancer 2016; 122:2689-97. [DOI: 10.1002/cncr.30112] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/10/2016] [Accepted: 02/16/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Adam J. Olszewski
- Department of Medicine; Alpert Medical School of Brown University; Providence Rhode Island
| | - Jaleh Fallah
- Department of Medicine; Memorial Hospital of Rhode Island; Pawtucket Rhode Island
| | - Jorge J. Castillo
- Department of Medicine; Harvard Medical School; Boston Massachusetts
- Division of Hematologic Oncology, Dana-Farber Cancer Institute; Boston Massachusetts
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Zanet E, Michieli M, Tirelli U. Autologous stem cell transplantation in HIV-positive patients affected by relapsed/partially responding lymphoma: let it be. Expert Rev Hematol 2016; 9:617-9. [PMID: 27269371 DOI: 10.1080/17474086.2016.1194751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ernesto Zanet
- a Unit of Cell Therapy and High Dose Chemotherapy , CRO National Cancer Institute , Aviano , Italy
| | - Mariagrazia Michieli
- a Unit of Cell Therapy and High Dose Chemotherapy , CRO National Cancer Institute , Aviano , Italy
| | - Umberto Tirelli
- b Division of Medical Oncology A , CRO National Cancer Institute , Aviano , Italy
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Autologous hematopoietic cell transplantation for HIV-related lymphoma: results of the BMT CTN 0803/AMC 071 trial. Blood 2016; 128:1050-8. [PMID: 27297790 DOI: 10.1182/blood-2015-08-664706] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 04/08/2016] [Indexed: 12/12/2022] Open
Abstract
Autologous hematopoietic cell transplant (AHCT) for HIV-infected patients is largely limited to centers with HIV-specific expertise. The Blood and Marrow Transplant Clinical Trials Network 0803/AIDS Malignancy Consortium 071 trial is a multicenter phase 2 study of AHCT for patients with HIV-related lymphoma (HRL). Eligible patients had chemotherapy-sensitive relapsed/persistent HRL, were >15 years of age, and had treatable HIV infection. Patients were prepared using carmustine, etoposide, cytarabine, and melphalan and received consistent management of peritransplant antiretroviral treatment. The primary endpoint was 1-year overall survival. Forty-three patients were enrolled; 40 underwent AHCT. Pretransplant HIV viral load was undetectable (<50 copies/mL) in 32 patients (80%); the median CD4 count was 249/μL (range, 39-797). At a median follow-up of 24.8 months, 1-year and 2-year overall survival probabilities were 87.3% (95% confidence interval [CI], 72.1-94.5) and 82% (95% CI, 65.9-91), respectively. The probability of 2-year progression-free survival was 79.8% (95% CI, 63.7-89.4). One-year transplant-related mortality was 5.2%. Median time to neutrophil and platelet recovery was 11 days and 18 days, respectively. Nine patients experienced a total of 13 unexpected grade 3-5 adverse events posttransplant (10 grade 3 and 3 grade 4 events). Twenty-two patients had at least 1 infectious episode posttransplant. At 1 year post-AHCT, median CD4(+) T-cell count was 280.3 (range, 28.8-1148.0); 82.6% had an undetectable HIV viral load. Trial patients were compared with 151 matched Center for International Bone Marrow Transplant Research controls. Outcomes between HIV-infected patients and controls were not statistically significantly different. HRL patients should be considered candidates for AHCT if they meet standard transplant criteria. The trial was registered at www.clinicaltrials.gov as #NCT01141712.
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Ribrag V, Koscielny S, Bosq J, Leguay T, Casasnovas O, Fornecker LM, Recher C, Ghesquieres H, Morschhauser F, Girault S, Le Gouill S, Ojeda-Uribe M, Mariette C, Cornillon J, Cartron G, Verge V, Chassagne-Clément C, Dombret H, Coiffier B, Lamy T, Tilly H, Salles G. Rituximab and dose-dense chemotherapy for adults with Burkitt's lymphoma: a randomised, controlled, open-label, phase 3 trial. Lancet 2016; 387:2402-11. [PMID: 27080498 DOI: 10.1016/s0140-6736(15)01317-3] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Short intensive chemotherapy is the standard of care for adult patients with Burkitt's leukaemia or lymphoma. Findings from single-arm studies suggest that addition of rituximab to these regimens could improve patient outcomes. Our objective was to test this possibility in a randomised trial. METHODS In this randomised, controlled, open-label, phase 3 trial, we recruited patients older than 18 years with untreated HIV-negative Burkitt's lymphoma (including Burkitt's leukaemia) from 45 haematological centres in France. Exclusion criteria were contraindications to any drug included in the chemotherapy regimens, any serious comorbidity, poor renal (creatinine concentration >150 μmol/L) or hepatic (cirrhosis or previous hepatitis B or C) function, pregnancy, and any history of cancer except for non-melanoma skin tumours or stage 0 (in situ) cervical carcinoma. Patients were stratified into two groups based on disease extension (absence [group B] or presence [group C] of bone marrow or central nervous system involvement). Patients were further stratified in group C according to age (<40 years, 40-60 years, and >60 years) and central nervous system involvement. Participants were randomly assigned in each group to either intravenous rituximab injections and chemotherapy (lymphome malin B [LMB]) or chemotherapy alone by the Groupe d'Etude des Lymphomes de l'Adulte datacentre. Randomisation was stratified by treatment group and centre using computer-assisted permuted-block randomisation (block size of four; allocation ratio 1:1). We gave rituximab (375 mg/m(2)) on day 1 and day 6 during the first two courses of chemotherapy (total of four infusions). The primary endpoint is 3 year event-free survival (EFS). We analysed all patients who had data available according to their originally assigned group. This trial is registered with ClinicalTrials.gov, number NCT00180882. RESULTS Between Oct 14, 2004, and Sept 7, 2010, we randomly allocated 260 patients to rituximab or no rituximab (group B 124 patients [64 no rituximab; 60 rituximab]; group C 136 patients [66 no rituximab; 70 rituximab]). With a median follow-up of 38 months (IQR 24-59), patients in the rituximab group achieved better 3 year EFS (75% [95% CI 66-82]) than did those in the no rituximab group (62% [53-70]; log-rank p stratified by treatment group=0·024). The hazard ratio estimated with a Cox model stratified by treatment group, assuming proportionality, was 0·59 for EFS (95% CI 0·38-0·94; p=0·025). Adverse events did not differ between the two treatment groups. The most common adverse events were infectious (grade 3-4 in 137 [17%] treatment cycles in the rituximab group vs 115 [15%] in the no rituximab group) and haematological (mean duration of grade 4 neutropenia of 3·31 days per cycle [95% CI 3·01-3·61] vs 3·38 days per cycle [3·05-3·70]) events. INTERPRETATION Addition of rituximab to a short intensive chemotherapy programme improves EFS in adults with Burkitt's leukaemia or lymphoma. FUNDING Gustave Roussy Cancer Campus, Roche, Chugai, Sanofi.
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Affiliation(s)
- Vincent Ribrag
- Department of Medicine, Gustave Roussy, Université Paris Saclay, Villejuif, France.
| | - Serge Koscielny
- Biostatistics and Epidemiology Unit, Gustave Roussy, Université Paris Saclay, Villejuif, France; Centre for Research in Epidemiology and Population Health, Institut national de la santé et de la recherche médicale U1018, Université Paris-Sud, Villejuif, France
| | - Jacques Bosq
- Department of Biopathology, Morphology Unit, Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Thibaut Leguay
- Service d'hématologie clinique et thérapie cellulaire, Hôpital du Haut-Lévèque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Olivier Casasnovas
- Service d'hématologie Clinique, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - Luc-Mathieu Fornecker
- Department of Oncology and Hematology, Hôpital de Hautepierre Université de Strasbourg, Strasbourg, France
| | - Christian Recher
- Service d'Hématologie, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Hervé Ghesquieres
- Onco-Hematology, Centre Léon Bérard, Université Claude Bernard Lyon 1, Lyon, France
| | - Franck Morschhauser
- Service des Maladies du Sang, Hôpital Huriez, Université de Lille, Unité Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Stéphane Girault
- Hématologie Clinique et Thérapie Cellulaire, Centre Hospitalier Universitaire Limoges, Limoges, France
| | - Steven Le Gouill
- Department of Hematology, Institut national de la santé et de la recherche médicale, Unité Mixte de Recherche 892, Equipe 10, Nantes Institut national de la santé et de la recherche médicale, Centre d'Investigation Clinique 004, Nantes University Hospital, Nantes, France
| | - Mario Ojeda-Uribe
- Department of Hematology and Cellular Therapy Unit, Hôpital Emile Muller, Centre de Competences on Thrombotic Microangiopathies, Mulhouse, France
| | - Clara Mariette
- Department of Haematology, Grenoble University Hospital, Grenoble, France
| | - Jerome Cornillon
- Département d'Hématologie, Institut de Cancérologie Lucien Neuwirth, Saint-Priest en Jarez, France
| | - Guillaume Cartron
- Department of Hematology, Unité Mixte de Recherche Centre national de la recherche scientifique 5235, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Veronique Verge
- Haematology Unit, Gustave Roussy, Université Paris Saclay, Villejuif, France
| | | | - Hervé Dombret
- Service d'hématologie clinique, Centre Hospitalier Universitaire Paris, Groupe Hospitalier Saint-Louis, Lariboisière, Fernand-Widal, Hôpital Saint-Louis, Paris, France
| | - Bertrand Coiffier
- Hématologie Clinique, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Thierry Lamy
- Department of Clinical Hematology, Rennes University Hospital, Rennes, France; Institut national de la santé et de la recherche médicale Unité Mixte de Recherche 917, Faculté de médecine, Université Rennes 1, Rennes Department of Clinical Investigation, Rennes University Hospital, Rennes, France
| | - Hervé Tilly
- Centre Henri Becquerel, Université de Rouen, Rouen, France
| | - Gilles Salles
- Hospices Civils de Lyon, Université Lyon 1, Pierre Bénite, France
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Quesada AE, Liu H, Miranda RN, Golardi N, Billah S, Medeiros LJ, Jaso JM. Burkitt lymphoma presenting as a mass in the thyroid gland: a clinicopathologic study of 7 cases and review of the literature. Hum Pathol 2016; 56:101-8. [PMID: 27257042 DOI: 10.1016/j.humpath.2016.05.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/07/2016] [Accepted: 05/19/2016] [Indexed: 01/08/2023]
Abstract
Burkitt lymphoma presenting in the thyroid gland is rare, and only a few cases have been reported. We retrospectively reviewed 7 patients diagnosed with Burkitt lymphoma of the thyroid gland between 2000 and 2015. There were 4 men and 3 women with a median age of 41 years (range, 19-49 years). All patients presented with a rapidly growing neck mass associated with upper airway compression in 5 (71%) patients. Two patients presented with localized (stage I/II) and 5 patients with disseminated (stage III/IV) disease. All cases showed morphologic and immunophenotypic features of Burkitt lymphoma with MYC rearrangement in all 5 cases tested. One case showed evidence of concurrent Hashimoto thyroiditis. Six of 7 patients were treated primarily with rituximab, hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone. One patient was treated primarily with dose-adjusted rituximab, etoposide, prednisolone, vincristine, and cyclophosphamide. At the end of the study period, 5 patients were alive: 4 in complete remission and 1 with persistent disease. Two patients died with persistent disease (median follow-up, 25 months; range, 12-361 months). We conclude that Burkitt lymphoma of the thyroid gland shows clinicopathologic features similar to sporadic Burkitt lymphoma at other anatomic sites, but patients present at an older median age. The clinical course is aggressive with a high frequency of disseminated disease at diagnosis; however, a subset of patients responds well to aggressive chemotherapy.
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Affiliation(s)
- Andrés E Quesada
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Huifei Liu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Natalia Golardi
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Shahreen Billah
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Jesse Manuel Jaso
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.
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Burotto M, Berkovits A, Dunleavy K. Double hit lymphoma: from biology to therapeutic implications. Expert Rev Hematol 2016; 9:669-78. [PMID: 27166590 DOI: 10.1080/17474086.2016.1182858] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Diffuse large B-cell lymphoma (DLBCL) is a molecularly heterogeneous disease defined by different cellular origins and mechanisms of oncogenic activation. Approximately 10% of DLBCL cases harbor a MYC rearrangement and this has been associated with a more aggressive clinical course following standard therapy. AREAS COVERED So-called 'double-hit lymphomas' (DHL) or 'triple hit lymphomas' (THL) occur when MYC is concurrently rearranged with BCL2 and/or BCL6. These tumors are characterized by high proliferation rate and a very poor outcome following standard R-CHOP (rituximab, cyclophosphamide, doxorubicin vincristine and prednisone) therapy, in most (though not all) studies that have looked at this. Though there is a paucity of published experience with other chemotherapy regimens, there is emerging evidence that more intensive approaches may improve outcome. Recently, there has been a lot of focus in the literature on 'double-expresser lymphomas' (DEL) with high MYC, BCL2 and/or BCL6 expression but typically without rearrangements of these genes. These DEL cases, have a poor outcome with R-CHOP and there is little consensus on how they should be approached. Expert commentary: This review will focus on the biology and treatment of DHL and DEL, discuss the outcome of these diseases with current standard as well as promising new approaches and conclude with a section on novel agents that are in development for these diseases.
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Affiliation(s)
- Mauricio Burotto
- a Hemato-Oncology Service, Clinica Alemana de Santiago , School of Medicine Universidad del Desarrollo , Santiago , Chile
| | - Alejandro Berkovits
- a Hemato-Oncology Service, Clinica Alemana de Santiago , School of Medicine Universidad del Desarrollo , Santiago , Chile
| | - Kieron Dunleavy
- b Lymphoid Malignancies Branch, Center for Cancer Research , National Cancer Institute , Bethesda , MD , USA
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195
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Gharwan H, Lai C, Grant C, Dunleavy K, Steinberg SM, Shovlin M, Fojo T, Wilson WH. Female fertility following dose-adjusted EPOCH-R chemotherapy in primary mediastinal B-cell lymphomas. Leuk Lymphoma 2016; 57:1616-24. [PMID: 27183887 DOI: 10.3109/10428194.2015.1118476] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We assessed fertility/gonadal function in premenopausal women treated with dose-adjusted EPOCH-Rituximab for untreated primary mediastinal B-cell lymphoma (PMBL). Eligible patents were ≤ 50 years and premenopausal. Serial reproductive histories were obtained and hormonal assays were performed on serum samples before, at the end of treatment and 4-18 months later. Twenty-eight eligible women had a median age (range) of 31 (21-50) years and were followed a median of 7.3 years. Of 23 patients who completed a questionnaire, 19 (83%) were and four were not menstruating prior to chemotherapy. Amenorrhea developed in 12 patients during chemotherapy. At > 1-year follow-up, 14/19 (74%) patients were menstruating, all < 35 years old, and six (43%) of these patients delivered healthy children. Hormonal assays showed ovarian dysfunction during chemotherapy in all patients with varying recovery at 4-18 months after treatment. Fertility was preserved in most women with ovarian failure confined to patients > 40 years old.
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Affiliation(s)
- Helen Gharwan
- a Lymphoid Malignancy Branch, Center for Cancer Research , National Cancer Institute , Bethesda , MD , USA
| | - Catherine Lai
- a Lymphoid Malignancy Branch, Center for Cancer Research , National Cancer Institute , Bethesda , MD , USA
| | - Cliona Grant
- a Lymphoid Malignancy Branch, Center for Cancer Research , National Cancer Institute , Bethesda , MD , USA
| | - Kieron Dunleavy
- a Lymphoid Malignancy Branch, Center for Cancer Research , National Cancer Institute , Bethesda , MD , USA
| | - Seth M Steinberg
- b Biostatistics and Data Management Section Center for Cancer Research , National Cancer Institute , Bethesda , MD , USA
| | - Margaret Shovlin
- a Lymphoid Malignancy Branch, Center for Cancer Research , National Cancer Institute , Bethesda , MD , USA
| | - Tito Fojo
- c Medical Oncology Branch, Center for Cancer Research , National Cancer Institute , Bethesda , MD , USA
| | - Wyndham H Wilson
- a Lymphoid Malignancy Branch, Center for Cancer Research , National Cancer Institute , Bethesda , MD , USA
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Allaoui M, Benchafai I, Mahtat EM, Regragui S, Boudhas A, Azzakhmam M, Boukhechba M, Al Bouzidi A, Oukabli M. Primary Burkitt lymphoma of the thyroid gland: case report of an exceptional type of thyroid neoplasm and review of the literature. BMC Clin Pathol 2016; 16:6. [PMID: 27175103 PMCID: PMC4864901 DOI: 10.1186/s12907-016-0028-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/05/2016] [Indexed: 11/10/2022] Open
Abstract
Background Primary thyroid lymphoma is an uncommon pathological entity that accounts for only 1 to 5 % of all thyroid malignancies. Primary Burkitt lymphoma of the thyroid gland is very rare. This article presents the first Moroccan case of a primary BL of the thyroid to be reported in the literature to date. Case presentation We describe here a case of a 70-year-old male who developed a rapidly enlarging thyroid gland with progressive symptoms of compression. Core biopsy confirmed the diagnosis of Burkitt lymphoma. The patient died of septic shock, 2 weeks after the first cycle of appropriate therapeutic chemotherapy. Conclusions This presentation emphasizes the importance of considering lymphoma when dealing with a thyroid mass, as its management is different from that of other thyroid pathologies, and affords an opportunity to review a very rare type of primary thyroid lymphoma.
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Affiliation(s)
- Mohamed Allaoui
- Department of Pathology, Military General Hospital Mohammed V, Mohammed V Souissi University - Faculty of Medicine and Pharmacy of Rabat, Hay Riad, Rabat, 10000 Morocco
| | - Ilias Benchafai
- Department of Clinical Haematology, Military General Hospital Mohammed V, Mohammed V Souissi University - Faculty of Medicine and Pharmacy of Rabat, Hay Riad, Rabat, 10000 Morocco
| | - El Mehdi Mahtat
- Department of Otorhinolaryngology, Military General Hospital Mohammed V, Mohammed V Souissi University - Faculty of Medicine and Pharmacy of Rabat, Hay Riad, Rabat, 10000 Morocco
| | - Safae Regragui
- Department of Otorhinolaryngology, Military General Hospital Mohammed V, Mohammed V Souissi University - Faculty of Medicine and Pharmacy of Rabat, Hay Riad, Rabat, 10000 Morocco
| | - Adil Boudhas
- Department of Pathology, Military General Hospital Mohammed V, Mohammed V Souissi University - Faculty of Medicine and Pharmacy of Rabat, Hay Riad, Rabat, 10000 Morocco
| | - Mustapha Azzakhmam
- Department of Pathology, Military General Hospital Mohammed V, Mohammed V Souissi University - Faculty of Medicine and Pharmacy of Rabat, Hay Riad, Rabat, 10000 Morocco
| | - Mohammed Boukhechba
- Department of Pathology, Military General Hospital Mohammed V, Mohammed V Souissi University - Faculty of Medicine and Pharmacy of Rabat, Hay Riad, Rabat, 10000 Morocco
| | - Abderrahmane Al Bouzidi
- Department of Pathology, Military General Hospital Mohammed V, Mohammed V Souissi University - Faculty of Medicine and Pharmacy of Rabat, Hay Riad, Rabat, 10000 Morocco
| | - Mohamed Oukabli
- Department of Pathology, Military General Hospital Mohammed V, Mohammed V Souissi University - Faculty of Medicine and Pharmacy of Rabat, Hay Riad, Rabat, 10000 Morocco
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Cairo MS, Pinkerton R. Childhood, adolescent and young adult non-Hodgkin lymphoma: state of the science. Br J Haematol 2016; 173:507-30. [DOI: 10.1111/bjh.14035] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Mitchell S. Cairo
- Department of Pediatrics, Medicine, Pathology, Microbiology & Immunology and Cell Biology & Anatomy; New York Medical College; Valhalla NY USA
| | - Ross Pinkerton
- Department of Oncology; Children's Health Queensland; Brisbane Australia
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Barta SK, Joshi J, Mounier N, Xue X, Wang D, Ribera JM, Navarro JT, Hoffmann C, Dunleavy K, Little RF, Wilson WH, Spina M, Galicier L, Noy A, Sparano JA. Central nervous system involvement in AIDS-related lymphomas. Br J Haematol 2016; 173:857-66. [PMID: 27062389 DOI: 10.1111/bjh.13998] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/03/2016] [Indexed: 11/29/2022]
Abstract
Central nervous system (CNS) involvement is reportedly more common in acquired immunodeficiency syndrome (AIDS)-related lymphomas (ARL). We describe factors and outcomes associated with CNS involvement at baseline (CNS(B) ) and relapse (CNS(R) ) in 886 patients with newly diagnosed ARL. Of 886 patients, 800 received either intrathecal (IT) therapy for CNS(B) or IT prophylaxis. CNS(B) was found in 13%. CNS(B) was not associated with reduced overall survival (OS). There was no difference in the prevalence of CNS(B) between the pre-combination antiretroviral therapy (cART) and cART eras. 5·3% of patients experienced CNS(R) at a median of 4·2 months after diagnosis (12% if CNS(B) ; 4% if not). Median OS after CNS(R) was 1·6 months. On multivariate analysis, only CNS(B) [hazard ratio (HR) 3·68, P = 0·005] and complete response to initial therapy (HR 0·14, P < 0·0001) were significantly associated with CNS(R) . When restricted to patients without CNS(B) , IT CNS prophylaxis with 3 vs. 1 agent did not significantly impact the risk of CNS(R) . Despite IT CNS prophylaxis, 5% of patients experienced CNS(R) . Our data confirms that CNS(R) in ARL occurs early and has a poor outcome. Complete response to initial therapy was associated with a reduced frequency of CNS(R) . Although CNS(B) conferred an increased risk for CNS(R) , it did not impact OS.
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Affiliation(s)
| | - Jitesh Joshi
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | | | - Xiaonan Xue
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Dan Wang
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Josep-Maria Ribera
- Hospital Universitari Germans Trias i Pujol, Josep Carreras Research Institute Badalona, Badalona, Spain
| | - Jose-Tomas Navarro
- Hospital Universitari Germans Trias i Pujol, Josep Carreras Research Institute Badalona, Badalona, Spain
| | - Christian Hoffmann
- IPM Study Centre, Hamburg, Germany.,University of Schleswig-Holstein, Kiel, Germany
| | - Kieron Dunleavy
- National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | - Richard F Little
- National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | - Wyndham H Wilson
- National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | - Michele Spina
- Division of Medical Oncology A, National Cancer Institute, Aviano, Italy
| | - Lionel Galicier
- Department of Clinical Immunology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris and Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Ariela Noy
- Memorial Sloan-Kettering Cancer Center & Weill Cornell New York, New York, NY, USA
| | - Joseph A Sparano
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
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Ebrahim AS, Sabbagh H, Liddane A, Raufi A, Kandouz M, Al-Katib A. Hematologic malignancies: newer strategies to counter the BCL-2 protein. J Cancer Res Clin Oncol 2016; 142:2013-22. [PMID: 27043233 DOI: 10.1007/s00432-016-2144-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/09/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION BCL-2 is the founding member of the BCL-2 family of apoptosis regulatory proteins that either induce (pro-apoptotic) or inhibit (anti-apoptotic) apoptosis. The anti-apoptotic BCL-2 is classified as an oncogene, as damage to the BCL-2 gene has been shown to cause a number of cancers, including lymphoma. Ongoing research has demonstrated that disruption of BCL-2 leads to cell death. BCL-2 is also known to be involved in the development of resistance to chemotherapeutic agents, further underscoring the importance of targeting the BCL-2 gene in cancer therapeutics. Thus, numerous approaches have been developed to block or modulate the production of BCL-2 at the RNA level using antisense oligonucleotides or at the protein level with BCL-2 inhibitors, such as the novel ABT737. METHODS In this article, we briefly review previous strategies to target the BCL-2 gene and focus on a new approach to silence DNA, DNA interference (DNAi). RESULTS AND CONCLUSION DNA interference is aimed at blocking BCL-2 gene transcription. Evaluations of this technology in preclinical and early clinical studies are very encouraging and strongly support further development of DNAi as cancer therapeutics. A pilot phase II clinical trial in patients with relapsed or refractory non-Hodgkin lymphoma, PNT2258 demonstrated clinical benefit in 11 of 13 patients with notable responses in diffuse large B cell lymphoma and follicular lymphoma. By targeting the DNA directly, the DNAi technology promises to be more effective compared with other gene-interference strategies that target the RNA or protein but leaves the dysregulated DNA functional.
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Affiliation(s)
- Abdul Shukkur Ebrahim
- Department of Internal Medicine-Lymphoma Research Lab, Wayne State University and School of Medicine, 8229 Scott Hall, 540 E. Canfield, Detroit, MI, 48201, USA
| | - Hussam Sabbagh
- Department of Internal Medicine-Lymphoma Research Lab, Wayne State University and School of Medicine, 8229 Scott Hall, 540 E. Canfield, Detroit, MI, 48201, USA
| | - Allison Liddane
- Department of Internal Medicine-Lymphoma Research Lab, Wayne State University and School of Medicine, 8229 Scott Hall, 540 E. Canfield, Detroit, MI, 48201, USA
| | - Ali Raufi
- Department of Internal Medicine-Lymphoma Research Lab, Wayne State University and School of Medicine, 8229 Scott Hall, 540 E. Canfield, Detroit, MI, 48201, USA
| | - Mustapha Kandouz
- Department of Pathology, Wayne State University, Detroit, MI, 48201, USA
| | - Ayad Al-Katib
- Department of Internal Medicine-Lymphoma Research Lab, Wayne State University and School of Medicine, 8229 Scott Hall, 540 E. Canfield, Detroit, MI, 48201, USA.
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Abstract
HIV is associated with an excess risk for lymphoid malignancies. Although the risk of lymphoma has decreased in HIV-infected individuals in the era of effective combination antiretroviral therapy, it remains high. Treatment outcomes have improved due to improvements in HIV and cancer therapeutics for the common HIV-associated lymphomas. R-CHOP/R-EPOCH are the standard of care for HIV-associated diffuse large B-cell lymphoma. HIV-infected patients with Burkitt lymphoma and good performance status should receive dose-intensive regimens. HIV-infected patients with primary central nervous system lymphoma can respond favorably to high-dose methotrexate-based therapy. In many cases, treatment and expected outcomes for HIV-infected patients with either Hodgkin or non-Hodgkin's lymphomas are very similar to HIV-negative patients. There is currently no standard treatment for HIV-associated multicentric Castleman disease or primary effusion lymphoma. For those hematologic cancers in which transplantation is part of standard care, this modality should be considered an option in those with well-controlled HIV infection.
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Affiliation(s)
- Chia-Ching J Wang
- a Division of Hematology/Oncology , San Francisco General Hospital , San Francisco , CA , USA
| | - Lawrence D Kaplan
- b Division of Hematology/Oncology, Helen Diller Comprehensive Cancer Center , University of California , San Francisco , CA , USA
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