1
|
Bock AM, Mwangi R, Wang Y, Khurana A, Maurer MJ, Ayers A, Kahl BS, Martin P, Cohen JB, Casulo C, Lossos IS, Farooq U, Ayyappan S, Reicks T, Habermann TM, Witzig TE, Flowers CR, Cerhan JR, Nastoupil LJ, Nowakowski GS. Defining primary refractory large B-cell lymphoma. Blood Adv 2024; 8:3402-3415. [PMID: 38669353 PMCID: PMC11255370 DOI: 10.1182/bloodadvances.2024012760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/24/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
ABSTRACT Patients with large B-cell lymphoma (LBCL) that fail to achieve a complete response (CR) or who relapse early after anthracycline-containing immunochemotherapy (IC) have a poor prognosis and are commonly considered to have "primary refractory disease." However, different definitions of primary refractory disease are used in the literature and clinical practice. In this study, we examined variation in the time to relapse used to define refractory status and association with survival outcomes in patients with primary refractory LBCL in a single-center prospective cohort with validation in an independent multicenter cohort. Patients with newly diagnosed LBCL were enrolled in the Molecular Epidemiological Resource cohort (MER; N = 949) or the Lymphoma Epidemiology of Outcomes cohort (LEO; N = 2755) from September 2002 to May 2021. Primary refractory LBCL was defined as no response (stable disease [SD]) or progressive disease (PD) during, or by the end of, frontline (1L) IC (primary PD; PPD); partial response at end of treatment (EOT PR); or relapse within 3 to 12 months after achieving CR at EOT to 1L IC (early relapse). In the MER cohort, patients with PPD had inferior overall survival (OS; 2-year OS rate: 15% MER, 31% LEO) when compared with other subgroups considered in defining primary refractory disease, EOT PR (2-year OS rate: 38% MER, 50% LEO) and early relapse (2-year OS rate: 44% MER, 58% LEO). Among patients receiving 1L IC with curative intent, we identified that patients with PPD are the key subgroup with poor outcomes. We propose a definition of primary refractory LBCL as SD or PD during, or by the end of, 1L treatment.
Collapse
Affiliation(s)
- Allison M. Bock
- Division of Hematology, Mayo Clinic, Rochester, MN
- Department of Hematology and Hematologic Malignancies, Huntsman Cancer Institute/University of Utah, Salt Lake City, UT
| | - Raphael Mwangi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Matthew J. Maurer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Amy Ayers
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brad S. Kahl
- Division of Oncology, Washington University in St. Louis, St. Louis, MO
| | - Peter Martin
- Division of Hematology/Oncology, Weill Cornell Medicine, New York, NY
| | - Jonathon B. Cohen
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - Carla Casulo
- Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY
| | | | - Umar Farooq
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Sabarish Ayyappan
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Tanner Reicks
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | | | - Christopher R. Flowers
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James R. Cerhan
- Department of Hematology and Hematologic Malignancies, Huntsman Cancer Institute/University of Utah, Salt Lake City, UT
| | - Loretta J. Nastoupil
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | |
Collapse
|
2
|
Villela L, Torre-Viera M, Idrobo-Quintero H, Beltran BE. Non-Hodgkin lymphoma treatment in middle-income countries in Latin America: perspective of the Latin American Study Group of Lymphoproliferative Disorders [ Grupo de Estudio de Linfoproliferativos de Latino América (GELL)]. Hematology 2022; 27:1208-1216. [DOI: 10.1080/16078454.2022.2141960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Luis Villela
- Facultad de Medicina, Universidad Autónoma de Sinaloa, Culiacán, Mexico
- Hospital Fernando Ocaranza ISSSTE, Hermosillo, Mexico
- Centro Médico “Dr. Ignacio Chávez” ISSSTESON, Hermosillo, Mexico
| | - María Torre-Viera
- Oncological Hematology Unit 360, Clínica Santa Sofía, Instituto de Oncología y Hematología, Universidad Central de Venezuela, Caracas, Venezuela
| | | | - Brady E. Beltran
- Department of Oncology and Radiotherapy, Hospital Nacional Edgardo Rebagliati Martins and Research Center for Precision Medicine, Universidad San Martín de Porres Medical School, Lima, Peru
| | | |
Collapse
|
3
|
Vrabac D, Smit A, Rojansky R, Natkunam Y, Advani RH, Ng AY, Fernandez-Pol S, Rajpurkar P. DLBCL-Morph: Morphological features computed using deep learning for an annotated digital DLBCL image set. Sci Data 2021; 8:135. [PMID: 34017010 PMCID: PMC8137959 DOI: 10.1038/s41597-021-00915-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/29/2021] [Indexed: 12/17/2022] Open
Abstract
Diffuse Large B-Cell Lymphoma (DLBCL) is the most common non-Hodgkin lymphoma. Though histologically DLBCL shows varying morphologies, no morphologic features have been consistently demonstrated to correlate with prognosis. We present a morphologic analysis of histology sections from 209 DLBCL cases with associated clinical and cytogenetic data. Duplicate tissue core sections were arranged in tissue microarrays (TMAs), and replicate sections were stained with H&E and immunohistochemical stains for CD10, BCL6, MUM1, BCL2, and MYC. The TMAs are accompanied by pathologist-annotated regions-of-interest (ROIs) that identify areas of tissue representative of DLBCL. We used a deep learning model to segment all tumor nuclei in the ROIs, and computed several geometric features for each segmented nucleus. We fit a Cox proportional hazards model to demonstrate the utility of these geometric features in predicting survival outcome, and found that it achieved a C-index (95% CI) of 0.635 (0.574,0.691). Our finding suggests that geometric features computed from tumor nuclei are of prognostic importance, and should be validated in prospective studies. Measurement(s) | B-cell lymphoma • histology | Technology Type(s) | machine learning | Factor Type(s) | patient | Sample Characteristic - Organism | Homo sapiens |
Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.14465178
Collapse
Affiliation(s)
- Damir Vrabac
- Department of Computer Science, Stanford University, Stanford, United States
| | - Akshay Smit
- Department of Computer Science, Stanford University, Stanford, United States
| | - Rebecca Rojansky
- Department of Pathology, Stanford University School of Medicine, Stanford, United States
| | - Yasodha Natkunam
- Department of Pathology, Stanford University School of Medicine, Stanford, United States
| | - Ranjana H Advani
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, United States
| | - Andrew Y Ng
- Department of Computer Science, Stanford University, Stanford, United States
| | | | - Pranav Rajpurkar
- Department of Computer Science, Stanford University, Stanford, United States.
| |
Collapse
|
4
|
Outcomes of Autologous Hematopoietic Cell Transplantation in Diffuse Large B Cell Lymphoma Refractory to Firstline Chemoimmunotherapy. Transplant Cell Ther 2020; 27:55.e1-55.e7. [PMID: 32949754 DOI: 10.1016/j.bbmt.2020.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 11/22/2022]
Abstract
Outcomes of patients with primary refractory diffuse large B cell lymphoma (DLBCL) are dismal. The role of autologous hematopoietic cell transplant (autoHCT) in this population is not well defined in the modern era. Most data sets combine these patients with those with relapsed disease. We report the outcomes of autoHCT in patients with primary refractory DLBCL that subsequently demonstrated chemosensitive disease with salvage therapies, using the Center for International Blood and Marrow Transplant Research registry. Between 2003 and 2018, 169 patients met the inclusion criteria. The median age of the cohort was 54 years, and 64% were male. The patients had advanced stage disease (73%) at diagnosis, 27% patients had stable disease, and 73% had progressive disease after frontline chemoimmunotherapy. Following salvage therapy, 36% patients were in complete remission (CR) and 64% in partial remission (PR). Nonrelapse mortality, progression/relapse, progression-free survival (PFS), and overall survival of this cohort at 4 years were 10.8% (95% confidence interval [CI], 6% to 13%), 47.8% (95% CI, 41% to 52%), 41.4% (95% CI, 38% to 50%), and 49.6% (95% CI, 44% to 56%), respectively. On univariate analysis, patients with progressive disease after frontline chemoimmunotherapy did just as well as those with stable disease. Patients achieving CR with salvage therapy had a lower cumulative incidence of progression/relapse at 1 year (30% versus 46.9%; P = .02) and experienced superior 1-year PFS compared to patients in PR (63.2% versus 46.7%; P = .03). AutoHCT provides durable disease control and should remain the standard of care in patients with primary refractory DLBCL who respond to salvage therapies.
Collapse
|
5
|
Lee H, Kim YR, Kim SJ, Park Y, Eom HS, Oh SY, Kim HJ, Kang HJ, Lee WS, Moon JH, Won YW, Kim TS, Kim JS. Clinical outcomes in patients with diffuse large B cell lymphoma with a partial response to first-line R-CHOP chemotherapy: prognostic value of secondary International Prognostic Index scores and Deauville scores. Ann Hematol 2017; 96:1873-1881. [PMID: 28831584 DOI: 10.1007/s00277-017-3107-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 08/16/2017] [Indexed: 12/21/2022]
Abstract
After introducing a rituximab-containing chemoimmunotherapy (R-CHOP) for diffuse large B cell lymphoma (DLBCL), a partial response (PR) which is regarded as treatment failure is still observed. To investigate the prognostic factors for the DLBCL patients with a PR to R-CHOP, we retrospectively evaluated 758 newly diagnosed DLBCL patients. After R-CHOP, 88 (11.6%) achieved a PR. Three-year progression-free and overall survival rates measured from the date of PR achievement (PFS2 and OS2) were 57.4 and 67.8%, respectively. The secondary International Prognostic Index (IPI2) scores after R-CHOP were low (0-1) in 68.2% and high (2-3) in 31.8% of the patients. The Deauville scores from 18-fluorodeoxyglucose positron emission tomography after R-CHOP showed low (2-3) in 58.0% and high (4) in 42.0% of the patients. High IPI2 and high Deauville scores were associated with worse PFS2 (P < 0.001 and P = 0.009) and OS2 (P = 0.013 and P = 0.067). The high-risk group defined by the IPI2 and Deauville scores, whose scores were both high, showed significantly lower 3-year PFS2 (P < 0.001) and OS2 (P = 0.006) rates compared with those of the other groups. In multivariate analyses, the IPI score of ≥ 3 at diagnosis and bone marrow involvement at diagnosis were independent prognostic factors. In addition, high IPI2-Deauville score after R-CHOP was significantly associated with poor PFS2 (P = 0.009) and demonstrated a trend toward inferior OS2. In conclusion, DLBCL patients who partially responded to R-CHOP are still a heterogeneous group, for which IPI2 and Deauville scores should be evaluated for prediction of prognosis.
Collapse
Affiliation(s)
- Hyewon Lee
- Center for Hematologic Malignancy, National Cancer Center, Goyang, South Korea
| | - Yu Ri Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, South Korea
| | - Soo-Jeong Kim
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Yong Park
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Hyeon-Seok Eom
- Center for Hematologic Malignancy, National Cancer Center, Goyang, South Korea
| | - Sung Yong Oh
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea
| | - Hyo Jung Kim
- Division of Hematology-Oncology, Department of Internal Medicine, College of Medicine, Hallym University, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Hye Jin Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Won-Sik Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Joon Ho Moon
- Department of Hematology and Medical Oncology, Kyungpook National University Hospital, Daegu, South Korea
| | - Young-Woong Won
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Tae-Sung Kim
- Department of Nuclear Medicine, National Cancer Center, Goyang, South Korea
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
| |
Collapse
|
6
|
Costa LJ, Maddocks K, Epperla N, Reddy NM, Karmali R, Umyarova E, Bachanova V, Costa C, Glenn MJ, Chavez JC, Calzada O, Lansigan F, Nasheed H, Barta SK, Zhou Z, Jaglal M, Chhabra S, Hernandez-Ilizaliturri F, Xavier AC, Mehta A, Peker D, Forero-Torres A, Al-Mansour Z, Evens AM, Cohen JB, Flowers CR, Fenske TS, Hamadani M. Diffuse large B-cell lymphoma with primary treatment failure: Ultra-high risk features and benchmarking for experimental therapies. Am J Hematol 2017; 92:161-170. [PMID: 27880984 DOI: 10.1002/ajh.24615] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 11/18/2016] [Accepted: 11/21/2016] [Indexed: 01/02/2023]
Abstract
The outcomes of patients with DLBCL and primary treatment failure (PTF) in the rituximab era are unclear. We analyzed 331 patients with PTF, defined as primary progression while on upfront chemoimmunotherapy (PP), residual disease at the end of upfront therapy (RD) or relapse < 6 months from end of therapy (early relapse; ER). Median age was 58 years and response to salvage was 41.7%. Two-year OS was 18.5% in PP, 30.6% in RD and 45.5% in ER. The presence of PP, intermediate-high/high NCCN-IPI at time of PTF or MYC translocation predicted 2-year OS of 13.6% constituting ultra-high risk (UHR) features. Among the 132 patients who underwent autologous hematopoietic cell transplantation, 2-year OS was 74.3%, 59.6% and 10.7% for patients with 0,1 and 2-3 UHR features respectively. Patients with PTF and UHR features should be prioritized for clinical trials with newer agents and innovative cellular therapy.
Collapse
Affiliation(s)
- Luciano J. Costa
- Division of Hematology and Oncology; University of Alabama at Birmingham; Birmingham Alabama USA
| | - Kami Maddocks
- Division of Hematology; Ohio state University; Columbus Ohio USA
| | - Narendranath Epperla
- Division of Hematology and Oncology; Medical College of Wisconsin; Milwaukee Wisconsin USA
| | - Nishitha M. Reddy
- Division of Hematology and Oncology; Vanderbilt University; Nashville Tennessee USA
| | - Reem Karmali
- Division of Hematology, Oncology and Cell Therapy; Rush University; Chicago Illinois USA
| | - Elvira Umyarova
- Division of Hematology and Oncology; Medical University of South Carolina; Charleston South Carolina USA
| | - Veronika Bachanova
- Division of Hematology; Oncology and Transplantation, University of Minnesota; Minneapolis Minnesota USA
| | - Cristiana Costa
- Department of Hematology and Oncology; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire USA
| | - Martha J. Glenn
- Division of Hematology and Hematologic Malignancies; University of Utah; Salt Lake City Utah USA
| | - Julio C. Chavez
- Department of Malignant Hematology; H. Lee Moffitt Cancer Center and Research; Tampa Florida USA
| | - Oscar Calzada
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Atlanta Georgia USA
| | - Frederick Lansigan
- Department of Hematology and Oncology; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire USA
| | - Hossain Nasheed
- Department of Hematology/Oncology; Fox Chase Cancer Center; Philadelphia Pennsylvania USA
| | - Stefan K. Barta
- Department of Hematology/Oncology; Fox Chase Cancer Center; Philadelphia Pennsylvania USA
| | - Zheng Zhou
- Division of Hematology-Oncology; University of Massachusetts; Worcester Massachusetts USA
| | - Michael Jaglal
- Department of Malignant Hematology; H. Lee Moffitt Cancer Center and Research; Tampa Florida USA
| | - Saurabh Chhabra
- Division of Hematology and Oncology; Medical University of South Carolina; Charleston South Carolina USA
| | | | - Ana C. Xavier
- Department of Pediatrics; University of Alabama at Birmingham; Birmingham Alabama USA
| | - Amitkumar Mehta
- Division of Hematology and Oncology; University of Alabama at Birmingham; Birmingham Alabama USA
| | - Deniz Peker
- Department of Pathology; University of Alabama at Birmingham; Birmingham Alabama USA
| | - Andreas Forero-Torres
- Division of Hematology and Oncology; University of Alabama at Birmingham; Birmingham Alabama USA
| | - Zeina Al-Mansour
- Division of Hematology/Oncology; Tufts University; Boston Massachusetts USA
| | - Andrew M. Evens
- Division of Hematology/Oncology; Tufts University; Boston Massachusetts USA
| | - Jonathon B. Cohen
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Atlanta Georgia USA
| | - Christopher R. Flowers
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Atlanta Georgia USA
| | - Timothy S. Fenske
- Division of Hematology and Oncology; Medical College of Wisconsin; Milwaukee Wisconsin USA
| | - Mehdi Hamadani
- Division of Hematology and Oncology; Medical College of Wisconsin; Milwaukee Wisconsin USA
| |
Collapse
|
7
|
Vardhana SA, Sauter CS, Matasar MJ, Zelenetz AD, Galasso N, Woo KM, Zhang Z, Moskowitz CH. Outcomes of primary refractory diffuse large B-cell lymphoma (DLBCL) treated with salvage chemotherapy and intention to transplant in the rituximab era. Br J Haematol 2017; 176:591-599. [PMID: 27982423 PMCID: PMC5556376 DOI: 10.1111/bjh.14453] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/12/2016] [Indexed: 12/15/2022]
Abstract
Rituximab-containing salvage chemotherapy followed by high-dose therapy and autologous stem cell transplant (ASCT) in chemosensitive patients remains the standard of care for patients with relapsed and refractory diffuse large B-cell lymphoma (DLBCL). However, its role in those patients achieving less than a complete response to first-line therapy (primary refractory disease) in the rituximab era is not well defined. We reviewed the outcomes of 82 transplant-eligible patients with primary refractory DLBCL who underwent salvage therapy with the intent of administering high-dose therapy and ASCT to patients achieving chemosensitive remission. The estimated 3-year overall and progression-free survival for all patients was 38% and 29%, respectively, and 65% and 60% respectively for patients proceeding to stem cell transplant. Long-term remission was achieved in 45% of patients achieving a partial response (PR) to initial induction therapy and <20% of patients with stable or progression of disease following initial therapy. These results suggest that salvage chemotherapy with the intent of subsequent high-dose therapy and ASCT remains a feasible strategy in certain patients with primary refractory DLBCL, particularly for those achieving a PR to frontline therapy. The primary barrier to curative therapy in patients with primary refractory disease is resistance to salvage therapy, and future studies should be aimed towards increasing the response rate in this population.
Collapse
Affiliation(s)
- Santosha A. Vardhana
- Deparment of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Craig S. Sauter
- Deparment of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew J. Matasar
- Deparment of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew D. Zelenetz
- Deparment of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Natasha Galasso
- Department of Epidemiology and Biostatistics, Sloan Kettering Cancer Center, New York, NY, USA
| | - Kaitlin M. Woo
- Department of Epidemiology and Biostatistics, Sloan Kettering Cancer Center, New York, NY, USA
| | - Zhigang Zhang
- Department of Epidemiology and Biostatistics, Sloan Kettering Cancer Center, New York, NY, USA
| | - Craig H. Moskowitz
- Deparment of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
8
|
|
9
|
Hitz F, Connors JM, Gascoyne RD, Hoskins P, Moccia A, Savage KJ, Sehn LH, Shenkier T, Villa D, Klasa R. Outcome of patients with primary refractory diffuse large B cell lymphoma after R-CHOP treatment. Ann Hematol 2015; 94:1839-43. [PMID: 26246466 DOI: 10.1007/s00277-015-2467-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
Primary refractory diffuse large B cell lymphoma (DLBCL) following R-CHOP chemotherapy is a major concern. We identified 1126 patients with DLBCL treated with R-CHOP from 2000 to 2009, of whom 166 (15 %) had primary refractory disease. Of the 75/166 (45 %) who were age <70 years and had been planned for stage-directed curative therapy, 43 (57 %) were primary nonresponders and 32 (43 %) relapsed within 3 months of completing R-CHOP. Thirty of 75 (40 %) patients had serious comorbidity and organ dysfunction precluding intensive treatment and had palliative treatment only. Twelve of 45 (27 %) patients responded to second-line treatment and underwent ASCT. The median overall survival for the 75 patients was 10 months with only seven patients alive without evidence of disease at follow-up ranging from 14 to 106 months. Primary refractory DLBCL after R-CHOP has a very poor outcome with only anecdotal survivors independent of the intended treatment approach.
Collapse
Affiliation(s)
- Felicitas Hitz
- Medical Oncology, Oncology/Haematology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland. .,British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada. .,Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland.
| | - J M Connors
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada
| | - R D Gascoyne
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada.,Division of Pathology, British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada
| | - P Hoskins
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada
| | - A Moccia
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada.,Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - K J Savage
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada
| | - L H Sehn
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada
| | - T Shenkier
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada
| | - D Villa
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada
| | - R Klasa
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada
| |
Collapse
|
10
|
Rovira J, Valera A, Colomo L, Setoain X, Rodríguez S, Martínez-Trillos A, Giné E, Dlouhy I, Magnano L, Gaya A, Martínez D, Martínez A, Campo E, López-Guillermo A. Prognosis of patients with diffuse large B cell lymphoma not reaching complete response or relapsing after frontline chemotherapy or immunochemotherapy. Ann Hematol 2014; 94:803-12. [PMID: 25501975 PMCID: PMC4374121 DOI: 10.1007/s00277-014-2271-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 12/01/2014] [Indexed: 01/18/2023]
Abstract
A retrospective study was performed to assess the outcome of patients with diffuse large B cell lymphoma (DLBCL) who did not achieve complete response or who relapsed before and after the use of rituximab. Clinical features and outcome of 816 (425 M/391 F; median age 63 years) patients diagnosed from 1991 to 2001 (pre-rituximab era, N = 348) and from 2002 to 2012 (rituximab era, N = 468) in a single institution were evaluated. Five hundred fifty-three patients achieved complete remission (CR), 57 partial response (PR), and 206 were refractory with a median overall survival of 15, 1.5, and 0.4 years, respectively. Patients receiving rituximab had lower risk of refractoriness or relapse. In primarily refractory and PR patients, there was not a difference in survival depending on whether patients received or not rituximab-containing frontline treatment. Early death rate was 11%, including 3.6% due to infectious complications. Rituximab did not modify these figures. In the relapse setting, 5-year survival from relapse was 25% for patients who never received rituximab, 54% for those who received rituximab only at relapse, and 48% for those treated with immunochemotherapy both as frontline and at relapse. In conclusion, relapsed/refractory patients with DLBCL show poor prognosis despite the use of frontline immunochemotherapy. New therapeutic approaches are needed in this group of patients.
Collapse
Affiliation(s)
- Jordina Rovira
- Hematology Department, Hospital Clínic, IDIBAPS, C/. Villarroel, 170, 08036, Barcelona, Spain,
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Telio D, Fernandes K, Ma C, Tsang R, Keating A, Crump M, Kuruvilla J. Salvage chemotherapy and autologous stem cell transplant in primary refractory diffuse large B-cell lymphoma: outcomes and prognostic factors. Leuk Lymphoma 2012; 53:836-41. [PMID: 22136378 DOI: 10.3109/10428194.2011.643404] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients with primary refractory diffuse large B-cell lymphoma (REF DLBCL: progression on or within 3 months of completion of primary therapy) sensitive to salvage chemotherapy undergo autologous stem cell transplant (ASCT). We conducted a retrospective review of 111 patients with REF DLBCL treated between 1999 and 2007. Primary treatment consisted of cyclophosphamide, adriamycin, vincristine and prednisone (CHOP; 66%) and rituximab with CHOP (R-CHOP; 33%); 14% received involved field radiation. The response rate (RR) to first salvage chemotherapy was 23% (RR by regimen: dexamethasone, cytosine arabinoside and cisplatin [DHAP] 15%, etoposide, Solu-Medrol, cytosine arabinoside and cisplatin [ESHAP] 36%, and gemcitabine, dexamethasone and cisplatin [GDP] 45%); 25% (n = 28) of patients underwent ASCT. With a median follow-up of 5.9 months (range 1-94), the median progression-free and overall survival from primary treatment failure was 3 and 10 months, respectively. Outcomes in patients with REF DLBCL after CHOP or R-CHOP appear equally poor. Second-generation platinum-containing regimens (ESHAP, GDP) may be superior to DHAP in this setting. Novel, prospectively evaluated treatment approaches should be pursued in REF DLBCL.
Collapse
Affiliation(s)
- David Telio
- Division of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, ON, Canada
| | | | | | | | | | | | | |
Collapse
|
12
|
Hung MH, Yu YB, Huang YC, Liu HT, Hong YC, Hsiao LT, Liu JH, Gau JP, Chiou TJ, Chen PM, Tzeng CH, Liu CY. Patients with diffuse large B cell lymphoma in partial response or stable disease after first-line R-CHOP: the prognostic value of the absolute lymphocyte count and impact of autologous stem cell transplantation. Ann Hematol 2012; 91:1907-15. [DOI: 10.1007/s00277-012-1536-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 07/23/2012] [Indexed: 11/25/2022]
|
13
|
Mizia-Malarz A, Sobol G, Janowska J, Wos H, Zahorska-Markiewicz B. Prognostic value of proangiogenic cytokines in children with lymphomas. Pediatr Blood Cancer 2009; 53:1195-9. [PMID: 19621434 DOI: 10.1002/pbc.22179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Angiogenesis and proangiogenic cytokines are involved in neoplastic development. The role of these processes in lymphoma formation has not been established. The aim of the study was to assess angiogenesis on the basis of serum levels of vascular-endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in childhood lymphomas. The prognostic value of these parameters was determined in the examined children. PROCEDURE Forty-two children with lymphomas (Hodgkin and non-Hodgkin Lymphomas) were studied (group A). Group A was divided into two subgroups: A(CR)-30 children with complete remission (CR) and A(PR+P+ER)-12 children with partial remission (PR), progressive disease (P), and early relapse (ER). The control group (group C) consisted of healthy 20 children. Using enzyme-linked immunosorbent assays we quantified VEGF and bFGF in serum of the healthy children and of the children with lymphomas. RESULTS The serum VEGF concentration in group A was 633.4 pg/ml (24.0-1,210.5) and was significantly higher (P = 0.0001) in comparison with group C (144.6 pg/ml; 32.3-734.8). In subgroup A(PR+P+ER), the baseline serum VEGF concentration was 865.0 pg/ml (205.8-1,209.2) and was significantly higher (P = 0.02) than in subgroup A(CR) (564.0 pg/ml; 24.0-1,210.5). The high serum VEGF concentration in children with lymphomas was the only independent risk factor for treatment failure (OR = 8.64; 95 CI: 1.51-49.34; P = 0.01). The cutoff point for the serum VEGF level >or=633.4 pg/ml as a parameter predicting treatment failure was established (P = 0.01). CONCLUSION Baseline serum VEGF concentration constitutes a prognostic marker for the progression of Hodgkin and non-Hodgkin Lymphomas in children.
Collapse
Affiliation(s)
- Agnieszka Mizia-Malarz
- Department of Pediatric Oncology, Hematology and Chemotherapy, Medical University of Silesia, Upper Silesia Children's Care Health Centre, Katowice, Poland.
| | | | | | | | | |
Collapse
|
14
|
Kawano R, Karube K, Kikuchi M, Takeshita M, Tamura K, Uike N, Eto T, Ohshima K, Suzumiya J. Oncogene associated cDNA microarray analysis shows PRAME gene expression is a marker for response to anthracycline containing chemotherapy in patients with diffuse large B-cell lymphoma. ACTA ACUST UNITED AC 2009; 49:1-7. [PMID: 19474511 DOI: 10.3960/jslrt.49.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CHOP (cyclophosphamide, adriamycin, vincristine, and prednisolone) therapy achieves a response in more than 60% patients with diffuse large B-cell lymphomas (DLBCLs). However, DLBCL shows a heterogeneous response to chemotherapy, and some patients are refractory to CHOP therapy. This difference in response to therapy is most likely due to differences in biological characteristics. We used cDNA microarray analysis to identify genes differentially expressed in anthracycline containing chemotherapy-resistant DLBCLs (7 patients) compared with anthracycline containing chemotherapy-sensitive DLBCLs (6 patients). Nine genes on the cDNA chip showed increased expression in anthracycline containing chemotherapy-resistant patients. We chose the preferentially expressed antigen of melanoma (PRAME) gene because it showed the highest expression in anthracycline containing chemotherapy-resistant DLBCLs on the cDNA chip, and it has been linked to prognosis of hematological malignancies. We also examined the relationship between PRAME gene expression and progression-free survival (PFS) in 45 patients with DLBCL. The progression-free survival of PRAME-positive patients (n=12) was significantly worse than that of PRAME-negative patients (n=33) (p=0.0373). Our results therefore indicate that PRAME expression in DLBCL correlates with response to anthracycline containing chemotherapy.
Collapse
Affiliation(s)
- Riko Kawano
- First Department of Internal Medicine, School of Medicine, Fukuoka University
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Atta J, Chow KU, Weidmann E, Mitrou PS, Hoelzer D, Martin H. Dexa-BEAM as salvage therapy in patients with primary refractory aggressive Non-Hodgkin lymphoma. Leuk Lymphoma 2009; 48:349-56. [PMID: 17325896 DOI: 10.1080/10428190600880084] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although aggressive NHL in relapse after remission can still be cured by second-line treatment followed by high-dose therapy and autologous stem cell transplantation, the long-term prognosis of patients who fail to obtain remission after first-line therapy remains extremely poor. We retrospectively evaluated a series of 29 consecutive patients with primary refractory high-grade NHL who were treated with Dexa-BEAM (DB) as uniform salvage therapy at a single institution. Twenty-nine patients with aggressive NHL primary refractory to CHOP or CHOP-like induction therapy with a median age of 47 (range, 22 - 64) years received 1 - 2 cycles of DB and were candidates for subsequent autologous stem cell (PBSC) mobilization and transplantation (PBSCT). Follow-up of all patients was updated in March 2004. Eight of 29 patients (28%) responded to one cycle of DB (1 complete/7 partial remissions); 2 of whom are alive after PBSCT (1 autologous/1 matched unrelated donor), 1 patient died after autologous PBSCT. Reasons for failure to proceed to high-dose therapy in spite of response to DB were recurrent progressive disease (n = 2), septicemia (n = 1), and allogeneic transplant-related mortality after mobilization failure to DB (n = 2). Twenty-one patients failed to respond to DB and died of progressive disease. Overall survival was 7% after 41 months. We conclude that Dexa-BEAM salvage therapy is not effective in patients with truly primary refractory high-grade NHL. The efficiency of rituximab combined with Dexa-BEAM or novel chemotherapeutic strategies needs to be established.
Collapse
Affiliation(s)
- Johannes Atta
- Department of Hematology, J. W. Goethe-University Hospital, Frankfurt, Germany.
| | | | | | | | | | | |
Collapse
|
16
|
Winter JN, Inwards DJ, Spies S, Wiseman G, Patton D, Erwin W, Rademaker AW, Weitner BB, Williams SF, Tallman MS, Micallef I, Mehta J, Singhal S, Evens AM, Zimmer M, Molina A, White CA, Gordon LI. Yttrium-90 ibritumomab tiuxetan doses calculated to deliver up to 15 Gy to critical organs may be safely combined with high-dose BEAM and autologous transplantation in relapsed or refractory B-cell non-Hodgkin's lymphoma. J Clin Oncol 2009; 27:1653-9. [PMID: 19255322 DOI: 10.1200/jco.2008.19.2245] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the maximum-tolerated radiation-absorbed dose (RAD) to critical organs delivered by yttrium-90 ((90)Y) ibritumomab tiuxetan in combination with high-dose carmustine, etoposide, cytarabine, and melphalan (BEAM) chemotherapy with autologous transplantation. PATIENTS AND METHODS Eligible patients had relapsed or refractory CD20+ non-Hodgkin's lymphoma (NHL). Individualized (90)Y activities were based on dosimetry and were calculated to deliver cohort-defined RAD (1 to 17 Gy) to critical organs with three to six patients per cohort. The therapeutic dose of (90)Y ibritumomab tiuxetan was followed by high-dose BEAM and autologous transplantation. RESULTS Forty-four patients were treated. Thirty percent of patients had achieved less than a partial remission to their most recent therapy and would not have been eligible for autologous transplantation at most centers. The toxicity profile was similar to that associated with high-dose BEAM chemotherapy. Two dose-limiting toxicities occurred at the 17 Gy dose level, which made 15 Gy the recommended maximum-tolerated RAD. Although eight patients received at least twice the conventional dose of 0.4 mCi/kg, a weight-based strategy at 0.8 mCi/kg would have resulted in a wide range of RAD; nearly 25% of patient cases would have received 17 Gy or more, and many would have received less than 10 Gy. With a median follow-up of 33 months for all patients, the estimated 3-year progression-free and overall survivals were 43% and 60%, respectively. CONCLUSION Dose-escalated (90)Y ibritumomab tiuxetan may be safely combined with high-dose BEAM with autologous transplantation and has the potential to be more effective than standard-dose radioimmunotherapy. Careful dosimetry is required to avoid toxicity and undertreatment.
Collapse
Affiliation(s)
- Jane N Winter
- Robert H Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Alici S, Bavbek S, Basaran M, Onat H. Prognostic factors in patients with aggressive non-Hodgkin's lymphoma without complete response to first-line therapy. Adv Ther 2006; 23:534-42. [PMID: 17050496 DOI: 10.1007/bf02850042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study was conducted to retrospectively identify the prognostic factors that specifically predict survival rates of patients with aggressive non-Hodgkin's lymphoma who did not achieve a complete response (CR) to first-line therapy. Prognostic factors in terms of survival were analyzed in 76 adult patients with non-Hodgkin's lymphoma who had failed to achieve CR to first-line chemotherapy (CT) regimens administered at Istanbul University, Institute of Oncology, between February 1989 and October 1998. A total of 41 patients were female, and median age was 60 y (range, 18-87 y). Twenty-seven patients (35%) had primary refractory disease (stable disease + progressive disease). A partial response (PR) was demonstrated in 49 (65%). In all, 92% had been administered anthracycline on the basis of computed tomography findings. Of 27 patients with primary refractory disease, 20 died because of initial CT toxicity or disease progression. A total of 10 patients with primary refractory disease underwent second-line CT. CR was observed in only 1 of those patients. Of the 49 patients who had a PR to first-line therapy, 31 died because of disease progression. Of those patients, 14 underwent second-line CT. Four patients were observed to have a CR. Median overall survival (OS) in all patients was established at 15 mo (range, 11-19 mo), and 5-y OS was 25%. On the other hand, median OS in patients with primary refractory disease was 7.6 mo (range, 5.7-9.4 mo) and was observed to be 17.8 mo (range, 9.4-26.1 mo) in patients with a PR. The difference in survival rates between patients with primary refractory disease and those with a PR was significant (P=.005). Although median OS was 18.1 mo (range, 8.4-27.8 mo) in patients with intermediate-grade histology, it was 6.1 mo (range, 1-11.7 mo) in patients with highgrade histology (P=.001). As a result of univariate analysis, significant rognostic factors associated with OS included histologic grade (intermediate/high) (P=.001), response to initial therapy (primary refractory disease/PR) (P=.005), performance status (0-2/2-4) (P=.024), and International Prognostic Index risk groups (low/low intermediate/intermediatehigh high risk) (P=.004). Multivariate analysis revealed that independent prognostic parameters associated with OS included response to initial therapy (P=.009) and histologic grade (P=.001). Although prognosis is rather poor in patients with high histologic grade and primary refractory disease, patients with a PR have a slightly better prognosis.
Collapse
Affiliation(s)
- Suleyman Alici
- Institute of Oncology, Istanbul University, Istanbul, Turkey
| | | | | | | |
Collapse
|
18
|
Pedersen LM, Klausen TW, Davidsen UH, Johnsen HE. Early changes in serum IL-6 and VEGF levels predict clinical outcome following first-line therapy in aggressive non-Hodgkin's lymphoma. Ann Hematol 2005; 84:510-6. [PMID: 15834569 DOI: 10.1007/s00277-005-1020-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2004] [Accepted: 02/08/2005] [Indexed: 11/29/2022]
Abstract
Inflammatory cytokines play important roles in the pathogenesis of lymphomas and may reflect underlying biological processes including tumour-host interactions with prognostic information that is not afforded by conventional clinical parameters. Several lines of evidence suggest that serum levels of interleukin (IL)-6 and vascular endothelial growth factor (VEGF) are independent indicators of long-term outcome in non-Hodgkin's lymphoma (NHL), but the clinical impact of early serial monitoring of these cytokines has not been reported. Serum samples from 64 newly diagnosed patients with aggressive NHL were obtained before the first cycle of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) and then weekly until the second cycle was given. Serum IL-6 and VEGF were measured by commercial enzyme-linked immunosorbent assays (ELISA). Pre-treatment serum IL-6 and VEGF levels were significantly correlated to response rate and overall survival. A significant decrease of IL-6 and VEGF levels was observed in the first weeks after CHOP therapy in patients achieving a complete remission after treatment. Multivariate analysis indicated that early changes of IL-6 and VEGF serum levels within the first 3 weeks after initiation of chemotherapy were independent predictors of clinical response even when corrected for the influence of clinical prognostic factors. Only changes in serum IL-6 level had borderline significance for the prediction of overall survival. The data indicate that serial measurements of serum IL-6 and VEGF may be early prognostic indicators and support the hypothesis of a clinical impact by early recognition of poor-risk patients and candidates for new treatment options.
Collapse
Affiliation(s)
- Lars Møller Pedersen
- Department of Hematology and Clinical Research Unit, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
| | | | | | | |
Collapse
|
19
|
Musolino A, Perrone MA, Michiara M, Delnevo D, Franciosi V, Di Blasio B, Ceci G, Camisa R, Ardizzoni A, Cocconi G. Lomustine (chloroethylnitrosourea [CCNU]), ifosfamide, bleomycin, vincristine, and cisplatin (CIBO-P) is an effective regimen for patients with poor prognostic refractory or multiple disease recurrent aggressive non-Hodgkin lymphoma. Cancer 2005; 103:2109-17. [PMID: 15803492 DOI: 10.1002/cncr.21024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The current study was designed to assess the activity and safety of a novel combination therapy for patients with recurrent or refractory aggressive non-Hodgkin lymphoma (NHL). METHODS Forty-three consecutive patients with recurrent or refractory aggressive NHL were treated with lomustine (chloroethylnitrosourea [CCNU]; 60 mg/m2 on Day 1), ifosfamide (1.5 g/m(2 on Days 1, 2 and 21, 22), bleomycin (5 mg/m2 on Days 1, 5 and 21, 25), vincristine (1.4 mg/m2 on Days 1, 8 and 21, 28), and cisplatin (25 mg/m2 on Days 3, 4, 5 and 23, 24, 25), every 42 days (CIBO-P regimen). RESULTS Thirty-nine patients (91%) were evaluable for response. The median patient age was 63 years. Thirty-five percent of the patients had received > or = 2 lines of previous chemotherapy and 40% had elevated lactate dehydrogenase levels at the time of treatment initiation. The overall objective response rate was 77% (95% confidence interval [95% CI], 63-90%), including 19 (49%) complete (CR) and 11 (28%) partial responses. CIBO-P induced responses in primary refractory disease and in patients treated for second or subsequent disease recurrences. A CR with previous therapy was the most important factor associated with a significantly higher CR rate. The median duration of response was 6 months (95% CI, 4.4-7.7 months) and the median survival duration was 10.7 months (95% CI, 5.9-18.1 months). Five patients (11.6%) remained disease free for > or = 24 months. By multivariate analysis, a CR with previous therapy and average dose intensity of CIBO-P drugs were independent prognostic factors for time-to-treatment failure, whereas a CR with previous therapy and serum lactate dehydrogenase were independent predictors for survival. Myelosuppression was the most frequent serious complication of this regimen. However, none of the patients had hemorrhage with thrombocytopenia, and only 2 patients (5%) had febrile neutropenia. CONCLUSIONS In the current study, CIBO-P was a novel, highly active, and safe combination therapy for patients with refractory disease with a poor prognosis or for patients with multiply recurrent aggressive NHL.
Collapse
|
20
|
Nückel H, Dürig J, Dührsen U. Salvage chemotherapy according to the ASHAP protocol: a single-center study of 24 patients with relapsed or refractory aggressive non-Hodgkin's lymphomas. Ann Hematol 2003; 82:481-486. [PMID: 12910375 DOI: 10.1007/s00277-003-0678-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2003] [Accepted: 04/22/2003] [Indexed: 10/26/2022]
Abstract
Numerous salvage protocols for relapsed or refractory aggressive non-Hodgkin's lymphomas have been described. The purpose of this retrospective study was to evaluate the efficacy and the toxicity of the ASHAP protocol, which combines a continuous infusion of doxorubicin and cisplatin with high-dose cytarabine and methylprednisolone. Twenty-four patients with relapsed or refractory aggressive non-Hodgkin's lymphomas were treated with a median of 3 cycles (range: 1-5) of ASHAP. Twelve patients achieved a complete and four a partial remission for an overall response rate of 67%. The 3-year overall and progression-free survival rates were 60% and 40%, respectively. Ten of the responding patients were consolidated by high-dose chemotherapy. After a median follow-up of 15.5 months, four patients are in continuous complete remission, while six patients suffered relapses (two fatal). For reasons of low risk profile [international prognostic index (IPI) score of 0, n=2] or age >60 years ( n=4), consolidation was limited to involved-field radiotherapy in six patients. All of these patients are alive after a median follow-up of 37 months, with two relapses. Factors predicting a poor response to salvage therapy were primary refractory disease, elevated lactate dehydrogenase activity, and an IPI score of >/=2. The principal toxicity was myelosuppression with grade III or IV neutropenia or thrombocytopenia occurring in 88% or 75%, respectively, of the patients. Nonhematological toxicity was generally mild. There were no treatment-related deaths. The ASHAP regimen is a highly active and well-tolerated salvage protocol for patients with relapsed aggressive non-Hodgkin's lymphomas which compares favorably with other established protocols.
Collapse
Affiliation(s)
- H Nückel
- Department of Hematology, University of Essen Medical School, Hufelandstrasse 55, 45122, Essen, Germany.
| | - J Dürig
- Department of Hematology, University of Essen Medical School, Hufelandstrasse 55, 45122, Essen, Germany
| | - U Dührsen
- Department of Hematology, University of Essen Medical School, Hufelandstrasse 55, 45122, Essen, Germany
| |
Collapse
|