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Gopal S, Fedoriw Y, Kaimila B, Montgomery ND, Kasonkanji E, Moses A, Nyasosela R, Mzumara S, Varela C, Chikasema M, Makwakwa V, Itimu S, Tomoka T, Kamiza S, Dhungel BM, Chimzimu F, Kampani C, Krysiak R, Richards KL, Shea TC, Liomba NG. CHOP Chemotherapy for Aggressive Non-Hodgkin Lymphoma with and without HIV in the Antiretroviral Therapy Era in Malawi. PLoS One 2016; 11:e0150445. [PMID: 26934054 PMCID: PMC4775030 DOI: 10.1371/journal.pone.0150445] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 02/15/2016] [Indexed: 11/23/2022] Open
Abstract
There are no prospective studies of aggressive non-Hodgkin lymphoma (NHL) treated with CHOP in sub-Saharan Africa. We enrolled adults with aggressive NHL in Malawi between June 2013 and May 2015. Chemotherapy and supportive care were standardized, and HIV+ patients received antiretroviral therapy (ART). Thirty-seven of 58 patients (64%) were HIV+. Median age was 47 years (IQR 39–56), and 35 (60%) were male. Thirty-five patients (60%) had stage III/IV, 43 (74%) B symptoms, and 28 (48%) performance status ≥2. B-cell NHL predominated among HIV+ patients, and all T-cell NHL occurred among HIV- individuals. Thirty-one HIV+ patients (84%) were on ART for a median 9.9 months (IQR 1.1–31.7) before NHL diagnosis, median CD4 was 121 cells/μL (IQR 61–244), and 43% had suppressed HIV RNA. HIV+ patients received a similar number of CHOP cycles compared to HIV- patients, but more frequently developed grade 3/4 neutropenia (84% vs 31%, p = 0.001), resulting in modestly lower cyclophosphamide and doxorubicin doses with longer intervals between cycles. Twelve-month overall survival (OS) was 45% (95% CI 31–57%). T-cell NHL (HR 3.90, p = 0.017), hemoglobin (HR 0.82 per g/dL, p = 0.017), albumin (HR 0.57 per g/dL, p = 0.019), and IPI (HR 2.02 per unit, p<0.001) were associated with mortality. HIV was not associated with mortality, and findings were similar among patients with diffuse large B-cell lymphoma. Twenty-three deaths were from NHL (12 HIV+, 11 HIV-), and 12 from CHOP (9 HIV+, 3 HIV-). CHOP can be safe, effective, and feasible for aggressive NHL in Malawi with and without HIV.
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Affiliation(s)
- Satish Gopal
- UNC Project-Malawi, Lilongwe, Malawi
- Lineberger Comprehensive Cancer Center, Chapel Hill, United States of America
- University of Malawi College of Medicine, Blantyre, Malawi
- * E-mail:
| | - Yuri Fedoriw
- Lineberger Comprehensive Cancer Center, Chapel Hill, United States of America
- University of North Carolina Department of Pathology and Laboratory Medicine, Chapel Hill, United States of America
| | | | - Nathan D. Montgomery
- University of North Carolina Department of Pathology and Laboratory Medicine, Chapel Hill, United States of America
| | | | - Agnes Moses
- UNC Project-Malawi, Lilongwe, Malawi
- University of Malawi College of Medicine, Blantyre, Malawi
| | | | - Suzgo Mzumara
- University of Malawi College of Medicine, Blantyre, Malawi
- Kamuzu Central Hospital, Lilongwe, Malawi
| | - Carlos Varela
- University of Malawi College of Medicine, Blantyre, Malawi
- Kamuzu Central Hospital, Lilongwe, Malawi
| | | | | | | | - Tamiwe Tomoka
- University of Malawi College of Medicine, Blantyre, Malawi
| | - Steve Kamiza
- University of Malawi College of Medicine, Blantyre, Malawi
| | | | | | | | | | | | - Thomas C. Shea
- Lineberger Comprehensive Cancer Center, Chapel Hill, United States of America
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Wohlfarth P, Carlström A, Staudinger T, Clauss S, Hermann A, Rabitsch W, Bojic A, Skrabs C, Porpaczy E, Schiefer AI, Valent P, Knöbl P, Agis H, Hauswirth A, Jäger U, Kundi M, Sperr WR, Schellongowski P. Incidence of intensive care unit admission, outcome and post intensive care survival in patients with diffuse large B-cell lymphoma. Leuk Lymphoma 2016; 57:1831-8. [DOI: 10.3109/10428194.2015.1106537] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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203
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Aggressive B cell Lymphoma: Optimal Therapy for MYC-positive, Double-Hit, and Triple-Hit DLBCL. Curr Treat Options Oncol 2015; 16:58. [DOI: 10.1007/s11864-015-0374-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Dose-Adjusted Etoposide, Prednisone, Vincristine, Cyclophosphamide, and Doxorubicin (EPOCH) With or Without Rituximab as First-Line Therapy for Aggressive Non-Hodgkin Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 16:76-81. [PMID: 26725264 DOI: 10.1016/j.clml.2015.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 11/09/2015] [Accepted: 11/12/2015] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-EPOCH) was developed in an effort to overcome inadequate drug concentrations and compensate for increased drug clearance. The goal of the present study was to examine the risk factors and outcomes of patients with aggressive non-Hodgkin lymphoma (aNHL) treated with DA-EPOCH. PATIENTS AND METHODS We report the data from 136 patients with previously untreated aNHL who received infusional DA-EPOCH chemotherapy with or without rituximab from 2005 to 2013. Overall survival was estimated using Kaplan-Meier methods. Univariate and multivariate logistic regression was used to determine the factors associated with death, progression, or relapse at 2 years. RESULTS The overall response rate was 82%. The relapse-free survival rate at 1, 3, and 5 years was 68%, 63%, and 52% with 95% confidence intervals (CIs) of 0.59% to 0.85%, 0.54% to 0.70%, and 0.31% to 0.70%, respectively. Patients with T-cell aNHL had an increased risk of death, progression, or relapse (Odds Ratio, 3.5; 95% CI, 1.4-8.8) compared with those with B-cell aNHL. In multivariate analysis, current smoking, disease in the bone marrow, and the number of cycles completed were independent predictors of death and relapse. CONCLUSION Our data suggest that EPOCH with or without rituximab is active in both B- and T-cell aNHL. Toxicity did not significantly affect timing of treatment delivery or treatment outcomes. Dose adjustment by hematopoietic nadir similarly had no effect. The effect of smoking during chemotherapy should be evaluated further.
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205
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Schiefer AI, Kornauth C, Simonitsch-Klupp I, Skrabs C, Masel EK, Streubel B, Vanura K, Walter K, Migschitz B, Stoiber D, Sexl V, Raderer M, Chott A, da Silva MG, Cabecadas J, Müllauer L, Jäger U, Porpaczy E. Impact of Single or Combined Genomic Alterations of TP53, MYC, and BCL2 on Survival of Patients With Diffuse Large B-Cell Lymphomas: A Retrospective Cohort Study. Medicine (Baltimore) 2015; 94:e2388. [PMID: 26717387 PMCID: PMC5291628 DOI: 10.1097/md.0000000000002388] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
MYC and BCL2 translocations as well as TP53 deletion/mutation are known risk factors in diffuse large B-cell lymphoma (DLBCL) but their interplay is not well understood.In this retrospective cohort study, we evaluated the combined prognostic impact of TP53 deletion and mutation status, MYC and BCL2 genomic breaks in tumor samples of 101 DLBCL patients. The cohort included 53 cases with MYC rearrangements (MYC+).TP53 deletions/mutations (TP53+) were found in 32 of 101 lymphomas and were equally distributed between MYC+ and MYC- cases (35.8% vs. 27.1%). TP53+ lymphomas had lower responses to treatment than TP53- (complete remission 34.4% vs. 60.9%; P = 0.01). TP53 alteration was the dominant independent prognostic factor in multivariate analysis (P = 0.01). Overall survival (OS) varied considerably between subgroups with different genomic alterations: Patients with sole MYC translocation, and interestingly, with triple MYC+/BCL2+/TP53+ aberration had favorable outcomes (median OS not reached) similar to patients without genomic alterations (median OS 65 months). In contrast, patients with MYC+/BCL2+/TP53- double-hit lymphomas (DHL) (28 months), MYC+/BCL2-/TP53+ lymphomas (10 months) or sole TP53 mutation/deletion (12 months) had a poor median OS. Our findings demonstrate differences in OS of DLBCL patients depending on absence or presence of single or combined genetic alterations of MYC, BCL2, and TP53. Cooccurrence of TP53 and BCL2 aberrations ameliorated the poor prognostic impact of single TP53+ or BCL2+ in MYC positive patients.This pilot study generates evidence for the complex interplay between the alterations of genetic pathways in DLBCL, which goes beyond the concept of DHL. The variable survival of DLBCL patients dependent on single or combined alterations in the TP53, MYC, and BCL2 genes indicates the need for comprehensive genomic diagnosis.
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Affiliation(s)
- Ana-Iris Schiefer
- From the Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria (A-IS, CK, IS-K, BS, KW, BM, LM); Division of Hematology and Hemostaseology, Department of Internal Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (CS, KV, UJ, EP); Division of Palliative Care, Department of Internal Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (EKM); Institute of Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria (DS); Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria (DS); Institute of Pharmacology and Toxicology, Department of Biomedical Sciences, Veterinary University of Vienna, Vienna, Austria (VS); Division of Oncology, Department of Internal Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (MR); Institute of Pathology and Bacteriology, Wilhelminenspital, Vienna, Austria (AC); Portuguese Institute of Oncology, Haematology Unit, Lisbon, Portugal (MGdS); and Portuguese Institute of Anatomical Pathology, Lisbon, Portugal (JC)
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206
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Ali AS, Al-Shraim M, Al-Hakami AM, Jones IM. Epstein- Barr Virus: Clinical and Epidemiological Revisits and Genetic Basis of Oncogenesis. Open Virol J 2015; 9:7-28. [PMID: 26862355 PMCID: PMC4740969 DOI: 10.2174/1874357901509010007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 06/08/2015] [Accepted: 09/18/2015] [Indexed: 12/21/2022] Open
Abstract
Epstein-Barr virus (EBV) is classified as a member in the order herpesvirales, family herpesviridae, subfamily gammaherpesvirinae and the genus lymphocytovirus. The virus is an exclusively human pathogen and thus also termed as human herpesvirus 4 (HHV4). It was the first oncogenic virus recognized and has been incriminated in the causation of tumors of both lymphatic and epithelial nature. It was reported in some previous studies that 95% of the population worldwide are serologically positive to the virus. Clinically, EBV primary infection is almost silent, persisting as a life-long asymptomatic latent infection in B cells although it may be responsible for a transient clinical syndrome called infectious mononucleosis. Following reactivation of the virus from latency due to immunocompromised status, EBV was found to be associated with several tumors. EBV linked to oncogenesis as detected in lymphoid tumors such as Burkitt's lymphoma (BL), Hodgkin's disease (HD), post-transplant lymphoproliferative disorders (PTLD) and T-cell lymphomas (e.g. Peripheral T-cell lymphomas; PTCL and Anaplastic large cell lymphomas; ALCL). It is also linked to epithelial tumors such as nasopharyngeal carcinoma (NPC), gastric carcinomas and oral hairy leukoplakia (OHL). In vitro, EBV many studies have demonstrated its ability to transform B cells into lymphoblastoid cell lines (LCLs). Despite these malignancies showing different clinical and epidemiological patterns when studied, genetic studies have suggested that these EBV- associated transformations were characterized generally by low level of virus gene expression with only the latent virus proteins (LVPs) upregulated in both tumors and LCLs. In this review, we summarize some clinical and epidemiological features of EBV- associated tumors. We also discuss how EBV latent genes may lead to oncogenesis in the different clinical malignancies
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Affiliation(s)
- Abdelwahid Saeed Ali
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Mubarak Al-Shraim
- Department of Pathology, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Ahmed Musa Al-Hakami
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Ian M Jones
- Department of Biomedical Sciences, School of Biological Sciences, Faculty of Life Sciences, University of Reading, G37 AMS Wing, UK
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207
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Dunleavy K, Pittaluga S, Shovlin M, Roschewski M, Lai C, Steinberg SM, Jaffe ES, Wilson WH. Phase II trial of dose-adjusted EPOCH in untreated systemic anaplastic large cell lymphoma. Haematologica 2015; 101:e27-9. [PMID: 26518748 DOI: 10.3324/haematol.2015.131151] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Kieron Dunleavy
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Stefania Pittaluga
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Margaret Shovlin
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Mark Roschewski
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Catherine Lai
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Elaine S Jaffe
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Wyndham H Wilson
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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208
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Song JY, Venkataraman G, Fedoriw Y, Herrera AF, Siddiqi T, Alikhan MB, Kim YS, Murata-Collins J, Weisenburger DD, Liu X, Duffield AS. Burkitt leukemia limited to the bone marrow has a better prognosis than Burkitt lymphoma with bone marrow involvement in adults. Leuk Lymphoma 2015; 57:866-71. [PMID: 26450341 DOI: 10.3109/10428194.2015.1085529] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Burkitt lymphoma patients with bulky disease often have bone marrow involvement. However, leukemic presentation of Burkitt lymphoma in the absence of a mass (pure Burkitt leukemia; PBL) is uncommon. Both PBL and Burkitt lymphoma/leukemia, presenting with a tumor mass and marrow involvement (BLL), are considered stage IV disease, which is associated with a poor prognosis. However, there is limited information on the prognosis in adults with PBL because they have typically been included in cohorts of patients with BLL. This study identified 23 patients, which included 10 PBL and 13 BLL cases. Complex karyotypes (100%) were seen in all BLL cases compared to the PBL group (40%; p = 0.061). Patients with PBL had a significantly better 5-year overall survival of 87.5% vs only 24.3% in the BLL group (p = 0.005). The 5-year overall survival of patients with PBL treated with intensive chemotherapy is superior to those with BLL who are similarly treated.
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Affiliation(s)
- Joo Y Song
- a Department of Pathology , City of Hope National Medical Center , Duarte , CA , USA
| | | | - Yuri Fedoriw
- c Department of Pathology and Laboratory Medicine , University of North Carolina , Chapel Hill , NC , USA
| | - Alex F Herrera
- d Department of Hematology and Hematopoietic Cell Transplantation , Duarte , CA , USA
| | - Tanya Siddiqi
- d Department of Hematology and Hematopoietic Cell Transplantation , Duarte , CA , USA
| | - Mir B Alikhan
- b Department of Pathology , University of Chicago , Chicago , IL , USA
| | - Young S Kim
- a Department of Pathology , City of Hope National Medical Center , Duarte , CA , USA
| | - Joyce Murata-Collins
- a Department of Pathology , City of Hope National Medical Center , Duarte , CA , USA
| | - Dennis D Weisenburger
- a Department of Pathology , City of Hope National Medical Center , Duarte , CA , USA
| | - Xueli Liu
- e Department of Biostatistics , City of Hope National Medical Center , Duarte , CA , USA , and
| | - Amy S Duffield
- f Department of Pathology , Johns Hopkins University , Baltimore , MD , USA
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210
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Baryakh EA, Tyurina NG, Vorobyev VI, Gemdzhyan EG, Mangasarova YK, Klyasova GA, Kovrigina AM, Obukhova TN, Zvonkov EE, Vernyuk MA, Chervontseva AM, Polyakov YY, Misyurina АЕ, Valiev TT, Zherebtsova VA, Magomedova AU, Galstyan GM, Yatskov KV, Nesterova ES, Vorobyev AI, Kravchenko SK. [Therapy for Burkitt's lymphoma according to the BL-M-04 protocol: 12-year experience]. TERAPEVT ARKH 2015; 87:4-14. [PMID: 26390720 DOI: 10.17116/terarkh20158774-14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM To evaluate the efficiency and toxicity of the intensive Burkitt's lymphoma (BL) therapy protocol BL-M-04. SUBJECTS AND METHODS A total of 70 patients diagnosed with BL, including 45 men and 25 women whose age was 15 to 62 years (median age 31 years), were followed up in 2003 to 2014. Stage I (according to S. Murphy) was diagnosed in 4 (5.7%) patients; II in 9 (12.9%), III in 25 (35.7%), IV in 11 (15.7%), and Burkitt's leukemia in 21 (30%). There were tumor involvements of the bone marrow and central nervous system in 23 (32.9%) and 15 (21.4%) patients, respectively. B symptoms were detected in 56 (80%) patients; enhanced lactate dehydrogenase (LDH) activity was found in 50 (78.1%) out of 64 patients; moreover, in 34 (56.2%) out of 64 patients, LDH activity was more than twice as high as the reference values. The median LDH activity was 2398 (238-20,300) U/I. Acute renal failure at disease onset was identified in 17 (24.2%) patients; chemotherapy was initiated in 8 patients during renal replacement therapy. The treatment was performed using the BL-M-04±R protocol (4 successive blocks of A-C-A-C±R). Six blocks of A-C-A-C-A-C with rituximab has been carried out in patients with bone marrow involvement since 2011. RESULTS Sixty-two (89%) patients achieved complete remission. At this time, 6 patients died from therapy complications during remission induction; 2 patients were observed to have disease progression; 3 developed disease recurrence (2 patients had early recurrence; 1 patient developed recurrence 2 years after treatment). Five-year overall survival (OS) was 85%; 5-year relapse-free survival (RFS) was 95%. The Cox multivariate regression analysis revealed that Burkitt's leukemia and bone marrow involvement were independent factors that influenced OS and RFS. The poor somatic status (3-4 ECOC scores versus 0-2 scores) proved to be statistically significant for OS rather than RFS. CONCLUSION Despite the optimistic results obtained by our study group, there is a need to further improve BL treatment protocols and to elaborate novel approaches to therapy particularly for older patients and patients with Burkitt's leukemia.
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Affiliation(s)
- E A Baryakh
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - N G Tyurina
- P.A. Herzen Moscow Oncology Research Institute, Ministry of Health of Russia, Moscow, Russia
| | - V I Vorobyev
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - E G Gemdzhyan
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - Ya K Mangasarova
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - G A Klyasova
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - A M Kovrigina
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - T N Obukhova
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - E E Zvonkov
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - M A Vernyuk
- P.A. Herzen Moscow Oncology Research Institute, Ministry of Health of Russia, Moscow, Russia
| | - A M Chervontseva
- P.A. Herzen Moscow Oncology Research Institute, Ministry of Health of Russia, Moscow, Russia
| | - Yu Yu Polyakov
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - А Е Misyurina
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - T T Valiev
- Research Institute of Pediatric Oncology and Hematology, N.N. Blokhin Russian Cancer Research Center, Moscow, Russia
| | - V A Zherebtsova
- Central Clinical Hospital with Polyclinic, Department for Presidential Affairs of the Russian Federation, Moscow, Russia
| | - A U Magomedova
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - G M Galstyan
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - K V Yatskov
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - E S Nesterova
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - A I Vorobyev
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - S K Kravchenko
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
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How I treat posttransplant lymphoproliferative disorders. Blood 2015; 126:2274-83. [PMID: 26384356 DOI: 10.1182/blood-2015-05-615872] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 09/13/2015] [Indexed: 01/13/2023] Open
Abstract
Posttransplant lymphoproliferative disorder (PTLD) is a potentially fatal disorder arising after solid organ transplant (SOT) or hematopoietic stem cell transplant (HSCT). Iatrogenically impaired immune surveillance and Epstein-Barr virus (EBV) primary infection/reactivation are key factors in the pathogenesis. However, current knowledge on all aspects of PTLD is limited due to its rarity, morphologic heterogeneity, and the lack of prospective trials. Furthermore, the broad spectrum of underlying immune disorders and the type of graft represent important confounding factors. Despite these limitations, several reviews have been written aimed at offering a guide for pathologists and clinicians in diagnosing and treating PTLD. Rather than providing another classical review on PTLD, this "How I Treat" article, based on 2 case reports, focuses on specific challenges, different perspectives, and novel insights regarding the pathogenesis, diagnosis, and treatment of PTLD. These challenges include the wide variety of PTLD presentation (making treatment optimization difficult), the impact of EBV on pathogenesis and clinical behavior, and the controversial treatment of Burkitt lymphoma (BL)-PTLD.
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212
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Abramson JS. Transformative Clinical Trials in Non-Hodgkin and Hodgkin Lymphomas. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15 Suppl:S141-6. [PMID: 26297267 DOI: 10.1016/j.clml.2015.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/03/2015] [Indexed: 11/20/2022]
Abstract
Dramatic progress in the understanding of underlying disease biology and the development of novel therapeutics has yielded a revolution that is poised to transform the face of lymphoma treatment across a broad spectrum of histologies. Ongoing randomized clinical trials are poised to unseat long-entrenched standards of care in diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, peripheral T-cell lymphoma, and Hodgkin lymphoma. Emerging treatment approaches are reviewed, including optimization of existing chemoimmunotherapy platforms, development of chemotherapy-sparing immunotherapy for follicular lymphoma, biologically targeted therapy for subsets of diffuse large B-cell lymphoma, and incorporation of novel agents into the treatment of mantle cell lymphoma and peripheral T-cell lymphoma. Novel therapies in early stage trials with future promise of redefining standards of care are also reviewed for non-Hodgkin and Hodgkin lymphomas, including small molecule pathway inhibitors and advances in immunotherapy.
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Affiliation(s)
- Jeremy S Abramson
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, and Department of Medicine, Harvard Medical School, Boston, MA.
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213
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HIV-related hematological malignancies: a concise review. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 14 Suppl:S96-103. [PMID: 25486964 DOI: 10.1016/j.clml.2014.06.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 04/18/2014] [Accepted: 06/04/2014] [Indexed: 01/01/2023]
Abstract
HIV (Human Immunodeficiency Virus) and its consequence, AIDS (acquired immunodeficiency syndrome) are responsible for a human tragedy of incalculable proportions. Patients afflicted by it are susceptible due to an early senescence of the immune system to opportunistic infections and malignancies. Since the introduction in 1996 of highly active anti-retroviral therapy (HAART), the landscape of malignancies associated to HIV/AIDS has changed in a significant manner as a direct result of significant improvement in the morbidity, mortality and life expectancy of HIV infected patients. While there has been a significant decrease in developed countries of malignancies such as Kaposi's sarcoma and Primary CNS lymphomas associated to the pre-HAART HIV-related immunodeficiency, hematological malignancies, particularly non-Hodgkin lymphomas continue to be the most common cancer-related cause of death in HIV infected individuals. This concise review of the subject highlights aspects of the natural history of HIV disease as it relates to the cause of malignancies with emphasis in the management and treatment of HIV-related hematological malignancies.
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214
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Law MF, Chan HN, Pang CY, Lai HK, Ha CY, Ng C, Ho R, Wong CK, Yeung YM, Yip SF. Durable survival after chemotherapy in a HIV patient with Burkitt's lymphoma presenting with massive upper gastrointestinal bleeding. Int J STD AIDS 2015; 27:690-6. [PMID: 26185043 DOI: 10.1177/0956462415596301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 06/18/2015] [Indexed: 11/17/2022]
Abstract
Massive upper gastrointestinal bleeding is an uncommon presentation of Burkitt's lymphoma in a patient with HIV/AIDS, and is seldom reported in the literature. A 39-year-old man who has sex with men presented with abdominal pain and massive haematemesis and a rapid drop in haemoglobin level to 4.8 g/dL. Upper gastrointestinal endoscopy showed a large blood clot in the stomach, and an emergency laparotomy was performed because of unstable haemodynamics. This showed active bleeding from multiple tumours in the fundus and body of the stomach. The patient underwent gastrectomy and gastric biopsy confirmed Burkitt's lymphoma. Further tests showed lymphoma involvement in bone marrow and central nervous system. The patient tested positive for HIV, and had a CD4 count of 212 cells/mm(3) and viral load of 18,000 copies/mL at diagnosis. He was commenced on a chemotherapy regimen of CODOX-M/IVAC, and highly active antiretroviral therapy consisting of indinavir, stavudine and lamivudine. The major side effect was peripheral neuropathy. Infective complications during chemotherapy were controlled by broad-spectrum antibiotics and anti-fungal agents. Complete remission of the lymphoma was achieved after the chemotherapy and remission was maintained for more than 14 years.
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Affiliation(s)
- Man F Law
- Department of Medicine, Tuen Mun Hospital, Hong Kong Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | - Hay N Chan
- Department of Medicine, Tuen Mun Hospital, Hong Kong
| | - Chun Y Pang
- Department of Pathology, North District Hospital, Hong Kong
| | - Ho K Lai
- Department of Medicine, Tuen Mun Hospital, Hong Kong
| | - Chung Y Ha
- Department of Medicine, Tuen Mun Hospital, Hong Kong
| | - Celia Ng
- Department of Medicine, Tuen Mun Hospital, Hong Kong
| | - Rita Ho
- Department of Medicine, North District Hospital, Hong Kong
| | - Cheuk K Wong
- Department of Radiology, Tuen Mun Hospital, Hong Kong
| | - Yiu M Yeung
- Department of Medicine, Tuen Mun Hospital, Hong Kong
| | - Sze F Yip
- Department of Medicine, Tuen Mun Hospital, Hong Kong
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Peripheral blood lymphocyte to monocyte ratio identifies high-risk adult patients with sporadic Burkitt lymphoma. Ann Hematol 2015; 94:1645-54. [PMID: 26082333 DOI: 10.1007/s00277-015-2427-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 06/09/2015] [Indexed: 01/29/2023]
Abstract
Adult sporadic Burkitt lymphoma (BL) is a rare subtype of lymphoma. In this retrospective study, we investigated the prognostic value of pretreatment lymphocyte to monocyte ratio (LMR) in a cohort of 62 patients. Using LMR <2.6 as the optimal cutoff point, 24 patients (38.7 %) had LMR <2.6. The complete response rates in high-LMR group and low-LMR group were 90.9 and 65.0 %, respectively (P = 0.019). At a median follow-up time of 41 months, the 3-year progression-free survival (PFS) rate and overall survival (OS) rates were 76 and 80 %, respectively. In a multivariate Cox regression model, it was found that the presence of bone marrow infiltration and low LMR were independently adverse prognostic factors for both PFS and OS. In the whole group, the addition of rituximab to treatment did not benefit patients significantly in PFS and OS. In subgroup analysis, in patients with high LMR, addition of rituximab can significantly improve survival outcomes (P = 0.046). In conclusion, we firstly found that low LMR (<2.60) was an independently adverse prognostic factor in adult patients with sporadic BL. Intensive chemotherapy could cure the majority of patients in our study, and the pretreatment LMR might predict the value of rituximab in this age population.
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Adding rituximab to CODOX-M/IVAC chemotherapy in the treatment of HIV-associated Burkitt lymphoma is safe when used with concurrent combination antiretroviral therapy. AIDS 2015; 29:903-10. [PMID: 25730506 DOI: 10.1097/qad.0000000000000623] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES CODOX-M/IVAC (cyclophosphamide, vincristine, doxorubicin-methatrexate/ifusamide, etoposide, cytarabine) chemotherapy is commonly used to treat Burkitt lymphoma and in the HIV-negative population. Rituximab is often added with suggested survival benefits. Concerns over increased toxicity in an already immunocompromized population have prevented its routine addition in people living with HIV (PLWH). This study evaluated the effect on treatment-related toxicity and efficacy of adding rituximab to CODOX-M/IVAC chemotherapy in PLWH. DESIGN Retrospective review of 91 PLWH (74 men) with Burkitt lymphoma treated in five London centers between 2003 and 2013. All patients received combination antiretroviral therapy. RESULTS Forty-nine patients received CODOX-M/IVAC and 42 rituximab (R)-CODOX-M/R-IVAC. The addition of rituximab did not confer any significant increase in grade 3/4 toxicities including infections, mucositis, diarrhea, renal impairment, and tumor lysis syndrome. There was no significant difference in toxic deaths between groups (P = 0.14). The 2-year overall survival (OS) was greater for patients receiving rituximab {2-year OS 72% [95% confidence interval (CI) 0.22-0.92, hazard ratio 0.46] vs. 55% [95% CI 1.1-4.5, hazard ratio 2.2]; log-rank P = 0.04}. Similarly, the 2-year progression-free survival (PFS) was greater in the rituximab cohort [2-year PFS 81% (95% CI 0.21-0.99, hazard ratio 0.46) vs. 55% (95% CI 1.0-4.8, hazard ratio 2.2); log-rank P = 0.04]. CONCLUSION Our multicenter analysis is the largest to date in this population and showed that the addition of rituximab to CODOX-M/IVAC chemotherapy confers no increase in toxicity and results in significantly improved OS and PFS in PLWH with Burkitt lymphoma who receive concomitant combination antiretroviral therapy.
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218
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Jabbour E, O'Brien S, Konopleva M, Kantarjian H. New insights into the pathophysiology and therapy of adult acute lymphoblastic leukemia. Cancer 2015; 121:2517-28. [PMID: 25891003 DOI: 10.1002/cncr.29383] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 02/26/2015] [Accepted: 03/02/2015] [Indexed: 01/13/2023]
Abstract
Significant advances have been made in the last decade toward a better understanding of the disease pathogenesis and the development of novel therapies that target specific subsets of adult acute lymphoblastic leukemia (ALL). Risk-adapted strategies are transforming the disease treatment and prognosis. With current treatment regimens, long-term survival is achieved by approximately 50% of patients with B-cell ALL, 50% to 60% of patients with Philadelphia chromosome-positive ALL, and approximately 80% of patients with Burkitt's leukemia. Genomic profiling in ALL has identified new prognostic markers, new therapeutic targets, and novel ALL subtypes. These may be amenable to future targeted therapies that can further improve outcomes. The early recognition of early precursor T-cell ALL, a distinct pathobiological entity with a poor prognosis, is essential for the development of an effective clinical management strategy. The role of monoclonal antibodies and cytotoxic T-cell therapies continues to be defined. Many of the approaches are currently being evaluated for ALL salvage. Their incorporation into frontline adult ALL therapy, in concomitant or sequential strategies, may increase the cure rates to levels achieved in pediatric ALL and may reduce the need for prolonged intensive and maintenance chemotherapy.
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Affiliation(s)
- Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Susan O'Brien
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
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219
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Burkitt leukaemia/lymphoma: R-CODOX-M/R-IVAC remains gold standard treatment in BL. Ir J Med Sci 2015; 185:773-777. [PMID: 25843016 DOI: 10.1007/s11845-015-1288-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 03/29/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sporadic Burkitt lymphoma (BL), characterised by translocation-associated C-MYC upregulation is a rare, aggressive lymphoma with a cure rate up to 90 % using the R-CODOX-M/R-IVAC (RCRI) protocol. RCRI is active in HIV-associated BL in combination with HAART. The WHO classification system defines lymphomas intermediate between DLBCL and BL, in which lymphomas with t(14;18)(q32;q21) and C-MYC-carrying translocation, i.e. 'double-hit' are included (BL-DH), and these patients are conventionally treated with RCRI. RESULT We describe the SJH experience of 25 patients with BL, BL + HIV and BL-DH treated with RCRI between 2002 and 2011. Twelve BL patients (8M/4F), median age 49.1 years (range 20-73 years); of whom 9 had extensive disease, including 8 with marrow and 2 with CNS involvement. Eleven patients remain in remission at 80.5 months (range 37-147 months) from completion of treatment and one died of progressive BL giving an OS of 91.6 % at 1 year with no late relapses. Eight patients with BL + HIV were treated (6M/2F) with a median age 40.25 years (range 24-64). Five remain in complete remission (CR) at 65 months (range 13-109 months), three patients died, two of progressive disease and one of treatment-associated hepatotoxicity in CR. Five patients with BL-DH were included; (3M/2F), age 47.8 years (range 42-55 years); and all patients died of progressive disease, 4 on RCRI therapy and a further patient despite an allogeneic transplantation. CONCLUSION These results confirm that RCRI is an effective treatment in adults with BL and BL + HIV and remains the gold standard against which other regimens should be compared. We confirm the poor prognosis found in BL-DH, indicating new treatment approaches are needed for this sub-group which should be identified at diagnosis by FISH analysis.
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220
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Pinzone MR, Berretta M, Cacopardo B, Nunnari G. Epstein-Barr Virus– and Kaposi Sarcoma-Associated Herpesvirus–Related Malignancies in the Setting of Human Immunodeficiency Virus Infection. Semin Oncol 2015; 42:258-71. [DOI: 10.1053/j.seminoncol.2014.12.026] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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221
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When and how to test for C-MYC in aggressive B cell lymphomas. J Hematop 2015. [DOI: 10.1007/s12308-014-0220-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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222
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Barta SK, Samuel MS, Xue X, Wang D, Lee JY, Mounier N, Ribera JM, Spina M, Tirelli U, Weiss R, Galicier L, Boue F, Little RF, Dunleavy K, Wilson WH, Wyen C, Remick SC, Kaplan LD, Ratner L, Noy A, Sparano JA. Changes in the influence of lymphoma- and HIV-specific factors on outcomes in AIDS-related non-Hodgkin lymphoma. Ann Oncol 2015; 26:958-966. [PMID: 25632071 DOI: 10.1093/annonc/mdv036] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 01/12/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We undertook the present analysis to examine the shifting influence of prognostic factors in HIV-positive patients diagnosed with aggressive non-Hodgkin lymphoma (NHL) over the last two decades. PATIENTS AND METHODS We carried out a pooled analysis from an existing database of patients with AIDS-related lymphoma. Individual patient data had been obtained prior from prospective phase II or III clinical trials carried out between 1990 until 2010 in North America and Europe that studied chemo(immuno)therapy in HIV-positive patients diagnosed with AIDS-related lymphomas. Studies had been identified by a systematic review. We analyzed patient-level data for 1546 patients with AIDS-related lymphomas using logistic regression and Cox proportional hazard models to identify the association of patient-, lymphoma-, and HIV-specific variables with the outcomes complete response (CR), progression-free survival, and overall survival (OS) in different eras: pre-cART (1989-1995), early cART (1996-2000), recent cART (2001-2004), and contemporary cART era (2005-2010). RESULTS Outcomes for patients with AIDS-related diffuse large B-cell lymphoma and Burkitt lymphoma improved significantly over time, irrespective of baseline CD4 count or age-adjusted International Prognostic Index (IPI) risk category. Two-year OS was best in the contemporary era: 67% and 75% compared with 24% and 37% in the pre-cART era (P < 0.001). While the age-adjusted IPI was a significant predictor of outcome in all time periods, the influence of other factors waxed and waned. Individual HIV-related factors such as low CD4 counts (<50/mm(3)) and prior history of AIDS were no longer associated with poor outcomes in the contemporary era. CONCLUSIONS Our results demonstrate a significant improvement of CR rate and survival for all patients with AIDS-related lymphomas. Effective HIV-directed therapies reduce the impact of HIV-related prognostic factors on outcomes and allow curative antilymphoma therapy for the majority of patients with aggressive NHL.
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Affiliation(s)
- S K Barta
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia.
| | - M S Samuel
- Department of Medical Oncology, Montefiore Medical Center, Bronx
| | - X Xue
- Department of Epidemiology and Population Health, Albert Einstein Cancer Center, Bronx
| | - D Wang
- Department of Epidemiology and Population Health, Albert Einstein Cancer Center, Bronx
| | - J Y Lee
- Department of Biostatistics, University of Arkansas, Little Rock, USA
| | - N Mounier
- Groupe d'Etude des Lymphomes de l'Adulte (GELA), France
| | - J-M Ribera
- ICO-Hospital Germans Trias i Pujol, Jose Carreras Research Institute and PETHEMA Group, Badalona, Spain
| | - M Spina
- Department of Medical Oncology, National Cancer Institute, Aviano, Italy
| | - U Tirelli
- Department of Medical Oncology, National Cancer Institute, Aviano, Italy
| | - R Weiss
- Private Practice for Hematology and Oncology, Bremen, Germany
| | - L Galicier
- Department of Immunology, Hopital St Louis, Assistance Publique-Hopitaux de Paris, Paris
| | - F Boue
- Department of Internal Medicine and Immunology, Hopital Antoine Beclere, Clamart, France
| | | | - K Dunleavy
- Department of Medical Oncology, National Cancer Institute, Bethesda, USA
| | - W H Wilson
- Department of Medical Oncology, National Cancer Institute, Bethesda, USA
| | - C Wyen
- Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - S C Remick
- Mary Babb Randolph Cancer Center, West Virginia University, Morgantown
| | - L D Kaplan
- Department of Hematology and Oncology, University of California San Francisco, San Francisco
| | - L Ratner
- Division of Oncology, Washington University School of Medicine, St Louis
| | - A Noy
- Memorial Sloan-Kettering Cancer Center and Weill Cornell, Lymphoma Service, New York, USA
| | - J A Sparano
- Department of Medical Oncology, Montefiore Medical Center, Bronx
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Johnson DH, Reske T, Ruiz M. Case report and review of immunodeficiency-associated Burkitt lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:e121-5. [PMID: 25701328 DOI: 10.1016/j.clml.2014.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 12/10/2014] [Accepted: 12/16/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel H Johnson
- Louisiana State University Health Sciences Center, New Orleans, LA.
| | - Thomas Reske
- Louisiana State University Health Sciences Center, New Orleans, LA
| | - Marco Ruiz
- Louisiana State University Health Sciences Center, New Orleans, LA
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Kojima M, Nakamura N, Yabe M, Tokunaka M, Kikuti YY, Kikuchi T, Murayama H, Moriuchi M, Tsuboi K, Ogawa Y, Ando K. A case of clonally distinct relapse of Burkitt lymphoma 9 years after complete remission. Int J Hematol 2015; 101:520-4. [DOI: 10.1007/s12185-014-1729-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 12/15/2014] [Accepted: 12/19/2014] [Indexed: 12/22/2022]
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225
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Chu Y, Hochberg J, Yahr A, Ayello J, van de Ven C, Barth M, Czuczman M, Cairo MS. Targeting CD20+ Aggressive B-cell Non-Hodgkin Lymphoma by Anti-CD20 CAR mRNA-Modified Expanded Natural Killer Cells In Vitro and in NSG Mice. Cancer Immunol Res 2014; 3:333-44. [PMID: 25492700 DOI: 10.1158/2326-6066.cir-14-0114] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 11/25/2014] [Indexed: 11/16/2022]
Abstract
The prognosis is very dismal for patients with relapsed CD20(+) B-cell non-Hodgkin lymphoma (B-NHL). Facilitating the development of alternative novel therapeutic strategies is required to improve outcomes in patients with recurrent/refractory CD20(+) B-NHL. In this study, we investigated functional activities of anti-CD20 CAR-modified, expanded peripheral blood NK cells (exPBNK) following mRNA nucleofection against CD20(+) B-NHL in vitro and in vivo. CAR(+) exPBNK had significantly enhanced in vitro cytotoxicity, compared with CAR(-) exPBNK against CD20(+) Ramos (P < 0.05), Daudi, Raji, and two rituximab-resistant cell lines, Raji-2R and Raji-4RH (P < 0.001). As expected, there was no significant difference against CD20(-) RS4;11 and Jurkat cells. CD107a degranulation and intracellular IFNγ production were also enhanced in CAR(+) exPBNK in response to CD20(+) B-NHL -: specific stimulation. In Raji-Luc and Raji-2R-Luc xenografted NOD/SCID/γ-chain(-/-) (NSG) mice, the luciferase signals measured in the CAR(+) exPBNK-treated group were significantly reduced, compared with the signals measured in the untreated mice and in mice treated with the CAR(-) exPBNK. Furthermore, the CAR exPBNK-treated mice had significantly extended survival time (P < 0.001) and reduced tumor size, compared with those of the untreated and the CAR(-) exPBNK-treated mice (P < 0.05). These preclinical data suggest that ex vivo-exPBNK modified with anti-CD20 CAR may have therapeutic potential for treating patients with poor-risk CD20(+) hematologic malignancies.
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Affiliation(s)
- Yaya Chu
- Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York
| | - Jessica Hochberg
- Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York
| | - Ashlin Yahr
- Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York
| | - Janet Ayello
- Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York
| | - Carmella van de Ven
- Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York
| | - Matthew Barth
- Department of Pediatrics, State University of New York at Buffalo, Buffalo, New York
| | - Myron Czuczman
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York. Department of Immunology, Roswell Park Cancer Institute, Buffalo, New York
| | - Mitchell S Cairo
- Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York. Department of Medicine, New York Medical College, Valhalla, New York. Department of Pathology, New York Medical College, Valhalla, New York. Department of Microbiology and Immunology, New York Medical College, Valhalla, New York. Department of Cell Biology and Anatomy, New York Medical College, Valhalla, New York.
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Abstract
Abstract
Double-hit lymphomas (DHLs) are a heterogeneous group of mature B-cell lymphomas that harbor concurrent rearrangements of MYC and BCL2 or, occasionally, BCL6. Several studies have now shown that they are associated with a very aggressive clinical course and poor outcome after standard R-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) therapy, with few patients surviving beyond 2 years. Due to their rarity, there is a paucity of data evaluating patient outcomes with alternative strategies to R-CHOP and no consensus on how they should be optimally managed. Recent studies have demonstrated that a significant proportion of diffuse large B-cell lymphoma (DLBCL) cases have high protein expression of MYC and BCL2 as detected by IHC. These so-called “double-expressor” DLBCLs are also associated with a poor outcome after R-CHOP, even when MYC and BCL2 rearrangements are absent. There is much interest in developing new strategies for DHL and better characterizing the underlying biology that drives their poor prognosis. Alternative chemotherapy platforms to R-CHOP, such as DA-EPOCH-R (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab), are under investigation for MYC-rearranged DLBCL, including DHL, and several novel small-molecule inhibitors of MYC and BCL2 are in development.
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227
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Cohen JB, Flowers CR. Optimal disease surveillance strategies in non-Hodgkin lymphoma. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2014; 2014:481-487. [PMID: 25696898 DOI: 10.1182/asheducation-2014.1.481] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Given the paucity of randomized controlled trial data, defining the ideal strategy for surveillance imaging in patients with non-Hodgkin lymphoma (NHL) has become increasingly challenging. The routine use of frequent surveillance scans has been a common component of patient care. Emerging data from prospective and retrospective observational studies and modeling approaches have highlighted the performance characteristics of imaging modalities and the challenges with this form of secondary screening. The majority of patients with relapsed lymphoma have clinical signs or symptoms that prompt further evaluation, and only a small proportion of patients experience relapse detected on a routine scan while being otherwise asymptomatic. Surveillance imaging is costly, may expose patients to minimal risks of mortality due to radiation-related secondary malignancies, and can lead to false-positive findings, leading to unnecessary biopsies. In addition, no prospective study has demonstrated a significant improvement in overall survival for those patients whose disease is discovered on a routine scan versus those who present with clinical symptoms. In this chapter, we examine the baseline risks of relapse for various NHL subtypes that provide the context for surveillance, review the data on imaging modalities, and establish a framework for discussing optimal surveillance strategies with individual patients. Patients should be counseled on the risks and benefits of routine surveillance imaging and decisions regarding surveillance should be made on an individual basis using patient-specific risk factors, response to induction therapy, and patient preferences with a bias toward using surveillance imaging in the 2 years after treatment only in those NHL patients with the greatest likelihood of benefit.
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Discovery of novel small-molecule compounds with selective cytotoxicity for Burkitt's lymphoma cells using 3D ligand-based virtual screening. Molecules 2014; 19:19209-19. [PMID: 25415480 PMCID: PMC6270761 DOI: 10.3390/molecules191119209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 11/06/2014] [Accepted: 11/11/2014] [Indexed: 11/17/2022] Open
Abstract
We describe a ligand-based approach towards compounds with more specific targeting for Burkitt's lymphoma. Using three-dimensional ligand-based similarity searches and a previously described hit compound, we have identified six compounds that are chemically different but with similar spatial conformations. Biological evaluation revealed that one compound has better growth inhibition and improved selectivity towards Burkitt's lymphoma cells than the query compound. However, initial mechanism-of-action studies show a different target profile in comparison with the previous hit compound, which does not involve the inhibition of the proteasome or the NFκB pathway. The data from this study provide a solid basis for further efforts in the search for selective agents against Burkitt's lymphoma.
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229
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Abstract
Abstract
Burkitt lymphoma (BL) is an aggressive B-cell non-Hodgkin lymphoma that is almost uniformly associated with translocations involving the gene for MYC on chromosome 8. The 3 subtypes of BL, endemic, sporadic, and immunodeficiency-associated, differ from epidemiologic and clinical perspectives but may be genetically similar. Prompt administration of multiagent immunochemotherapy regimens is associated with favorable outcomes for the majority of patients. Survival is inferior in older patients, likely reflecting increased therapy-related toxicity, possibly resulting in decreased treatment intensity. Central nervous system prophylaxis, tumor lysis prevention and treatment, and management of infectious complications from myelosuppressive regimens are critical. Prognosis of refractory or relapsed disease is poor and patients are best treated on clinical trials when available.
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Improved outcome of adult Burkitt lymphoma/leukemia with rituximab and chemotherapy: report of a large prospective multicenter trial. Blood 2014; 124:3870-9. [PMID: 25359988 DOI: 10.1182/blood-2014-03-563627] [Citation(s) in RCA: 187] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This largest prospective multicenter trial for adult patients with Burkitt lymphoma/leukemia aimed to prove the efficacy and feasibility of short-intensive chemotherapy combined with the anti-CD20 antibody rituximab. From 2002 to 2011, 363 patients 16 to 85 years old were recruited in 98 centers. Treatment consisted of 6 5-day chemotherapy cycles with high-dose methotrexate, high-dose cytosine arabinoside, cyclophosphamide, etoposide, ifosphamide, corticosteroids, and triple intrathecal therapy. Patients >55 years old received a reduced regimen. Rituximab was given before each cycle and twice as maintenance, for a total of 8 doses. The rate of complete remission was 88% (319/363); overall survival (OS) at 5 years, 80%; and progression-free survival, 71%; with significant difference between adolescents, adults, and elderly patients (OS rate of 90%, 84%, and 62%, respectively). Full treatment could be applied in 86% of the patients. The most important prognostic factors were International Prognostic Index (IPI) score (0-2 vs 3-5; P = .0005), age-adjusted IPI score (0-1 vs 2-3; P = .0001), and gender (male vs female; P = .004). The high cure rate in this prospective trial with a substantial number of participating hospitals demonstrates the efficacy and feasibility of chemoimmunotherapy, even in elderly patients. This trial was registered at www.clinicaltrials.gov as #NCT00199082.
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231
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Hong J, Kim SJ, Ahn JS, Song MK, Kim YR, Lee HS, Yhim HY, Yoon DH, Kim MK, Oh SY, Park Y, Mun YC, Do YR, Ryoo HM, Lee JJ, Lee JH, Kim WS, Suh C. Treatment Outcomes of Rituximab Plus Hyper-CVAD in Korean Patients with Sporadic Burkitt or Burkitt-like Lymphoma: Results of a Multicenter Analysis. Cancer Res Treat 2014; 47:173-81. [PMID: 25544581 PMCID: PMC4398112 DOI: 10.4143/crt.2014.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 03/25/2014] [Indexed: 02/02/2023] Open
Abstract
PURPOSE This study was conducted to evaluate outcomes in adult patients with Burkitt lymphoma (BL) or Burkitt-like lymphoma treated with an rituximab plus hyper-CVAD (R-hyper-CVAD) regimen by focusing on tolerability and actual delivered relative dose intensity (RDI). MATERIALS AND METHODS Patients ≥ 20 years of age and pathologically diagnosed with BL or Burkitt-like lymphoma were treated with at least one cycle of R-hyper-CVAD as the first-line treatment in this study. Eligible patients' case report forms were requested from their physicians to obtain clinical and laboratory data for this retrospective study. RESULTS Forty-three patients (median age, 51 years) from 14 medical centers in Korea were analyzed, none of which were infected with human immunodeficiency virus. The majority of patients had advanced diseases, and 24 patients achieved a complete response (75.0%). After a median follow-up period of 20.0 months, 2-year event-free and overall survival rates were 70.9% and 81.4%, respectively. Eleven patients (25.6%) were unable to complete the R-hyper-CVAD regimen, including six patients due to early death. The RDIs of adriamycin, vincristine, methotrexate, and cytarabine were between 60% and 65%, which means less than 25% of patients received greater than 80% of the planned dose of each drug. Poor performance status was related to the lower RDIs of doxorubicin and methotrexate. CONCLUSION R-hyper-CVAD showed excellent treatment outcomes in patients who were suitable for dose-intense chemotherapy. However, management of patients who are intolerant to a dose-intense regimen remains problematic due to the frequent occurrence of treatmentrelated complications.
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Affiliation(s)
- Junshik Hong
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Seok Jin Kim
- Department of Medicine, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Sook Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Moo Kon Song
- Department of Hematology-Oncology, Pusan National University Hospital, Busan, Korea
| | - Yu Ri Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Sup Lee
- Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Ho-Young Yhim
- Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Kyoung Kim
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Sung Yong Oh
- Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
| | - Yong Park
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yeung-Chul Mun
- Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Young Rok Do
- Department of Hematology-Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Hun-Mo Ryoo
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Je-Jung Lee
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jae Hoon Lee
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Won Seog Kim
- Department of Medicine, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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232
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Dunleavy K, Roschewski M, Wilson WH. Precision treatment of distinct molecular subtypes of diffuse large B-cell lymphoma: ascribing treatment based on the molecular phenotype. Clin Cancer Res 2014; 20:5182-93. [PMID: 25320368 PMCID: PMC7521674 DOI: 10.1158/1078-0432.ccr-14-0497] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Although diffuse large B-cell lymphoma (DLBCL), the most common type of non-Hodgkin lymphoma, was once considered to be a single disease, novel insights into its biology have revealed that it is molecularly heterogeneous. Technologies such as gene expression profiling have revealed that DLBCL consists of at least three distinct molecular diseases that have disparate outcomes following standard therapy. These subtypes arise from different stages of B-cell differentiation and are characterized by distinct oncogenic activation mechanisms. This knowledge has led to the investigation of strategies and novel agents that have selective activity within molecular subtypes and sets the stage for an era of precision medicine in DLBCL therapeutics, where therapy can be ascribed based on molecular phenotype. This work offers the chance of improving the curability of DLBCL, particularly in the activated B-cell subtype, where standard approaches are inadequate for a high proportion of patients. See all articles in this CCR Focus section, "Paradigm Shifts in Lymphoma."
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Affiliation(s)
- Kieron Dunleavy
- Lymphoid Malignancy Branch, National Cancer Institute, Bethesda, Maryland
| | - Mark Roschewski
- Lymphoid Malignancy Branch, National Cancer Institute, Bethesda, Maryland
| | - Wyndham H Wilson
- Lymphoid Malignancy Branch, National Cancer Institute, Bethesda, Maryland.
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233
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Camilo GB, Machado DC, de Oliveira CE, Lacerda LDS, de Oliveira RV, Silva MDF, Lopes AJ. Burkitt lymphoma with initial clinical presentation due to infiltration of the central nervous system and eye orbits. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:404-10. [PMID: 25243420 PMCID: PMC4173803 DOI: 10.12659/ajcr.891224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Patient: Male, 17 Final Diagnosis: Burkitt lymphoma Symptoms: Anisocoria, ipsilateral ptosis, opthalmoparesis, paresis Medication: — Clinical Procedure: — Specialty: Oncology
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Affiliation(s)
| | | | | | | | | | - Monique de França Silva
- Department of Anatomic Pathology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Postgraduate Programe in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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234
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Abola MV, Prasad V, Jena AB. Association between treatment toxicity and outcomes in oncology clinical trials. Ann Oncol 2014; 25:2284-2289. [PMID: 25193993 DOI: 10.1093/annonc/mdu444] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Whether or not toxicity predicts clinical outcomes has long been a question regarding cancer treatments. While prior studies have focused on specific cancers, therapies, and toxicities, no comprehensive evidence exists on whether treatment toxicity predicts favorable outcomes. METHODS We abstracted treatment toxicity and clinical outcome data from a sample of phase III oncology randomized clinical trials (n = 99 trials). We investigated whether treatments with relatively greater toxicity compared with their controls had relatively higher, lower, or equivocal rates of clinical efficacy, measured by progression-free survival (PFS) and overall survival (OS). Several toxicities were assessed (all grades, grades III/IV, cutaneous rash, gastrointestinal toxicity, and myelosuppression). RESULTS Toxicity and efficacy were greater among treatments than controls (e.g. 3.5 instances of all-grade toxicity per patient in treatment arms versus 2.8 instances in controls, P < 0.001; mean PFS of 9.1 months across treatment arms versus 7.1 months across controls, P < 0.001; mean OS of 18.6 months across treatment arms versus 16.9 months across controls, P < 0.001). Across trials, greater relative treatment toxicity was strongly associated with greater PFS in treatments versus controls (P < 0.001), but not OS (P = 0.44). Although higher relative rates of myelosuppression and cutaneous rash among treatments were not associated with greater treatment efficacy, greater relative gastrointestinal toxicity among treatments was associated with greater relative PFS compared with controls (P = 0.007). CONCLUSION Across trials, treatments with relatively greater all-grade toxicity compared with controls are associated with relatively greater PFS but not OS.
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Affiliation(s)
- M V Abola
- Department of Family Medicine, Case Western Reserve University School of Medicine, Cleveland
| | - V Prasad
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda
| | - A B Jena
- Department of Health Care Policy, Harvard Medical School, Boston; Department of Medicine, Massachusetts General Hospital, Boston, USA.
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235
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Impact of induction regimen and stem cell transplantation on outcomes in double-hit lymphoma: a multicenter retrospective analysis. Blood 2014; 124:2354-61. [PMID: 25161267 DOI: 10.1182/blood-2014-05-578963] [Citation(s) in RCA: 330] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Patients with double-hit lymphoma (DHL), which is characterized by rearrangements of MYC and either BCL2 or BCL6, face poor prognoses. We conducted a retrospective multicenter study of the impact of baseline clinical factors, induction therapy, and stem cell transplant (SCT) on the outcomes of 311 patients with previously untreated DHL. At median follow-up of 23 months, the median progression-free survival (PFS) and overall survival (OS) rates among all patients were 10.9 and 21.9 months, respectively. Forty percent of patients remain disease-free and 49% remain alive at 2 years. Intensive induction was associated with improved PFS, but not OS, and SCT was not associated with improved OS among patients achieving first complete remission (P = .14). By multivariate analysis, advanced stage, central nervous system involvement, leukocytosis, and LDH >3 times the upper limit of normal were associated with higher risk of death. Correcting for these, intensive induction was associated with improved OS. We developed a novel risk score for DHL, which divides patients into high-, intermediate-, and low-risk groups. In conclusion, a subset of DHL patients may be cured, and some patients may benefit from intensive induction. Further investigations into the roles of SCT and novel agents are needed.
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236
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Barta SK, Xue X, Wang D, Lee JY, Kaplan LD, Ribera JM, Oriol A, Spina M, Tirelli U, Boue F, Wilson WH, Wyen C, Dunleavy K, Noy A, Sparano JA. A new prognostic score for AIDS-related lymphomas in the rituximab-era. Haematologica 2014; 99:1731-7. [PMID: 25150257 DOI: 10.3324/haematol.2014.111112] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
While the International Prognostic Index is commonly used to predict outcomes in immunocompetent patients with aggressive B-cell non-Hodgkin lymphomas, HIV-infection is an important competing risk for death in patients with AIDS-related lymphomas. We investigated whether a newly created prognostic score (AIDS-related lymphoma International Prognostic Index) could better assess risk of death in patients with AIDS-related lymphomas. We randomly divided a dataset of 487 patients newly diagnosed with AIDS-related lymphomas and treated with rituximab-containing chemoimmunotherapy into a training (n=244) and validation (n=243) set. We examined the association of HIV-related and other known risk factors with overall survival in both sets independently. We defined a new score (AIDS-related lymphoma International Prognostic Index) by assigning weights to each significant predictor [age-adjusted International Prognostic Index, extranodal sites, HIV-score (composed of CD4 count, viral load, and prior history of AIDS)] with three risk categories similar to the age-adjusted International Prognostic Index (low, intermediate and high risk). We compared the prognostic value for overall survival between AIDS-related lymphoma International Prognostic Index and age-adjusted International Prognostic Index in the validation set and found that the AIDS-related lymphoma International Prognostic Index performed significantly better in predicting risk of death than the age-adjusted International Prognostic Index (P=0.004) and better discriminated risk of death between each risk category (P=0.015 vs. P=0.13). Twenty-eight percent of patients were defined as low risk by the ARL-IPI and had an estimated 5-year overall survival (OS) of 78% (52% intermediate risk, 5-year OS 60%; 20% high risk, 5-year OS 50%).
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Affiliation(s)
| | - Xiaonan Xue
- Albert Einstein Cancer Center, Bronx, NY, USA
| | - Dan Wang
- Albert Einstein Cancer Center, Bronx, NY, USA
| | | | | | - Josep-Maria Ribera
- ICO-Hospital Germans Trias i Pujol, Jose Carreras Research Institute and PETHEMA Group, Badalona, Spain
| | - Albert Oriol
- ICO-Hospital Germans Trias i Pujol, Jose Carreras Research Institute and PETHEMA Group, Badalona, Spain
| | | | | | | | | | | | | | - Ariela Noy
- Memorial-Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
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237
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Goldman S, Smith L, Galardy P, Perkins SL, Frazer JK, Sanger W, Anderson JR, Gross TG, Weinstein H, Harrison L, Shiramizu B, Barth M, Cairo MS. Rituximab with chemotherapy in children and adolescents with central nervous system and/or bone marrow-positive Burkitt lymphoma/leukaemia: a Children's Oncology Group Report. Br J Haematol 2014; 167:394-401. [PMID: 25066629 DOI: 10.1111/bjh.13040] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/13/2014] [Indexed: 12/16/2022]
Abstract
Children and adolescents with Burkitt Lymphoma (BL) and combined central nervous system (CNS) and bone marrow involvement still have a poor prognosis with chemotherapy alone. We therefore investigated in children and adolescents with bone marrow (≥25% blasts) and/or CNS-positive Burkitt lymphoma the chemoimmunotherapy combination of rituximab (375 mg/m(2) ) and the standard chemotherapy arm of our previously reported French-American-British (FAB) Lymphome Malins de Burkitt (LMB) 96 trial. Central pathological and cytogenetic characterization was also performed. There were 40 evaluable patients with Burkitt histology (25 with leukaemia and 15 with CNS disease ± leukaemia). The chemoimmunotherapy regimen was well tolerated. The incidence of grade III/IV mucositis during induction cycles with combined chemotherapy and rituximab was 31% and 26%, respectively. The 3-year event-free survival (EFS)/overall survival (OS) was 90% (95% confidence interval [CI], 76-96%) in the entire cohort and 93% (95% CI, 61-99%) in patients with CNS disease. Based on the results of this trial, an international randomized study of FAB/LMB 96 chemotherapy ± rituximab for high-risk patients is currently under investigation.
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Affiliation(s)
- Stanton Goldman
- Division of Pediatric Hematology/Oncology, Medical City Children's Hospital, Dallas, TX, USA
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238
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Avivi I, Farbstein D, Brenner B, Horowitz NA. Non-Hodgkin lymphomas in pregnancy: tackling therapeutic quandaries. Blood Rev 2014; 28:213-20. [PMID: 25108745 DOI: 10.1016/j.blre.2014.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/23/2014] [Accepted: 06/27/2014] [Indexed: 12/15/2022]
Abstract
Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) often present with systemic symptoms such as fatigue, shortness of breath and night sweats, mimicking pregnancy-related features which may result in delayed disease diagnosis. Furthermore, the wish to avoid investigational imaging, aiming to protect the fetus from radiation exposure, may lead to a further delay, which does not often result in significant changes in HL clinical nature and patient outcome. In contrast, a more aggressive behavior (i.e., advanced disease stage and reproductive organ involvement) of most NHL types diagnosed in pregnancy may require urgent therapeutic intervention to prevent disease progression. Current management of pregnancy-associated NHL depends on histological subtype of the disease, gestational stage at diagnosis and the urgency of treatment for a specific patient. Patients diagnosed with indolent lymphoma may often be just followed, whereas those presenting with aggressive or highly aggressive disease need to be urgently treated with chemoimmunotherapy, either after undergoing an elective pregnancy termination if diagnosed at an early gestational stage, or with pregnancy preservation, if diagnosed later. Supportive care of NHL is also important; however, granulocyte colony stimulating factor (G-CSF) which is commonly used outside of pregnancy, should be cautiously employed, considering its established teratogenicity in animals, though this is less proven in humans. In conclusion, given the paucity of studies prospectively evaluating the outcome of pregnant women with NHL, international efforts are warranted to elucidate critical issues and develop guidelines for the management of such patients.
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Affiliation(s)
- Irit Avivi
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Dan Farbstein
- Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Benjamin Brenner
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Netanel A Horowitz
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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239
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Jejunal Perforation: A Rare Presentation of Burkitt's Lymphoma-Successful Management. Case Rep Oncol Med 2014; 2014:538359. [PMID: 24995139 PMCID: PMC4065695 DOI: 10.1155/2014/538359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/13/2014] [Accepted: 05/22/2014] [Indexed: 12/11/2022] Open
Abstract
Malignant tumors of the small bowel presenting as acute abdomen are a rare occurrence. Burkitt's lymphoma presenting as a surgical emergency needing emergency laparotomy is an uncommon presentation of this tumor. We present an interesting case of jejunal perforation as a first manifestation of Burkitt's lymphoma which was successfully managed with surgical resection, high dose chemotherapy, and good supportive care.
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240
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Cerny J, Devitt K, Yu H, Ramanathan M, Woda B, Nath R. Early relapse of Burkitt lymphoma heralded by a bone marrow necrosis and numb chin syndrome successfully treated with allogeneic stem cell transplantation. Leuk Res Rep 2014; 3:51-3. [PMID: 25068102 PMCID: PMC4110356 DOI: 10.1016/j.lrr.2014.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 05/26/2014] [Accepted: 06/03/2014] [Indexed: 11/29/2022] Open
Abstract
The optimal salvage therapy for patients with relapsed Burkitt lymphoma is unknown. Bone marrow necrosis is an underreported (<1% of bone marrow failures). Numb chin syndrome is another rare syndrome associated with aggressive malignancies. Survival of these syndromes is dictated by the underlying disease and is usually dismal. Our 35-year-old patient experienced an early relapse of Burkitt lymphoma accompanied by syndromes, achieved second complete remission and underwent allogeneic stem cell transplantation. He remains alive and well >2 years after the transplant. To our knowledge, this is the longest reported survival of the two syndromes in the setting of BL relapse.
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Affiliation(s)
- Jan Cerny
- Division of Hematology Oncology, Department of Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Katherine Devitt
- Department of Pathology, UMass Memorial Medical Center, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Hongbo Yu
- Department of Pathology, UMass Memorial Medical Center, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Muthalagu Ramanathan
- Division of Hematology Oncology, Department of Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Bruce Woda
- Department of Pathology, UMass Memorial Medical Center, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Rajneesh Nath
- Division of Hematology Oncology, Department of Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
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241
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Shahbazi S, Peer CJ, Figg WD. Prolonged low intensity EPOCH-rituximab has improved toxicity in Burkitt lymphoma compared with standard short, high intensity therapy. Cancer Biol Ther 2014; 15:1117-9. [PMID: 24919059 DOI: 10.4161/cbt.29504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Burkitt lymphoma is an aggressive form of non-Hodgkin lymphoma that has a short doubling time, thus intense short-cycle chemotherapy has been thought to be essential. A recent NCI-sponsored clinical trial investigated DA-EPOCH-R given to 19 HIV-negative patients and a short course regimen (SC-EPOCH-RR) given to 11 HIV-positive patients in hopes of maintaining the efficacy of the regimen while decreasing the typical side effects from the intensive short-cycle chemotherapy. Low intensity EPOCH-R based therapy achieved excellent rates of efficacy despite a significant difference in the median cumulative dose between the DA-EPOCH-R and SC-EPOCH-RR cohorts. Furthermore, both cohorts experienced mainly grade 1 and grade 2 toxicities, with SC-EPOCH-RR cohort patients experiencing less adverse events than DA-EPOCH-R cohort patients. This recent clinical investigation suggests the most important therapeutic principle is not the intensity but rather the length of exposure time above an effective threshold concentration. Since short, intense bolus doses are the standard therapy for Burkitt lymphoma, these findings are clinically relevant and significant.
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Affiliation(s)
- Shandiz Shahbazi
- Clinical Pharmacology Program; Medical Oncology Branch; National Cancer Institute; Bethesda, MD USA
| | - Cody J Peer
- Clinical Pharmacology Program; Medical Oncology Branch; National Cancer Institute; Bethesda, MD USA
| | - William D Figg
- Clinical Pharmacology Program; Medical Oncology Branch; National Cancer Institute; Bethesda, MD USA
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242
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Navarro JT, Ribera JM. Unique clinical implications of HIV-related lymphoma. Int J Hematol Oncol 2014. [DOI: 10.2217/ijh.14.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- José-Tomás Navarro
- Catalan Institute of Oncology-Germans Trias I Pujol Hospital, Josep Carreras Leukemia Research Institute, Carretera de Canyet s/n, Universitat Autònoma de Barcelona, Barcelona, CP 08916, Spain
| | - Josep-Maria Ribera
- Catalan Institute of Oncology-Germans Trias I Pujol Hospital, Josep Carreras Leukemia Research Institute, Carretera de Canyet s/n, Universitat Autònoma de Barcelona, Barcelona, CP 08916, Spain
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243
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Hentrich M, Hoffmann C, Mosthaf F, Müller M, Siehl J, Wyen C, Hensel M. Therapy of HIV-associated lymphoma—recommendations of the oncology working group of the German Study Group of Physicians in Private Practice Treating HIV-Infected Patients (DAGNÄ), in cooperation with the German AIDS Society (DAIG). Ann Hematol 2014; 93:913-21. [DOI: 10.1007/s00277-014-2058-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 03/15/2014] [Indexed: 11/24/2022]
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244
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Rizzieri DA, Johnson JL, Byrd JC, Lozanski G, Blum KA, Powell BL, Shea TC, Nattam S, Hoke E, Cheson BD, Larson RA. Improved efficacy using rituximab and brief duration, high intensity chemotherapy with filgrastim support for Burkitt or aggressive lymphomas: cancer and Leukemia Group B study 10 002. Br J Haematol 2014; 165:102-11. [PMID: 24428673 DOI: 10.1111/bjh.12736] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 11/08/2013] [Indexed: 01/30/2023]
Abstract
To improve long-term outcomes for Burkitt leukaemia/lymphoma (BL) or aggressive lymphomas in adults, we assessed the benefit of adding rituximab and filgrastim support to a dose-dense modified chemotherapy regimen from the Cancer and Leukemia Group B (CALGB) 9251 trial. One hundred and five patients (aged 19-79 years) were enrolled; 27% were >60 years old; 47% had high or high-intermediate risk by International Prognostic Index (IPI) criteria. Common severe toxicities included stomatitis/upper gastrointestinal toxicity (69%), renal insufficiency (10%), neurological events (25%) and pulmonary events (18%). Seven died from treatment-related causes (one central nervous system bleed, four infections, two respiratory failure); five were >60 years old. Results in this adult population are encouraging as complete response (CR) was observed in 83% and 4-year event-free (EFS) and overall survivals (OS) were 74% and 78%, respectively. Results compare favourably to our prior chemotherapy alone study (CALGB 9251) but despite this, high-risk patients still had worse outcomes. In conclusion, short duration, intensive chemo-immunotherapy is feasible and should be considered in adults with BL as it results in high remission rates and durable remissions.
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Affiliation(s)
- David A Rizzieri
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
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245
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HU ZHEYU, XU FEI, SUN RUI, CHEN YANFENG, ZHANG DONGSHENG, FAN YUHUA, SUN JIAN. Apogossypolone induces reactive oxygen species accumulation and controls cell cycle progression in Raji Burkkit’s lymphoma cells. Mol Med Rep 2012; 12:337-44. [DOI: 10.3892/mmr.2015.3404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 02/05/2015] [Indexed: 11/05/2022] Open
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