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Wieland CM, Tuin AM, Dort EJ, Hall AG, Krishnan M, Velagapudi M. Long-Term Survival Rates and Treatment Trends of Burkitt Lymphoma in Patients with HIV-A National Cancer Database (NCDB) Study. Cancers (Basel) 2024; 16:1397. [PMID: 38611075 PMCID: PMC11011134 DOI: 10.3390/cancers16071397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/30/2024] [Accepted: 03/31/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Burkitt lymphoma (BL) accounts for 10-35% of AIDS-defining lymphoma in people with HIV (PWH). Previous research consisting of smaller cohorts has shown decreased survival for HIV-associated BL. This study aims to compare overall mortality in BL patients with and without HIV, while investigating impact of treatment modalities in HIV-associated BL. METHODS Using the 2004-2019 NCDB, we identified 4312 patients with stage 3 or 4 BL who had a known HIV status and received either chemotherapy alone or chemotherapy and immunotherapy. Time to death was evaluated using Kaplan-Meier survival estimates. Risk of death was evaluated using an extended multivariable Cox model adjusted for multiple factors and with a Heaviside function for HIV status by time period (0-3 month vs. 3-60 month). RESULTS Of the 4312 patients included, 1514 (35%) had HIV. For months 0-3 from time of diagnosis, HIV status was not associated with a statistically significant increase in risk of death (HR = 1.04, 95% CI: 0.86, 1.26, p = 0.6648). From month 3to 60, positive HIV status was associated with a 55% increase in risk of death compared to those without HIV (95% CI: 1.38, 1.75, p < 0.0001). Further, this difference in hazard rates (0-3 vs. 3-60) was statistically significant (HR = 1.49, 95% CI: 1.22-1.82, p < 0.001). CONCLUSIONS There is an increased mortality rate from months 3 to 60 in BL patients with HIV compared to patients without HIV. Additionally, risk of death in the first 3 months is significantly decreased by 45% in patients with HIV treated with combination chemotherapy and immunotherapy compared to patients without HIV receiving combination chemotherapy and immunotherapy, providing valuable clinical insight into treatment decision making in the care of HIV-associated BL.
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Affiliation(s)
- Clare M. Wieland
- School of Medicine, Creighton University, Omaha, NE 68178, USA; (C.M.W.); (A.M.T.); (E.J.D.)
| | - Ashley M. Tuin
- School of Medicine, Creighton University, Omaha, NE 68178, USA; (C.M.W.); (A.M.T.); (E.J.D.)
| | - Elizabeth J. Dort
- School of Medicine, Creighton University, Omaha, NE 68178, USA; (C.M.W.); (A.M.T.); (E.J.D.)
| | - Alexander G. Hall
- Department of Clinical Research & Public Health, School of Medicine, Creighton University, Omaha, NE 68178, USA;
| | - Mridula Krishnan
- Division of Hematology/Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| | - Manasa Velagapudi
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Creighton University, CHI Health, Omaha, NE 68124, USA
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Lu X, Liu Y, Liu R, Liu J, Yan X, Qian L. Comparison of chemotherapy regimens plus rituximab in adult Burkitt lymphoma: A single-arm meta-analysis. Front Oncol 2022; 12:1063689. [PMID: 36620579 PMCID: PMC9816660 DOI: 10.3389/fonc.2022.1063689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Background and aim Given the paucity of evidence-based treatment recommendations, the most appropriate first-line regimen for adult Burkitt lymphoma is currently undefined. We aimed to identify the optimal treatment regimen containing rituximab for adult Burkitt lymphoma patients. Methods The PubMed, Embase, Web of Science, and Cochrane databases were searched in December 2021 (10). We included all studies for the treatment of Burkitt lymphoma including rituximab. We excluded studies of patients aged ≤14 years old and those with sample numbers ≤10 patients. Random-effects models were used to compare different chemotherapy regimens regarding estimated 2-year overall survival (OS) rate, 2-year progression-free survival (PFS) rate, and overall response rate (ORR). Results A total of 17 studies were included in this meta-analysis and divided into four groups: CODOX-M/IVAC, DA-EPOCH, GMALL-B-ALL/NHL2002, and Hyper-CVAD. DA-EPOCH was associated with a significantly higher 2-year OS rate [0.95, 95% confidence interval (CI) 0.86-1.00]. There was no significant difference in the 2-year PFS rates (0.81, 95% CI 0.76-0.85) and ORR (0.90, 95% CI 0.87-0.94) between these four treatment regimens. Conclusions The meta-analysis indicates that DA-EPOCH could be more effective in providing curative treatment for adult Burkitt lymphoma patients, especially without CNS and BM involvement considering OS time. Due to the types of studies and the limited number of included studies, bias should be acknowledged and a randomized controlled trial (RCT) needs to be performed to further identify the optimal treatment regimen for such patients.
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Affiliation(s)
- Xiaoxuan Lu
- Senior Department of Hematology, The Fifth Medical Center of People's Liberation Army (PLA), General Hospital, Beijing, China
| | - Yu Liu
- Senior Department of Hematology, The Fifth Medical Center of People's Liberation Army (PLA), General Hospital, Beijing, China
| | - Ruyu Liu
- Senior Department of Hematology, The Fifth Medical Center of People's Liberation Army (PLA), General Hospital, Beijing, China
| | - Jiaxin Liu
- Department of Hematology, The Sixth Medical Center of People's Liberation Army (PLA), General Hospital, Beijing, China
| | - Xiaojing Yan
- Department of Hematology, The First Affiliated Hospital of China Medical University, Shenyang, China,*Correspondence: Xiaojing Yan, ; Liren Qian,
| | - Liren Qian
- Senior Department of Hematology, The Fifth Medical Center of People's Liberation Army (PLA), General Hospital, Beijing, China,Department of Hematology, The Sixth Medical Center of People's Liberation Army (PLA), General Hospital, Beijing, China,*Correspondence: Xiaojing Yan, ; Liren Qian,
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3
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Shi Z, Zhu Y, Zhang J, Chen B. Monoclonal antibodies: new chance in the management of B-cell acute lymphoblastic leukemia. Hematology 2022; 27:642-652. [PMID: 35622074 DOI: 10.1080/16078454.2022.2074704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This review aims to see the progress of several clinically-used monoclonal antibodies in treating ALL patients and how they improved patients' outcomes. METHODS We searched Web of Science, Elsevier and PubMed for relevant published studies, and summarized eligible evidence on the management of newly-diagnosed and relapsed or refractory ALL with monoclonal antibodies. Ongoing trials were identified from ClinicalTrials.gov. RESULTS Rituximab, an anti-CD20 monoclonal antibody, prolonged patients' complete remission duration and overall survival when combined with hyper-CVAD regimen. Another anti-CD20 monoclonal antibody, Ofatumumab, was reported to have similar benefits. Blinatumomab allows endogenous CD3-positive cytotoxic T cells to target and eliminate CD19-positive blasts. FDA has approved its efficacy in patients with R/R B-ALL and eliminating minimal residual disease (MRD). It serves as a bridge to eradicate MRD before transplantation, and may also be a new choice for patients unable to undergo transplantation. An anti-CD22 monoclonal antibody named Inotuzumab Ozogamicin showed great improvement in patients' outcome, but its toxicity to liver is also worthy of our attention. CONCLUSION Monoclonal antibodies are proven to be a promising immunotherapeutic strategy to improve ALL patients' outcome in the long term. There's still a need for individualized treatment with effective and well-tolerated medicines.Trial registration: ClinicalTrials.gov identifier: NCT01363128.Trial registration: ClinicalTrials.gov identifier: NCT01466179.Trial registration: ClinicalTrials.gov identifier: NCT02013167.Trial registration: ClinicalTrials.gov identifier: NCT02000427.Trial registration: ClinicalTrials.gov identifier: NCT01564784.Trial registration: ClinicalTrials.gov identifier: NCT03677596.Trial registration: ClinicalTrials.gov identifier: NCT01363297.Trial registration: ClinicalTrials.gov identifier: NCT02981628.Trial registration: ClinicalTrials.gov identifier: NCT03094611.Trial registration: ClinicalTrials.gov identifier: NCT01371630.Trial registration: ClinicalTrials.gov identifier: NCT04224571.Trial registration: ClinicalTrials.gov identifier: NCT02458014.Trial registration: ClinicalTrials.gov identifier: NCT04546399.Trial registration: ClinicalTrials.gov identifier: NCT02879695.Trial registration: ClinicalTrials.gov identifier: NCT03913559.Trial registration: ClinicalTrials.gov identifier: NCT03441061.Trial registration: ClinicalTrials.gov identifier: NCT03739814.Trial registration: ClinicalTrials.gov identifier: NCT02877303.Trial registration: ClinicalTrials.gov identifier: NCT03698552.Trial registration: ClinicalTrials.gov identifier: NCT04601584.Trial registration: ClinicalTrials.gov identifier: NCT04684147.Trial registration: ClinicalTrials.gov identifier: NCT04681105.
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Affiliation(s)
- Zheng Shi
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Yiqian Zhu
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Jing Zhang
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Baoan Chen
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
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Knerr JM, Kledal TN, Rosenkilde MM. Molecular Properties and Therapeutic Targeting of the EBV-Encoded Receptor BILF1. Cancers (Basel) 2021; 13:4079. [PMID: 34439235 PMCID: PMC8392491 DOI: 10.3390/cancers13164079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 12/12/2022] Open
Abstract
The γ-herpesvirus Epstein-Barr Virus (EBV) establishes lifelong infections in approximately 90% of adults worldwide. Up to 1,000,000 people yearly are estimated to suffer from health conditions attributed to the infection with this virus, such as nasopharyngeal and gastric carcinomas as well as several forms of B, T and NK cell lymphoma. To date, no EBV-specific therapeutic option has reached the market, greatly reducing the survival prognoses of affected patients. Similar to other herpesviruses, EBV encodes for a G protein-coupled receptor (GPCR), BILF1, affecting a multitude of cellular signaling pathways. BILF1 has been identified to promote immune evasion and tumorigenesis, effectively ensuring a life-long persistence of EBV in, and driving detrimental health conditions to its host. This review summarizes the epidemiology of EBV-associated malignancies, their current standard-of-care, EBV-specific therapeutics in development, GPCRs and their druggability, and most importantly consolidates the findings of over 15 years of research on BILF1 in the context of EBV-specific drug development. Taken together, BILF1 constitutes a promising target for the development of novel EBV-specific therapeutics.
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Affiliation(s)
- Julius Maximilian Knerr
- Laboratory for Molecular Pharmacology, Department of Biomedical Sciences, University of Copenhagen, 2200 København, Denmark;
| | | | - Mette Marie Rosenkilde
- Laboratory for Molecular Pharmacology, Department of Biomedical Sciences, University of Copenhagen, 2200 København, Denmark;
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5
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HIV-associated Burkitt lymphoma: outcomes from a US-UK collaborative analysis. Blood Adv 2021; 5:2852-2862. [PMID: 34283175 DOI: 10.1182/bloodadvances.2021004458] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/03/2021] [Indexed: 01/29/2023] Open
Abstract
Data addressing prognostication in patients with HIV related Burkitt lymphoma (HIV-BL) currently treated remain scarce. We present an international analysis of 249 (United States: 140; United Kingdom: 109) patients with HIV-BL treated from 2008 to 2019 aiming to identify prognostic factors and outcomes. With a median follow up of 4.5 years, the 3-year progression-free survival (PFS) and overall survival (OS) were 61% (95% confidence interval [CI] 55% to 67%) and 66% (95%CI 59% to 71%), respectively, with similar results in both countries. Patients with baseline central nervous system (CNS) involvement had shorter 3-year PFS (36%) compared to patients without CNS involvement (69%; P < .001) independent of frontline treatment. The incidence of CNS recurrence at 3 years across all treatments was 11% with a higher incidence observed after dose-adjusted infusional etoposide, doxorubicin, vincristine, prednisone, cyclophosphamide (DA-EPOCH) (subdistribution hazard ratio: 2.52; P = .03 vs other regimens) without difference by CD4 count 100/mm3. In multivariate models, factors independently associated with inferior PFS were Eastern Cooperative Oncology Group (ECOG) performance status 2-4 (hazard ratio [HR] 1.87; P = .007), baseline CNS involvement (HR 1.70; P = .023), lactate dehydrogenase >5 upper limit of normal (HR 2.09; P < .001); and >1 extranodal sites (HR 1.58; P = .043). The same variables were significant in multivariate models for OS. Adjusting for these prognostic factors, treatment with cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate, ifosfamide, etoposide, and high-dose cytarabine (CODOX-M/IVAC) was associated with longer PFS (adjusted HR [aHR] 0.45; P = .005) and OS (aHR 0.44; P = .007). Remarkably, HIV features no longer influence prognosis in contemporaneously treated HIV-BL.
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Abstract
Despite widely available antiretroviral therapy, lymphoma remains the leading cause of death for human immunodeficiency virus (HIV)-infected persons in economically developed countries. Even a few months of drug interruptions can lead to drops in the CD4 cell count, HIV viremia, and an increased risk of lymphoma. Currently, good HIV control facilitates intensive therapies appropriate to the lymphoma, including autologous and even allogeneic hematopoietic stem cell transplantation. Nonetheless, HIV-related lymphomas have unique aspects, including pathogenetic differences driven by the presence of HIV and often coinfection with oncogenic viruses. Future therapies might exploit these differences. Lymphoma subtypes also differ in the HIV-infected population, and the disease has a higher propensity for advanced-stage, aggressive presentation and extranodal disease. Other unique aspects include the need to avoid potential interactions between antiretroviral therapy and chemotherapeutic agents and the need for HIV-specific supportive care such as infection prophylaxis. Overall, the care of these patients has progressed sufficiently that recent guidelines from the American Society of Clinical Oncology advocate the inclusion of HIV-infected patients alongside HIV-negative patients in cancer clinical trials when appropriate. This article examines HIV lymphoma and includes Burkitt lymphoma in the general population.
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7
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Marín-Sánchez A, Martínez-Fernández G, Gómez-Catalán I, Montoya-Morcillo MC, Algarra JL, García ÁI, Hernández-Fernández F, Romero-Macías JR. Comparison in safety of chemotherapy protocols for blood cancers: toxicity of H-CVAD versus GELA/BURKIMAB/PETHEMA LAL. Ecancermedicalscience 2021; 15:1206. [PMID: 33912231 PMCID: PMC8057780 DOI: 10.3332/ecancer.2021.1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Indexed: 11/06/2022] Open
Abstract
Background and objective The Hyper-CVAD/Methotrexate-Cytarabine (H-CVAD/MTX-AraC) chemotherapy protocol has been one of the standard treatments for blood cancers, such as Mantle cell lymphoma (MCL), Burkitt’s lymphoma (BL) and B-cell and T-cell acute lymphoblastic leukaemia (ALL). Due to high toxicity, it has been progressively replaced with new specific regimens with a better safety profile (GELA protocol for MCL, BURKIMAB for BL and PETHEMA for B-cell and T-cell ALL). The objective of this study is to analyse the toxicity and infectious complications of these therapeutic regimens, as well as the event free survival (EFS). Patients and methods This is a retrospective and descriptive observational study of 81 patients, comparing 42 patients treated with H-CVAD/MTX-AraC (group A) versus 39 patients treated with GELA/BURKIMAB/PETHEMA (group B). Results All patients in group A developed pancytopenia, but in group B 74.4% neutropenia, 51.3% thrombocytopenia and 69.2% anaemia. The total number of infections in group A was higher than in group B: 154 versus 48, 3.67 versus 1.23 per patient and 0.59 versus 0.25 per cycle. Likewise, febrile neutropenia happened: 106 versus 21 cases, 2.52 versus 0.52 per patient and 0.41 versus 0.11 per cycle. EVS is higher in group B: 33% versus 79% (2-year), and 24% versus 69% (5-year). Conclusions Current therapeutic protocols have shown higher EFS due to better safety profile, with less haematological, neurological and haemorrhagic toxicity, as well as lower rates of infectious complications.
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Affiliation(s)
- Alberto Marín-Sánchez
- Haematology Department, Complejo Hospitalario Universitario de Albacete, Calle Hermanos Falcó 37, 02008 Albacete, Spain
| | | | - Irene Gómez-Catalán
- Haematology Department, Complejo Hospitalario Universitario de Albacete, Calle Hermanos Falcó 37, 02008 Albacete, Spain
| | - Mari Carmen Montoya-Morcillo
- Haematology Department, Complejo Hospitalario Universitario de Albacete, Calle Hermanos Falcó 37, 02008 Albacete, Spain
| | - Jesús Lorenzo Algarra
- Haematology Department, Complejo Hospitalario Universitario de Albacete, Calle Hermanos Falcó 37, 02008 Albacete, Spain
| | - Ángela Ibañez García
- Haematology Department, Complejo Hospitalario Universitario de Albacete, Calle Hermanos Falcó 37, 02008 Albacete, Spain
| | - Francisco Hernández-Fernández
- Neurology Department, Complejo Hospitalario Universitario de Albacete, Calle Hermanos Falcó 37, 02008 Albacete, Spain
| | - Juan Ramón Romero-Macías
- Haematology Department, Complejo Hospitalario Universitario de Albacete, Calle Hermanos Falcó 37, 02008 Albacete, Spain
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8
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Cwynarski K, Khwaja J, Montoto S. 'CARMEN': is less, more? Lessons from trials in human immunodeficiency virus-Burkitt lymphoma (HIV-BL). Br J Haematol 2020; 192:13-14. [PMID: 33090470 DOI: 10.1111/bjh.17187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Kate Cwynarski
- Department of Haematology, University College London Hospital, London, UK
| | - Jahanzaib Khwaja
- Department of Haematology, University College London Hospital, London, UK
| | - Silvia Montoto
- Department of Haematology, St Bartholomew's and The Royal London NHS Trust, London, UK
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9
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Ferreri AJM, Cattaneo C, Lleshi A, Verga L, Allione B, Facchetti F, Ponzoni M, Foppoli M, Ferrari D, Rigacci L, Pecciarini L, Donadoni G, Fumagalli L, Sassone M, Calimeri T, Rossi G, Spina M, Re A. A dose-dense short-term therapy for human immunodeficiency virus/acquired immunodeficiency syndrome patients with high-risk Burkitt lymphoma or high-grade B-cell lymphoma: safety and efficacy results of the "CARMEN" phase II trial. Br J Haematol 2020; 192:119-128. [PMID: 33085777 DOI: 10.1111/bjh.17188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/02/2020] [Indexed: 12/14/2022]
Abstract
A few prospective trials in HIV-positive patients with Burkitt lymphoma (BL) or high-grade B-cell lymphoma (HGBL) have been reported. Investigated therapies have shown good efficacy but relevant safety problems, with high rates of interruptions, severe mucositis, septic complications, and fungal infections. Here, we report the results of a multicentre phase II trial addressing a new dose-dense, short-term therapy aimed at maintaining efficacy and improving tolerability. The experimental programme included a 36-day polychemotherapy induction followed by high-dose cytarabine-based consolidation and response-tailored BEAM (carmustine, etoposide, cyatarabine, and melphalan)- conditioned autologous stem cell transplantation (ASCT). This therapy would be considered active if ≥11 complete remissions (CR) after induction (primary endpoint) were recorded among 20 assessable patients. HIV-positive adults (median age 42, range 26-58; 16 males) with untreated BL (n = 16), HGBL (n = 3) or double-hit lymphoma (n = 1) were enrolled. All patients had high-risk features, with meningeal and bone marrow infiltration in five and nine patients respectively. The experimental programme was safe and active in a multicentre setting, with only two episodes of grade 4 non-haematological toxicity (hepatotoxicity and mucositis), and no cases of systemic fungal infections; two patients died of toxicity (bacterial infections). Response after induction (median duration: 47 days; interquartile range 41-54), was complete in 13 patients and partial in five [overall response rate = 90%; 95% confidence interval (CI) = 77-100]. All responders received consolidation, and five required autologous stem cell transplant. At a median follow-up of 55 (41-89) months, 14 patients are relapse-free and 15 are alive, with a five-year progression-free survival and an overall survival of 70% (95% CI = 60-80%) and 75% (95% CI = 66-84) respectively. No patient with cerebrospinal fluid (CSF)/meningeal lymphoma experienced central nervous system recurrence. With respect to previously reported regimens, this programme was delivered in a shorter period, and achieved the main goal of maintaining efficacy and improving tolerability.
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Affiliation(s)
- Andrés J M Ferreri
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Cattaneo
- Division of Hematology, Ospedali Civili di Brescia, Brescia, Italy
| | - Arben Lleshi
- Division of Medical Oncology and Immune-related tumors, IRCCS Centro di Riferimento Oncologico (CRO), Aviano (PN), Italy
| | - Luisa Verga
- Division of Hematology, Azienda Ospedaliera San Gerardo, Monza, Italy
| | | | | | - Maurilio Ponzoni
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milano, Italy
| | - Marco Foppoli
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daris Ferrari
- Division of Medical Oncology, Azienda Ospedaliera San Paolo, Milan, Italy
| | - Luigi Rigacci
- Division of Hematology, Ospedale Careggi, Florence, Italy
| | | | - Giovanni Donadoni
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Fumagalli
- Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marianna Sassone
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Teresa Calimeri
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Rossi
- Division of Hematology, Ospedali Civili di Brescia, Brescia, Italy
| | - Michele Spina
- Division of Medical Oncology and Immune-related tumors, IRCCS Centro di Riferimento Oncologico (CRO), Aviano (PN), Italy
| | - Alessandro Re
- Division of Hematology, Ospedali Civili di Brescia, Brescia, Italy
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10
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Atallah-Yunes SA, Murphy DJ, Noy A. HIV-associated Burkitt lymphoma. LANCET HAEMATOLOGY 2020; 7:e594-e600. [PMID: 32735838 DOI: 10.1016/s2352-3026(20)30126-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/08/2020] [Accepted: 04/15/2020] [Indexed: 12/30/2022]
Abstract
Burkitt lymphoma is a rare and aggressive non-Hodgkin lymphoma with three classifications: endemic, sporadic, and immunodeficiency-related. High-intensity chemotherapeutic regimens have considerably improved overall survival for patients with Burkitt lymphoma. In this Review of HIV-associated Burkitt lymphoma, we summarise expert opinion and provide general recommendations for the treatment of Burkitt lymphoma in patients with HIV on the basis of retrospective and prospective studies, taking into consideration immune status, CD4 cell counts, the presence of systemic disease, and the risk of CNS involvement or relapse. We also discuss the role of rituximab and antiretroviral therapy. We highlight the reasons behind the possible different mechanisms of lymphomagenesis in HIV-associated Burkitt lymphoma and endemic Burkitt lymphoma, which indicate that HIV might have either a direct or indirect oncogenic role in Burkitt lymphoma. We discuss the possible mechanisms by which HIV and HIV proteins could directly contribute to lymphomagenesis. Identifying these mechanisms might lead to the development of therapies that have fewer toxic effects than high-intensity chemotherapeutic regimens.
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Affiliation(s)
- Suheil Albert Atallah-Yunes
- Department of Medicine, University of Massachusetts Medical School-Baystate Medical Center, Springfield, MA, USA
| | - Dermot J Murphy
- Department of Medicine, Mercy Medical Center, Springfield, MA, USA
| | - Ariela Noy
- Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY, USA.
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Jakobsen LH, Ellin F, Smeland KB, Wästerlid T, Christensen JH, Jørgensen JM, Josefsson PL, Øvlisen AK, Holte H, Blaker YN, Grauslund JH, Bjørn J, Molin D, Lagerlöf I, Smedby KE, Colvin K, Thanarajasingam G, Maurer MJ, Habermann TM, Song KW, Zhu KY, Gerrie AS, Cheah CY, El-Galaly TC. Minimal relapse risk and early normalization of survival for patients with Burkitt lymphoma treated with intensive immunochemotherapy: an international study of 264 real-world patients. Br J Haematol 2020; 189:661-671. [PMID: 32017050 DOI: 10.1111/bjh.16425] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/28/2019] [Indexed: 11/27/2022]
Abstract
Non-endemic Burkitt lymphoma (BL) is a rare germinal centre B-cell-derived malignancy with the genetic hallmark of MYC gene translocation and with rapid tumour growth as a distinct clinical feature. To investigate treatment outcomes, loss of lifetime and relapse risk in adult BL patients treated with intensive immunochemotherapy, retrospective clinic-based and population-based lymphoma registries from six countries were used to identify 264 real-world patients. The median age was 47 years and the majority had advanced-stage disease and elevated LDH. Treatment protocols were R-CODOX-M/IVAC (47%), R-hyper-CVAD (16%), DA-EPOCH-R (11%), R-BFM/GMALL (25%) and other (2%) leading to an overall response rate of 89%. The two-year overall survival and event-free survival were 84% and 80% respectively. For patients in complete remission/unconfirmed, the two-year relapse risk was 6% but diminished to 0·6% for patients reaching 12 months of post-remission event-free survival (pEFS12). The loss of lifetime for pEFS12 patients was 0·4 (95% CI: -0·7 to 2) months. In conclusion, real-world outcomes of adult BL are excellent following intensive immunochemotherapy. For pEFS12 patients, the relapse risk was low and life expectancy similar to that of a general population, which is important information for developing meaningful follow-up strategies with increased focus on survivorship and less focus on routine disease surveillance.
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Affiliation(s)
- Lasse H Jakobsen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Fredrik Ellin
- Department of Clinical Sciences Lund, Oncology, Lund University, Lund, Sweden
| | - Knut B Smeland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Tove Wästerlid
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | | | - Judit M Jørgensen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Andreas K Øvlisen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Harald Holte
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- KG Jebsen Centre for B-cell malignancies, Oslo, Norway
| | - Yngvild N Blaker
- KG Jebsen Centre for B-cell malignancies, Oslo, Norway
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | | | - Jon Bjørn
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - Daniel Molin
- Experimental and Clinical Oncology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Ingemar Lagerlöf
- Division of Drug Research, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Karin E Smedby
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Katherine Colvin
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | | | - Matthew J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Kevin W Song
- Leukemia/BMT Program of BC, Centre for Lymphoid Cancer, BC Cancer, Vancouver, Canada
| | - Katie Y Zhu
- Leukemia/BMT Program of BC, Centre for Lymphoid Cancer, BC Cancer, Vancouver, Canada
| | - Alina S Gerrie
- Leukemia/BMT Program of BC, Centre for Lymphoid Cancer, BC Cancer, Vancouver, Canada
| | - Chan Y Cheah
- Department of Hematology, Sir Charles Gairdner Hospital, Nedlands, Australia
- Department of Hematology, Pathwest Laboratory Medicine WA, Nedlands, Australia
- Medical School, University of Western Australia, Crawley, Australia
| | - Tarec C El-Galaly
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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12
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Zayac AS, Olszewski AJ. Burkitt lymphoma: bridging the gap between advances in molecular biology and therapy. Leuk Lymphoma 2020; 61:1784-1796. [PMID: 32255708 DOI: 10.1080/10428194.2020.1747068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Genomic studies have revealed molecular mechanisms involved in the pathogenesis of Burkitt's lymphoma, including the ID3/TCF3-dependent centroblast gene expression program, tonic PI3K-AKT-mTOR signaling, and deregulation of cell cycle and apoptosis through mutations in cyclin D3, CDKN2A, or TP53. Unfortunately, these advances have not been translated into treatment, which relies on dose-intense cytotoxic chemotherapy. While most patients achieve long-term survival, options for relapsed/refractory disease are lacking, as Burkitt lymphoma is often excluded from clinical trials of novel approaches. The lower-intensity, dose-adjusted EPOCH plus rituximab (DA-EPOCH-R) regimen constitutes a major advance allowing for treatment of older and HIV-positive patients but needs augmentation to better address the central nervous system involvement. Furthermore, DA-EPOCH-R provides a platform for the study of targeted or immunotherapeutic approaches while de-escalating cytotoxic agents and their associated adverse effects. In this review we discuss the epidemiology and molecular genetics of BL, first-line treatment considerations, and potential novel treatment strategies.
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Affiliation(s)
- Adam S Zayac
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Adam J Olszewski
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
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13
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Prospective study of Burkitt lymphoma treatment in adolescents and adults in Malawi. Blood Adv 2020; 3:612-620. [PMID: 30796065 DOI: 10.1182/bloodadvances.2018029199] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 01/16/2019] [Indexed: 12/18/2022] Open
Abstract
Burkitt lymphoma (BL) is common in sub-Saharan Africa (SSA). In high-income countries, BL is highly curable with chemotherapy. However, there are few prospective studies from SSA describing nonpediatric BL and no regional standard of care. Thirty-five participants age 15 years or older with newly diagnosed BL were enrolled in Malawi from 2013 to 2018. Chemotherapy was administered according to institutional guidelines, with concurrent antiretroviral therapy if HIV infected. Median age was 21 years (range, 15-61) and 15 participants (43%) were HIV infected. Twenty-seven participants (77%) had stage III to IV disease, and 19 (54%) had Eastern Cooperative Oncology Group performance status >1. Among HIV-infected participants, median CD4 count was 130 (range, 29-605) and 10 (67%) had suppressed HIV viral load. Four participants (11%) died before receiving chemotherapy. First-line chemotherapy consisted of: cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) (n = 22 [71%]); infusional etoposide, prednisolone, vincristine, cyclophosphamide, and doxorubicin (n = 4 [13%]); high-dose methotrexate-based chemotherapy (n = 4 [13%]); and rituximab plus CHOP (n = 1 [3%]). Among 28 evaluable participants, 14 (50%) achieved a complete response. Median overall survival (OS) was 7 months; 1-year OS was 40% (95% confidence interval [CI], 24%-56%). Sixteen (73%) of 22 deaths were a result of disease progression. Compared with CHOP, more intensive chemotherapy was associated with decreased mortality (hazard ratio, 0.24; 95% CI, 0.05-1.02; P = .05). This is among the best characterized prospective cohorts of nonpediatric BL in SSA. Most deaths resulted from progressive BL. Patients who received more intensive therapy seemed to have better outcomes. Defining optimal approaches is an urgent priority in SSA.
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14
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Silva WFD, Garibaldi PMM, Rosa LID, Bellesso M, Clé DV, Delamain MT, Rego EM, Pereira J, Rocha V. Outcomes of HIV-associated Burkitt Lymphoma in Brazil: High treatment toxicity and refractoriness rates - A multicenter cohort study. Leuk Res 2019; 89:106287. [PMID: 31864677 DOI: 10.1016/j.leukres.2019.106287] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/30/2019] [Accepted: 12/09/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although the increased use of combined antiretroviral therapy (cART) has decreased the incidence of lymphomas HIV-associated, Burkitt lymphoma (BL) incidence remains stable. Reported outcomes on HIV-associated BL from developed countries seem to corroborate that the regimens do not need to be tailored to the HIV-positive population. MATERIALS AND METHODS This is a retrospective multicenter cohort study from Brazil, including HIV-positive patients aged 15 years and above diagnosed with BL. RESULTS A total of 54 patients were included. Median age was 39 years (range, 15-64). At diagnosis, advanced disease was found in 86% and 52% had a CD4+ count lower than 200 cells/mm3. Five patients died before starting any regimen. Among the remaining 49 patients, most were treated with Hyper-CVAD (53%) and CODOX-M IVAC (18%). Rituximab was used in frontline in only 16% of the patients. Primary refractory disease was found in 14%. A treatment-related mortality of 38.7% and a complete response rate of 44.9% were found. At 4 years, estimated overall survival (OS) was 39.8%. All relapsed and primary refractory patients eventually died. Remaining patients died from infections (24/34), despite antimicrobial prophylaxis and associated cART. CONCLUSION Early mortality and toxicity were higher in our cohort than in developed countries. A faster diagnosis, better understanding of the biology of the disease, establishment of low toxicity regimens, inclusion of rituximab and improvement of supportive care may decrease the mortality of HIV-associated BL in developing countries.
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Affiliation(s)
- Wellington F da Silva
- Instituto do Cancer de Sao Paulo (ICESP), Universidade de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil.
| | - Pedro Manoel Marques Garibaldi
- Hospital das Clínicas da Faculdade de Medicina de Ribeirao Preto (HCRP), Av. Bandeirantes, 3900 - Vila Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Lidiane Inês da Rosa
- Instituto do Cancer de Sao Paulo (ICESP), Universidade de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil; HEMOMED - Instituto de Oncologia e Hematologia, Av. Arnolfo Azevedo, 121 - Pacaembu, São Paulo, SP, 01236-030, Brazil
| | - Marcelo Bellesso
- Instituto do Cancer de Sao Paulo (ICESP), Universidade de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil; HEMOMED - Instituto de Oncologia e Hematologia, Av. Arnolfo Azevedo, 121 - Pacaembu, São Paulo, SP, 01236-030, Brazil
| | - Diego Villa Clé
- Hospital das Clínicas da Faculdade de Medicina de Ribeirao Preto (HCRP), Av. Bandeirantes, 3900 - Vila Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Márcia Torresan Delamain
- Hospital de Clínicas da Universidade Estadual de Campinas (Unicamp), R. Vital Brasil, 251 - Cidade Universitária, Campinas, SP, 13083-888, Campinas, Brazil
| | - Eduardo Magalhães Rego
- Instituto do Cancer de Sao Paulo (ICESP), Universidade de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil; Laboratory of Medical Investigation on Pathogenesis and Targeted Therapy in Onco-immuno-hematology (LIM-31), Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 155 - Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Juliana Pereira
- Instituto do Cancer de Sao Paulo (ICESP), Universidade de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil; Laboratory of Medical Investigation on Pathogenesis and Targeted Therapy in Onco-immuno-hematology (LIM-31), Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 155 - Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Vanderson Rocha
- Instituto do Cancer de Sao Paulo (ICESP), Universidade de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil; Laboratory of Medical Investigation on Pathogenesis and Targeted Therapy in Onco-immuno-hematology (LIM-31), Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 155 - Cerqueira César, São Paulo, SP, 05403-000, Brazil
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15
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Goldstein JS, Switchenko JM, Behera M, Flowers CR, Koff JL. Insurance status impacts overall survival in Burkitt lymphoma. Leuk Lymphoma 2019; 60:3225-3234. [PMID: 31274033 PMCID: PMC6923579 DOI: 10.1080/10428194.2019.1623884] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/16/2019] [Accepted: 05/15/2019] [Indexed: 12/11/2022]
Abstract
The impact of insurance status on clinical outcomes in Burkitt (BL) and plasmablastic (PBL) lymphomas remains unknown. We used the National Cancer Database to examine insurance status' effect on overall survival (OS) in adults diagnosed with these lymphomas between 2004 and 2014. BL patients with private insurance had significantly better OS compared to those without. In patients aged <65 years, hazard ratios were 1.4 for uninsured status (95% confidence interval 1.2-1.7), 1.2 for Medicaid (95% CI 1.0-1.4), and 1.5 for Medicare (95% CI 1.2-1.9). For patients aged >65 years, hazard ratio for uninsured status was 8.4 (95% CI 2.5-28.3). Conversely, underinsured PBL patients experienced no difference in OS. Thus, expanding insurance-related access to care may improve survival in BL, for which curative therapy exists, but not PBL, where more effective therapies are needed. Our findings add to mounting evidence that adequate health insurance is particularly important for patients with curable cancers.
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Affiliation(s)
| | - Jeffrey M. Switchenko
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Madhusmita Behera
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Christopher R. Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Jean L. Koff
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
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16
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Philippe L, Lancar R, Laurent C, Algarte-Genin M, Chassagne-Clément C, Fabiani B, Pierre Chenard M, Lazure T, Parrens M, Charlotte F, Delattre C, Gibault L, Capron F, Goubin-Versini I, Petitjean B, Boué F, Mounier N, Costello R, Costagliola D, Prevot S, Besson C. In situ BCL2 expression is an independent prognostic factor in HIV-associated DLBCL, a LYMPHOVIR cohort study. Br J Haematol 2019; 188:413-423. [PMID: 31468517 DOI: 10.1111/bjh.16176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/04/2019] [Indexed: 12/13/2022]
Abstract
The prognostic value of cell of origin (COO) classification and BCL2 expression is not well established in diffuse large B-cell lymphoma (DLBCL) patients with human immunodeficiency virus (HIV) infection in the recent era. Phenotypic patterns were determined by immunohistochemistry (IHC) of pathological samples from patients with HIV-associated DLBCL prospectively enrolled in the French AIDS and Viral Hepatitis CO16 Lymphovir cohort between 2008 and 2015. Molecular subgroup classification into germinal centre B-cell (GCB) and non-GCB subtypes was determined using the Hans algorithm. Among 52 samples of systemic DLBCL subjected to centralized pathological analysis, 25 of the 42 tested for BCL2 expression were positive. Samples were further classified into GCB (n = 19) and non-GCB (n = 16) subtypes and 17 remained unclassified. In multivariable analysis, BCL2 expression was an independent pejorative prognostic biomarker [4-year progression-free survival (PFS): 52% for BCL2+ vs. 88% for BCL2- , P = 0·02] and tended to reduce 4-year overall survival (OS) (63% for BCL2+ vs. 88% for BCL2- , P = 0·06). The difference between CGB and non-GCB subtypes on PFS and OS did not reach significance (4-year PFS: 79% for GCB vs. 53% for non-GCB, P = 0·24 and 4-year OS: 78% for GCB vs. 69% for non-GCB, P = 0·34). BCL2 expression determined by IHC is an independent pejorative prognostic biomarker in HIV-associated DLBCL in the recent era. This supports the investigation of new therapeutic strategies in patients with BCL2 expression.
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Affiliation(s)
- Laure Philippe
- Unit of Haematology-Oncology, Centre Hospitalier Versailles, Le Chesnay, France.,Université Versailles Saint Quentin en Yvelines, Paris-Saclay University, Communauté Paris-Saclay, Saint-Quentin en Yvelines, France
| | - Remi Lancar
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Sorbonne Université, Paris, France
| | - Camille Laurent
- Department of Pathology, Institut Universitaire du Cancer-Oncopole, CHU Toulouse, Toulouse, France.,INSERM, U.1037, Centre de Recherche en Cancérologie de Toulouse-Purpan, Toulouse, France
| | - Michele Algarte-Genin
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Sorbonne Université, Paris, France
| | | | - Bettina Fabiani
- Department of Pathology, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Marie Pierre Chenard
- Department of Pathology, Hôpital de Hautepierre, University Hospital of Strasbourg, Strasbourg, France
| | - Thierry Lazure
- Faculté de médecine Paris Sud, Université Paris Sud, Le Kremlin-Bicêtre, France.,Department of Pathology, AP-HP, Hôpitaux Paris Sud, Paris Sud University, Le Kremlin-Bicetre, France
| | - Marie Parrens
- Department of Pathology, Haut-Lévêque Hospital, Southern Hospital Group, Bordeaux University Hospital, Pessac, France
| | - Frederic Charlotte
- Department of Pathology, Hopital Pitie-Salpetriere and Sorbonne University, Paris, France
| | | | - Laure Gibault
- Department of Pathology, Hôpital Européen Georges Pompidou, AP-HP, and Université Paris Descartes, Paris, France
| | - Frederique Capron
- Department of Pathology, Faculté de médecine Pierre-et-Marie-Curie, Hopital Pitié-Salpêtrière, AP-HP, Paris, France
| | | | - Bruno Petitjean
- Department of Pathology, René DUBOS Hospital, Cergy-Pontoise, France
| | - François Boué
- Faculté de médecine Paris Sud, Université Paris Sud, Le Kremlin-Bicêtre, France.,Clinical Immunology Unit, AP-HP, Hôpitaux Paris Sud Site Béclère, Clamart, France
| | - Nicolas Mounier
- Department of Onco-Haematology, Archet Hospital, Nice, France
| | - Regis Costello
- Department of Haematology, AP-HM, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Dominique Costagliola
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Sorbonne Université, Paris, France
| | - Sophie Prevot
- Faculté de médecine Paris Sud, Université Paris Sud, Le Kremlin-Bicêtre, France.,Department of Pathology, AP-HP, Hôpitaux Paris Sud, Paris Sud University, Le Kremlin-Bicetre, France
| | - Caroline Besson
- Unit of Haematology-Oncology, Centre Hospitalier Versailles, Le Chesnay, France.,Université Versailles Saint Quentin en Yvelines, Paris-Saclay University, Communauté Paris-Saclay, Saint-Quentin en Yvelines, France.,INSERM U1018, Centre pour la Recherche en Epidémiologie et Santé des Populations (CESP), Equipe "Générations et Santé" Gustave Roussy, Villejuif, France
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17
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Liu ZL, Liu PP, Bi XW, Lei DX, Wang Y, Li ZM, Jiang WQ, Xia Y. Trends in survival of patients with stage I/II Burkitt lymphoma in the United States: A SEER database analysis. Cancer Med 2019; 8:874-881. [PMID: 30706675 PMCID: PMC6434224 DOI: 10.1002/cam4.1870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/15/2018] [Accepted: 10/22/2018] [Indexed: 11/16/2022] Open
Abstract
The treatment strategy for management of Burkitt lymphoma (BL) has evolved during the past decades and the clinical outcome for this disease as a whole has also improved. Due to limited information reported on survival trends of patients with stage I/II (limited‐stage) BL, here we used the Surveillance, Epidemiology, and End Results (SEER) database to conduct our study. The time period was divided into two eras (1983‐2001 and 2002‐2014) as the recent era reflected more intensive chemotherapy regimens, the availability of rituximab, the widespread use of antiretroviral therapy (ART) and improvements in supportive care. Patients with limited‐stage BL had a significantly better 5‐year overall survival (OS) in the 2002‐2014 era in both univariate analysis and multivariate analysis, compared with those in the 1983‐2001 era (64.1% vs 57.4%). However, clinical outcomes of elderly patients (≥60 years) and children patients (0‐19 years) did not significantly improve. Older age and race of black were correlated with poorer OS in multivariate analysis, whereas sex, primary sites, and application of radiotherapy did not significantly influence OS. In conclusion, the prognosis of patients with limited‐stage BL has improved in the 2002‐2014 era, but the outcome was still much poorer in elderly patients, which needs to be improved by identifying newly molecular‐targeted drugs and developing novel personalized therapeutic approaches.
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Affiliation(s)
- Ze-Long Liu
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Pan-Pan Liu
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Xi-Wen Bi
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - De-Xin Lei
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Yu Wang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Zhi-Ming Li
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Wen-Qi Jiang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Yi Xia
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
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18
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Hiv and Lymphoma: from Epidemiology to Clinical Management. Mediterr J Hematol Infect Dis 2019; 11:e2019004. [PMID: 30671210 PMCID: PMC6328036 DOI: 10.4084/mjhid.2019.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/23/2018] [Indexed: 01/19/2023] Open
Abstract
Patients infected with human immunodeficiency virus (HIV) are at increased risk for developing both non-Hodgkin’s lymphoma (NHL) and Hodgkin’s lymphoma (HL). Even if this risk has decreased for NHL after the introduction of combination antiretroviral therapy (cART), they remain the most common acquired immune deficiency syndrome (AIDS)-related cancer in the developed world. They are almost always of B-cell origin, and some specific lymphoma types are more common than others. Some of these lymphoma types can occur in both HIV-uninfected and infected patients, while others preferentially develop in the context of AIDS. HIV-associated lymphoma differs from lymphoma in the HIV negative population in that they more often present with advanced disease, systemic symptoms, and extranodal involvement and are frequently associated with oncogenic viruses (Epstein-Barr virus and/or human herpesvirus-8). Before the introduction of cART, most of these patients could not tolerate the treatment strategies routinely employed in the HIV-negative population. The widespread use of cART has allowed for the delivery of full-dose and dose-intensive chemotherapy regimens with improved outcomes that nowadays can be compared to those seen in non-HIV infected patients. However, a great deal of attention should be paid to opportunistic infections and other infectious complications, cART-chemotherapy interactions, and potential cumulative toxicity. In the context of relatively sparse prospective and randomized trials, the optimal treatment of AIDS-related lymphomas remains a challenge, particularly in patients with severe immunosuppression. This paper will address epidemiology, pathogenesis, and therapeutic strategies in HIV-associated NHL and HL.
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19
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Polcyn R, God J, Capone M, Matzelle D, Banik NL, Haque A. A Missing Link between Neuron Specific Enolase Release and Poor Prognosis in Aging Patients with B-cell Lymphoma. JOURNAL OF CLINICAL & CELLULAR IMMUNOLOGY 2018; 9:e121. [PMID: 30464859 PMCID: PMC6242283 DOI: 10.4172/2155-9899.1000e121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Rachel Polcyn
- Department of Microbiology and Immunology, Hollings Cancer Center, Medical University of South Carolina, Charleston, USA
| | - Jason God
- Department of Microbiology and Immunology, Hollings Cancer Center, Medical University of South Carolina, Charleston, USA
| | - Mollie Capone
- Department of Microbiology and Immunology, Hollings Cancer Center, Medical University of South Carolina, Charleston, USA
| | - Denise Matzelle
- Department of Neurosurgery, Medical University of South Carolina, Charleston, USA
- Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Naren L Banik
- Department of Microbiology and Immunology, Hollings Cancer Center, Medical University of South Carolina, Charleston, USA
- Department of Neurosurgery, Medical University of South Carolina, Charleston, USA
- Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Azizul Haque
- Department of Microbiology and Immunology, Hollings Cancer Center, Medical University of South Carolina, Charleston, USA
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20
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Painschab M, Gopal S. Guidelines for sub-Saharan Africa: a call for evidence. Lancet Oncol 2018; 19:445-446. [PMID: 29611515 PMCID: PMC8588873 DOI: 10.1016/s1470-2045(18)30124-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/08/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Matthew Painschab
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi.
| | - Satish Gopal
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi
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21
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Esteban RE, Christianne B, Alvaro A, Demichelis-Gómez R. Prognostic Effect of CD20 Expression in Adult B-cell Acute Lymphoblastic Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:361-367. [PMID: 29544762 DOI: 10.1016/j.clml.2018.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 02/21/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The expression of the CD20 on adult B-cell acute lymphoblastic leukemia (ALL-B) has generally been associated with a poor prognosis, and several studies have explored the incorporation of rituximab into the therapeutic regimen for adult ALL-B patients, with a positive effect on event-free survival (EFS). PATIENTS AND METHODS We analyzed the prognostic value of CD20 expression and the effect of rituximab for the treatment of Hispanic adult ALL-B patients. We performed a retrospective study of 152 ALL-B patients treated from 2009 to 2016. The patient characteristics and treatment outcomes were analyzed according to CD20 expression (CD20+ vs. CD20-), age group, and treatment with rituximab. RESULTS CD20 expression was positive for 47.7% of patients (n = 72). Excluding the patients who had received rituximab, the overall survival (OS) was greater for the CD20- patient subgroup than for the CD20+ subgroup (11.2 vs. 6.9 months; 95% confidence interval [CI], 7.43-14.9; P = .008). In the CD20+ subgroup, 10 patients (7.2%) received treatment with rituximab, with 100% reaching complete remission (CR) 4 weeks after treatment. In the 18- to 39-year age group, CD20+ patients treated with rituximab had EFS and OS that was not reached. In addition, for CD20+ patients who received with chemotherapy, EFS was 3.9 months (95% CI, 0.6-7.2 months; P = .025) and OS was 7.2 months (95% CI, 3.37-11.0; P = .013). Multivariate analysis showed that the use of rituximab was independently associated with OS and CR at 4 weeks after induction. CONCLUSION CD20 expression in adult ALL-B is associated with decreased OS. Treatment with rituximab can increase OS, EFS, and CR in the 18- to 39-year age group.
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Affiliation(s)
- Reibán-Espinoza Esteban
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Bourlon Christianne
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Aguayo Alvaro
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Roberta Demichelis-Gómez
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico.
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Kanakry JA, Ambinder RF. Virus-Associated Lymphoma. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Rezahosseini O, Hanaei S, Hamadani M, Keshavarz-Fathi M, Rezaei N. The promising role of monoclonal antibodies for immunotherapy of the HIV-associated cancer, non-Hodgkin lymphoma. Int Rev Immunol 2017; 37:165-173. [PMID: 29257907 DOI: 10.1080/08830185.2017.1405396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Association between HIV/AIDS and some of the cancers such as lymphomais is well known. Relative risk for developing non-Hodgkin lymphoma (NHL) increases 60-200 folds in HIV-infected individuals. Diffuse large B cell lymphoma (DLBCL), primary effusion lymphoma (PEL), Burkitt's lymphoma (BL) and Plasmablastic Lymphoma (PBL) are among the most frequent subtypes. During the last century, scientists found that the immune system could potentially detect and destroy cancer cells. Therefore, they started a new field of study, which is named immunotherapy. There are different immunotherapeutic methods, among which therapeutic antibodies, such as Brentuximabvedotin (Adcetris), Ibritumomabtiuxetan (Zevalin) and rituximab (Rituxan), used for treatment of NHLs showed promising results. In this article, we will review the immunotherapeutic option, monoclonal antibodies, for treatment of HIV-associated NHLs as well as their recent clinical status. We will also discuss the selective monoclonal antibody for each subtype of NHLs.
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Affiliation(s)
- Omid Rezahosseini
- a Cancer Immunology Project (CIP) , Universal Scientific Education and Research Network (USERN) , Tehran , Iran.,b Department of Infectious and Tropical diseases , Imam Khomeini Hospital Complex, Tehran University of Medical Sciences , Tehran , Iran
| | - Sara Hanaei
- a Cancer Immunology Project (CIP) , Universal Scientific Education and Research Network (USERN) , Tehran , Iran.,c Research Center for Immunodeficiencies , Children's Medical Center, Tehran University of Medical Sciences , Tehran , Iran.,d School of Medicine , Tehran University of Medical Sciences , Tehran , Iran
| | - Mehdi Hamadani
- e Division of Hematology & Oncology , Medical College of Wisconsin , Milwaukee , WI , USA.,f Cancer Immunology Project (CIP) , Universal Scientific Education and Research Network (USERN) , Milwaukee , WI , USA
| | - Mahsa Keshavarz-Fathi
- a Cancer Immunology Project (CIP) , Universal Scientific Education and Research Network (USERN) , Tehran , Iran.,c Research Center for Immunodeficiencies , Children's Medical Center, Tehran University of Medical Sciences , Tehran , Iran.,d School of Medicine , Tehran University of Medical Sciences , Tehran , Iran.,g Students' Scientific Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Nima Rezaei
- c Research Center for Immunodeficiencies , Children's Medical Center, Tehran University of Medical Sciences , Tehran , Iran.,h Department of Immunology, School of Medicine , Tehran University of Medical Sciences , Tehran , Iran.,i Cancer Immunology Project (CIP) , Universal Scientific Education and Research Network (USERN) , Sheffield , UK
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Pisano G, Roy A, Ahmed Ansari M, Kumar B, Chikoti L, Chandran B. Interferon-γ-inducible protein 16 (IFI16) is required for the maintenance of Epstein-Barr virus latency. Virol J 2017; 14:221. [PMID: 29132393 PMCID: PMC5683537 DOI: 10.1186/s12985-017-0891-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/02/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Epstein-Barr virus (EBV) exhibits both lytic and latent (Lat. I, II, and III) phases in an infected individual. It's during the latent phase of EBV that all EBV-associated cancers, including Burkitt's lymphoma, nasopharyngeal carcinoma and lymphoproliferative disease arise. Interferon-γ-inducible protein 16 (IFI16) is a well-established innate immune sensor and viral transcriptional regulator involved in response to invading DNA viruses. During latency, IFI16 remains in the nucleus, in part bound to the EBV genome; however, neither its role in EBV lytic cycle or latency has been established. METHODS Short interfering RNA against IFI16 and IFI16 overexpression were used to identify the role of IFI16 in the maintenance of EBV latency I. We also studied how induction of the lytic cycle affected IFI16 using the EBV positive, latently infected Akata or MUTU-1 cell lines. Akata cells were induced with TPA and MUTU-1 cells with TGF-β up to 96 h and changes in IFI16 protein were analyzed by Western blotting and immunofluorescence microscopy. To assess the mechanism of IFI16 decrease, EBV DNA replication and late lytic transcripts were blocked using the viral DNA polymerase inhibitor phosphonoacetic acid. RESULTS Knockdown of IFI16 mRNA by siRNA resulted in enhanced levels of EBV lytic gene expression from all temporal gene classes, as well as an increase in the total EBV genome abundance, whereas overexpression of exogenous IFI16 reversed these effects. Furthermore, 96 h after induction of the lytic cycle with either TPA (Akata) or TGF-β (MUTU-1), IFI16 protein levels decreased up to 80% as compared to the EBV-negative cell line BJAB. Reduction in IFI16 was observed in cells expressing EBV lytic envelope glycoprotein. The decreased levels of IFI16 protein do not appear to be dependent on late lytic transcripts of EBV but suggest involvement of the immediate early, early, or a combination of both gene classes. CONCLUSIONS Reduction of IFI16 protein levels following lytic cycle induction, as well as reactivation from latency after IFI16 mRNA knockdown suggests that IFI16 is crucial for the maintenance of EBV latency. More importantly, these results identify IFI16 as a unique host factor protein involved in the EBV lifecycle, making it a potential therapeutic target to combat EBV-related malignancies.
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Affiliation(s)
- Gina Pisano
- H.M. Bligh Cancer Research Laboratories, Department of Microbiology and Immunology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA.
| | - Arunava Roy
- H.M. Bligh Cancer Research Laboratories, Department of Microbiology and Immunology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Mairaj Ahmed Ansari
- H.M. Bligh Cancer Research Laboratories, Department of Microbiology and Immunology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Binod Kumar
- H.M. Bligh Cancer Research Laboratories, Department of Microbiology and Immunology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Leela Chikoti
- H.M. Bligh Cancer Research Laboratories, Department of Microbiology and Immunology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Bala Chandran
- H.M. Bligh Cancer Research Laboratories, Department of Microbiology and Immunology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
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Han X, Jemal A, Hulland E, Simard EP, Nastoupil L, Ward E, Flowers CR. HIV Infection and Survival of Lymphoma Patients in the Era of Highly Active Antiretroviral Therapy. Cancer Epidemiol Biomarkers Prev 2016; 26:303-311. [PMID: 27756777 DOI: 10.1158/1055-9965.epi-16-0595] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/29/2016] [Accepted: 10/12/2016] [Indexed: 11/16/2022] Open
Abstract
Background: Highly active antiretroviral therapy (HAART) has extended the life expectancy of patients with HIV/AIDS to approach that of the general population. However, it remains unclear whether HIV infection affects the survival of patients with lymphoma in the HAART era.Methods: Patients diagnosed with Hodgkin lymphoma, diffuse large B-cell lymphoma (DLBCL), Burkitt lymphoma, peripheral T-cell lymphoma (PTCL), or follicular lymphoma during 2004-2011 were identified from the National Cancer Database. Survival analyses were conducted, where each HIV-infected patient was propensity score matched to a HIV-uninfected patient on the basis of demographic factors, clinical features, and treatment characteristics.Results: Among 179,520 patients, the prevalence of HIV-infection ranged from 1.0% for follicular lymphoma, 3.3% for PTCL, 4.7% for Hodgkin lymphoma, 5.4% for DLBCL, to 29% for Burkitt lymphoma. HIV infection was significantly associated with inferior overall survival for patients with each lymphoma subtype: Hodgkin lymphoma [HR, 1.47; 95% confidence interval (CI), 1.25-1.74], DLBCL (HR, 1.95; 95% CI, 1.80-2.11), Burkitt lymphoma (HR, 1.46; 95% CI, 1.24-1.73), PTCL (HR, 1.43; 95% CI, 1.14-1.79), and follicular lymphoma (HR, 1.44; 95% CI, 1.04-2.00).Conclusions: HIV/AIDS continues to be independently associated with increased risk of death among patients with lymphoma in the HAART era in the United States, and the association varies by lymphoma histologic subtype.Impact: Examination of effective management strategies for patients with HIV/AIDS-associated lymphoma and enrollment of patients in prospective clinical trials are needed to improve patient outcomes. Cancer Epidemiol Biomarkers Prev; 26(3); 303-11. ©2016 AACR.
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Affiliation(s)
- Xuesong Han
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Erin Hulland
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.,Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Edgar P Simard
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Loretta Nastoupil
- Winship Cancer Institute, Emory University, Atlanta, Georgia.,University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth Ward
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
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Maury S, Chevret S, Thomas X, Heim D, Leguay T, Huguet F, Chevallier P, Hunault M, Boissel N, Escoffre-Barbe M, Hess U, Vey N, Pignon JM, Braun T, Marolleau JP, Cahn JY, Chalandon Y, Lhéritier V, Beldjord K, Béné MC, Ifrah N, Dombret H. Rituximab in B-Lineage Adult Acute Lymphoblastic Leukemia. N Engl J Med 2016; 375:1044-53. [PMID: 27626518 DOI: 10.1056/nejmoa1605085] [Citation(s) in RCA: 223] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Treatment with rituximab has improved the outcome for patients with non-Hodgkin's lymphoma. Patients with B-lineage acute lymphoblastic leukemia (ALL) may also have the CD20 antigen, which is targeted by rituximab. Although single-group studies suggest that adding rituximab to chemotherapy could improve the outcome in such patients, this hypothesis has not been tested in a randomized trial. METHODS We randomly assigned adults (18 to 59 years of age) with CD20-positive, Philadelphia chromosome (Ph)-negative ALL to receive chemotherapy with or without rituximab, with event-free survival as the primary end point. Rituximab was given during all treatment phases, for a total of 16 to 18 infusions. RESULTS From May 2006 through April 2014, a total of 209 patients were enrolled: 105 in the rituximab group and 104 in the control group. After a median follow-up of 30 months, event-free survival was longer in the rituximab group than in the control group (hazard ratio, 0.66; 95% confidence interval [CI], 0.45 to 0.98; P=0.04); the estimated 2-year event-free survival rates were 65% (95% CI, 56 to 75) and 52% (95% CI, 43 to 63), respectively. Treatment with rituximab remained associated with longer event-free survival in a multivariate analysis. The overall incidence rate of severe adverse events did not differ significantly between the two groups, but fewer allergic reactions to asparaginase were observed in the rituximab group. CONCLUSIONS Adding rituximab to the ALL chemotherapy protocol improved the outcome for younger adults with CD20-positive, Ph-negative ALL. (Funded by the Regional Clinical Research Office, Paris, and others; ClinicalTrials.gov number, NCT00327678 .).
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Affiliation(s)
- Sébastien Maury
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Sylvie Chevret
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Xavier Thomas
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Dominik Heim
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Thibaut Leguay
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Françoise Huguet
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Patrice Chevallier
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Mathilde Hunault
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Nicolas Boissel
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Martine Escoffre-Barbe
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Urs Hess
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Norbert Vey
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Jean-Michel Pignon
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Thorsten Braun
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Jean-Pierre Marolleau
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Jean-Yves Cahn
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Yves Chalandon
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Véronique Lhéritier
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Kheira Beldjord
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Marie C Béné
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Norbert Ifrah
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Hervé Dombret
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
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Sissolak G, Seftel M, Uldrick TS, Esterhuizen TM, Mohamed N, Kotze D. Burkitt's Lymphoma and B-Cell Lymphoma Unclassifiable With Features Intermediate Between Diffuse Large B-Cell Lymphoma and Burkitt's Lymphoma in Patients With HIV: Outcomes in a South African Public Hospital. J Glob Oncol 2016; 3:218-226. [PMID: 28717763 PMCID: PMC5493215 DOI: 10.1200/jgo.2015.002378] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose Burkitt’s lymphoma (BL) is a common HIV-associated lymphoma in South Africa. B-cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt’s lymphoma (BL/DLBCL) also occurs in HIV infection. Outcomes of HIV-infected patients with BL or BL/DLBCL in a resource-constrained setting are not defined. Methods We performed a retrospective study of HIV-positive patients with BL or BL/DLBCL treated from 2004 to 2012 with curative intent at a publically funded academic medical center in South Africa. Differences between BL and BL/DLBCL, survival outcomes, and factors associated with survival were analyzed. Results There were 35 patients with either HIV-associated BL (24) or BL/DLBCL (11) who met study criteria. Median CD4+ T-lymphocyte count at lymphoma diagnosis was 188 cells/μL (range, 10 to 535 cells/μL). Patients with BL/DLBCL were significantly older and had less bone marrow involvement and lower baseline serum lactase dehydrogenase than patients with BL. Eighty-nine percent of patients presented with advanced disease, and 25% had baseline CNS involvement. Chemotherapy regimens consisted of cytoreduction with low-dose cyclophosphamide, vincristine, and prednisone followed by induction with vincristine, methotrexate, cyclophosphamide, doxorubicin and prednisone (LMB 86; 57%); hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate, and cytarabine (hyper-CVAD; 20%); cyclophosphamide, doxorubicin, vincristine, and prednisone and high-dose methotrexate with leucovorin rescue on day 10 with accompanying prophylactic IT chemotherapy (Stanford regimen; 14%); and cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP-like; 9%) regimens. Twenty-three patients received CNS treatment or prophylaxis, and 31 received concurrent combination antiretroviral therapy. Two-year overall survival was 38% (95% CI, 22% to 54%) and 2-year event-free survival was 23% (95% CI, 11% to 38%), with no difference between histologic subtypes. Common causes of death were infection (41%) and CNS disease progression or systemic relapse (41%). Conclusion Cure of HIV-associated BL and BL/DLBCL with intensive regimens is possible in resource-limited settings, but lower toxicity regimens, improved CNS prophylaxis, and increased resources for supportive care are required.
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Affiliation(s)
- Gerhard Sissolak
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
| | - Matthew Seftel
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
| | - Thomas S Uldrick
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
| | - Tonya M Esterhuizen
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
| | - Nooroudien Mohamed
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
| | - Danie Kotze
- , , , and , Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; , University of Manitoba, Winnipeg, Manitoba, Canada; and , National Cancer Institute, Bethesda, MD
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Dai X, Wu Y, Jia X, Chang Y, Wu H, Wang C, Chen H, Chen W, Huang Q, Wei W. hIgD promotes human Burkitt lymphoma Daudi cell proliferation by accelerated G1/S transition via IgD receptor activity. Immunol Res 2016; 64:978-87. [DOI: 10.1007/s12026-015-8777-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Dalla Pria A, Bendle M, Ramaswami R, Boffito M, Bower M. The pharmacokinetics of high-dose methotrexate in people living with HIV on antiretroviral therapy. Cancer Chemother Pharmacol 2015; 77:653-7. [PMID: 26696583 PMCID: PMC4767850 DOI: 10.1007/s00280-015-2940-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 12/07/2015] [Indexed: 12/01/2022]
Abstract
Purpose
Clinical outcomes for lymphoma in people living with HIV (PLWH) are similar to those in the general public. However, a number of concerns remain including pharmacological interactions between cytotoxic chemotherapy and antiretroviral therapy (ARVs). Much attention has focussed on pharmacokinetic interactions attributable to effects on hepatic microsomal enzymes, but not on competition for the renal organic anion transport system. High-dose (3 g/m2) intravenous methotrexate (MTX) is part a of (R)-CODOX-M/IVAC chemotherapy regimen for HIV-associated Burkitt/Burkitt-like lymphoma (BL/BLL). We investigated MTX pharmacokinetics and evaluated the effects of renal function (eGFR), age and use of different classes of ARVs. Methods Forty-three PLWH treated with ARVs and (R)-CODOX-M/IVAC are included in the analysis. Plasma MTX concentration was measured (ARK TM MTX assay, VITROS® 5600) daily after administration until levels were <0.04/mmol/L. MTX elimination half-life was correlated with age, renal function and antiretroviral regimen. Results One hundred and fifty timed plasma MTX levels were collected. The median MTX elimination half-life was 21.7 h (range 9.4–204.4). MTX elimination half-life was not influenced by age (p = 0.71), eGFR (p = 0.67) or use of non-nucleoside reverse transcriptase inhibitors (NNRTIs) or integrase inhibitors (p = 0.15). Similarly, different NRTI backbones did not affect MTX elimination kinetics (p = 0.68), despite the potential overlapping competition for active renal tubular transporters between MTX and tenofovir. Conclusion Although there is potential competition for active renal tubular transporters between MTX and tenofovir, no prolongation of MTX half-life was observed. These findings are reassuring to clinicians managing patients with dual diagnoses.
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Affiliation(s)
- Alessia Dalla Pria
- Department of Oncology, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - Maggie Bendle
- Department of Oncology, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - Ramya Ramaswami
- Department of Oncology, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - Marta Boffito
- Department of HIV Medicine, Chelsea and Westminster Hospital, London, SW10 9NH, UK
| | - Mark Bower
- Department of Oncology, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK.
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Abstract
HIV infection is related to an increased risk of cancer compared with general population, both AIDS-defining cancers (Kaposi's sarcoma, non Hodgkin's lymphoma, invasive cervical cancer) and non-AIDS-defining cancers. Although the advent of the highly active antiretroviral therapy era has decreased the Kaposi's sarcoma and non-Hodgkin's lymphoma incidences, non-AIDS-defining malignancies, such as lung cancer, hepatocarcinoma, anal cancer and skin cancers, remain a major cause of morbidity and death in the HIV-infected population. The clinical presentation is often different between the infected and non-infected populations, often with a more advanced stage at diagnosis, a more aggressive pathology, and associated morbidities like immunosuppression, leading to poorer outcomes. Numerous studies have focused on HIV-related malignancies' treatment, however specific guidelines are still missing. Practitioners have to be careful with interactions between antiretroviral and antineoplastic drugs, particularly through the cytochrome P 450. Because of this, a national multidisciplinary approach, "Cancer and HIV, " was started in 2013 thanks to the National Institute of Cancer (INCa). The aim of this review is to present a scientific update about AIDS-and non-AIDS-defining malignancies, both in their clinical aspects and regarding their specific therapeutic management.
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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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Issa DE, van de Schans SAM, Chamuleau MED, Karim-Kos HE, Wondergem M, Huijgens PC, Coebergh JWW, Zweegman S, Visser O. Trends in incidence, treatment and survival of aggressive B-cell lymphoma in the Netherlands 1989-2010. Haematologica 2014; 100:525-33. [PMID: 25512643 DOI: 10.3324/haematol.2014.107300] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Only a small number of patients with aggressive B-cell lymphoma take part in clinical trials, and elderly patients in particular are under-represented. Therefore, we studied data of the population-based nationwide Netherlands Cancer Registry to determine trends in incidence, treatment and survival in an unselected patient population. We included all patients aged 15 years and older with newly diagnosed diffuse large B-cell lymphoma or Burkitt lymphoma in the period 1989-2010 and mantle cell lymphoma in the period 2001-2010, with follow up until February 2013. We examined incidence, first-line treatment and survival. We calculated annual percentage of change in incidence and carried out relative survival analyses. Incidence remained stable for diffuse large B-cell lymphoma (n=23,527), while for mantle cell lymphoma (n=1,634) and Burkitt lymphoma (n=724) incidence increased for men and remained stable for women. No increase in survival for patients with aggressive B-cell lymphoma was observed during the period 1989-1993 and the period 1994-1998 [5-year relative survival 42% (95%CI: 39%-45%) and 41% (38%-44%), respectively], but increased to 46% (43%-48%) in the period 1999-2004 and to 58% (56%-61%) in the period 2005-2010. The increase in survival was most prominent in patients under 65 years of age, while there was a smaller increase in patients over 75 years of age. However, when untreated patients were excluded, patients over 75 years of age had a similar increase in survival to younger patients. In the Netherlands, survival for patients with aggressive B-cell lymphoma increased over time, particularly in younger patients, but also in elderly patients when treatment had been initiated. The improvement in survival coincided with the introduction of rituximab therapy and stem cell transplantation into clinical practice.
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Affiliation(s)
- Djamila E Issa
- Department of Haematology, VU University Medical Centre, Amsterdam
| | | | | | - Henrike E Karim-Kos
- Department of Public Health, Erasmus University Medical Centre Rotterdam, The Netherlands
| | | | - Peter C Huijgens
- Department of Haematology, VU University Medical Centre, Amsterdam Comprehensive Cancer Centre the Netherlands, Utrecht
| | - Jan Willem W Coebergh
- Department of Public Health, Erasmus University Medical Centre Rotterdam, The Netherlands
| | - Sonja Zweegman
- Department of Haematology, VU University Medical Centre, Amsterdam
| | - Otto Visser
- Comprehensive Cancer Centre the Netherlands, Utrecht
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Rowe M, Fitzsimmons L, Bell AI. Epstein-Barr virus and Burkitt lymphoma. CHINESE JOURNAL OF CANCER 2014; 33:609-19. [PMID: 25418195 PMCID: PMC4308657 DOI: 10.5732/cjc.014.10190] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 11/06/2014] [Indexed: 12/12/2022]
Abstract
In 1964, a new herpesvirus, Epstein-Barr virus (EBV), was discovered in cultured tumor cells derived from a Burkitt lymphoma (BL) biopsy taken from an African patient. This was a momentous event that reinvigorated research into viruses as a possible cause of human cancers. Subsequent studies demonstrated that EBV was a potent growth-transforming agent for primary B cells, and that all cases of BL carried characteristic chromosomal translocations resulting in constitutive activation of the c-MYC oncogene. These results hinted at simple oncogenic mechanisms that would make Burkitt lymphoma paradigmatic for cancers with viral etiology. In reality, the pathogenesis of this tumor is rather complicated with regard to both the contribution of the virus and the involvement of cellular oncogenes. Here, we review the current understanding of the roles of EBV and c-MYC in the pathogenesis of BL and the implications for new therapeutic strategies to treat this lymphoma.
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Affiliation(s)
- Martin Rowe
- School of Cancer Sciences, University of Bir-mingham CMDS, Vincent Drive, Edgbaston, Birmingham, B15 2TT, UK.
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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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God JM, Zhao D, Cameron CA, Amria S, Bethard JR, Haque A. Disruption of HLA class II antigen presentation in Burkitt lymphoma: implication of a 47,000 MW acid labile protein in CD4+ T-cell recognition. Immunology 2014; 142:492-505. [PMID: 24628049 DOI: 10.1111/imm.12281] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 12/22/2022] Open
Abstract
While Burkitt lymphoma (BL) has a well-known defect in HLA class I-mediated antigen presentation, the exact role of BL-associated HLA class II in generating a poor CD4(+) T-cell response remains unresolved. Here, we found that BL cells are deficient in their ability to optimally stimulate CD4(+) T cells via the HLA class II pathway. This defect in CD4(+) T-cell recognition was not associated with low levels of co-stimulatory molecules on BL cells, as addition of external co-stimulation failed to elicit CD4(+) T-cell activation by BL. Further, the defect was not caused by faulty antigen/class II interaction, because antigenic peptides bound with measurable affinity to BL-associated class II molecules. Interestingly, functional class II-peptide complexes were formed at acidic pH 5·5, which restored immune recognition. Acidic buffer (pH 5·5) eluate from BL cells contained molecules that impaired class II-mediated antigen presentation and CD4(+) T-cell recognition. Biochemical analysis showed that these molecules were greater than 30,000 molecular weight in size, and proteinaceous in nature. In addition, BL was found to have decreased expression of a 47,000 molecular weight enolase-like molecule that enhances class II-mediated antigen presentation in B cells, macrophages and dendritic cells, but not in BL cells. These findings demonstrate that BL likely has multiple defects in HLA class II-mediated antigen presentation and immune recognition, which may be exploited for future immunotherapies.
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Affiliation(s)
- Jason M God
- Department of Microbiology and Immunology, Hollings Cancer Center, and Children's Research Institute, Medical University of South Carolina, Charleston, SC, USA
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Kojima Y, Hagiwara S, Uehira T, Ajisawa A, Kitanaka A, Tanuma J, Okada S, Nagai H. Clinical outcomes of AIDS-related Burkitt lymphoma: a multi-institution retrospective survey in Japan. Jpn J Clin Oncol 2014; 44:318-323. [PMID: 24558129 DOI: 10.1093/jjco/hyu012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024] Open
Abstract
OBJECTIVE Acquired immunodeficiency syndrome-related non-Hodgkin lymphoma is treated similarly to non-acquired immunodeficiency syndrome lymphoma, but it is not clear whether highly intensive regimens are beneficial for acquired immunodeficiency syndrome-related Burkitt lymphoma. We conducted a multicenter retrospective survey to clarify the clinical outcomes of acquired immunodeficiency syndrome-related Burkitt lymphoma in the combined antiretroviral therapy era in Japan. METHODS We retrospectively analyzed the outcome of 33 patients with acquired immunodeficiency syndrome-related Burkitt lymphoma, who were diagnosed at five regional hospitals for human immunodeficiency virus/acquired immunodeficiency syndrome in Japan between January 2002 and December 2010. RESULTS The median follow-up period was 20.0 months (range 0.5-92.7 months). Six (18.2%) patients were treated with cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate, ifosphamide, etoposide and high-dose cytarabine, and 23 (69.7%) patients were treated with hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, high-dose methotrexate and high-dose cytarabine. The overall response rate for all patients was 78.8%, with a complete response rate of 72.7%. The two-year overall survival rate was 68.1%. There was no significant difference in overall survival between chemotherapeutic regimens with rituximab (n = 20) and without rituximab (n = 13) (P = 0.49). The two-year overall survival rate was 66.7% for patients receiving cyclophosphamide, vincristine, doxorubicin, dexamethasone, etoposide, ifosfamide and cytarabine, and was 72.6% for patients receiving cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate and cytarabine (P = 0.72). There was one treatment-related death. CONCLUSIONS Highly intensive chemotherapy would bring a high remission rate and prolonged overall survival for patients with acquired immunodeficiency syndrome-related Burkitt lymphoma.
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Affiliation(s)
- Yuki Kojima
- *Department of Hematology, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan.
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Xicoy B, Ribera JM, Müller M, García O, Hoffmann C, Oriol A, Hentrich M, Grande C, Wasmuth JC, Esteve J, van Lunzen J, del Potro E, Knechten H, Brunet S, Mayr C, Escoda L, Schommers P, Alonso N, Vall-llovera F, Pérez M, Morgades M, González J, Fernández A, Thoden J, Gökbuget N, Hoelzer D, Fätkenheuer G, Wyen C. Dose-intensive chemotherapy including rituximab is highly effective but toxic in human immunodeficiency virus-infected patients with Burkitt lymphoma/leukemia: parallel study of 81 patients. Leuk Lymphoma 2014; 55:2341-8. [DOI: 10.3109/10428194.2013.878933] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
BACKGROUND The incidence of lung cancer cases among HIV-infected individuals is increasing with time. It is unclear whether HIV-infected individuals receive the same care for lung cancer as immunocompetent patients because of comorbidities, the potential for interaction between antiretroviral agents and cancer chemotherapy, and concerns regarding complications related to treatment or infection. OBJECTIVES The objective of this study was to assess the effect of HIV infection on receipt of guidance-concordant care, and its impact on overall survival among non-small cell lung cancer Medicare beneficiaries. DESIGN The study design was a matched case-control design where each HIV patient was matched by age group, sex, race, and lung cancer stage at diagnosis with 20 controls randomly selected among those who were not HIV infected. SUBJECTS The patients included in this study were Medicare beneficiaries diagnosed with non-small cell lung cancer between 1998 and 2007, who qualified for Medicare on the basis of age and were 65 years of age or older at the time of lung cancer diagnosis. HIV infection status was based on Medicare claims data. A total of 174 HIV cases and 3480 controls were included in the analysis. MEASURES Odds ratios for receiving guidance-concordant care and hazard ratios for overall survival were estimated. RESULTS HIV infection was not independently associated with the receipt of guidance-concordant care. Among stage I/II patients, median survival times were 26 and 43 months, respectively, for those with and without HIV infection (odds ratio=1.48, P=0.021). CONCLUSIONS HIV infection was not associated with receipt of guidance-concordant care but reduced survival in early-stage patients.
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Barta SK, Xue X, Wang D, Tamari R, Lee JY, Mounier N, Kaplan LD, Ribera JM, Spina M, Tirelli U, Weiss R, Galicier L, Boue F, Wilson WH, Wyen C, Oriol A, Navarro JT, Dunleavy K, Little RF, Ratner L, Garcia O, Morgades M, Remick SC, Noy A, Sparano JA. Treatment factors affecting outcomes in HIV-associated non-Hodgkin lymphomas: a pooled analysis of 1546 patients. Blood 2013; 122:3251-62. [PMID: 24014242 PMCID: PMC3821722 DOI: 10.1182/blood-2013-04-498964] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 08/27/2013] [Indexed: 12/27/2022] Open
Abstract
Limited comparative data exist for the treatment of HIV-associated non-Hodgkin lymphoma. We analyzed pooled individual patient data for 1546 patients from 19 prospective clinical trials to assess treatment-specific factors (type of chemotherapy, rituximab, and concurrent combination antiretroviral [cART] use) and their influence on the outcomes complete response (CR), progression free survival (PFS), and overall survival (OS). In our analysis, rituximab was associated with a higher CR rate (odds ratio [OR] 2.89; P < .001), improved PFS (hazard ratio [HR] 0.50; P < .001), and OS (HR 0.51; P < .0001). Compared with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), initial therapy with more dose-intense regimens resulted in better CR rates (ACVBP [doxorubicin, cyclophosphamide, vindesine, bleomycin and prednisolone]: OR 1.70; P < .04), PFS (ACVBP: HR 0.72; P = .049; "intensive regimens": HR 0.35; P < .001) and OS ("intensive regimens": HR 0.54; P < .001). Infusional etoposide, prednisone, infusional vincristine, infusional doxorubicin, and cyclophosphamide (EPOCH) was associated with significantly better OS in diffuse large B-cell lymphoma (HR 0.33; P = .03). Concurrent use of cART was associated with improved CR rates (OR 1.89; P = .005) and trended toward improved OS (HR 0.78; P = .07). These findings provide supporting evidence for current patterns of care where definitive evidence is unavailable.
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MESH Headings
- Anti-HIV Agents/therapeutic use
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antiretroviral Therapy, Highly Active
- Clinical Trials as Topic
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Drug Administration Schedule
- Etoposide/therapeutic use
- HIV/drug effects
- HIV Infections/complications
- HIV Infections/drug therapy
- HIV Infections/mortality
- HIV Infections/virology
- Humans
- Infusions, Intravenous
- Lymphoma, AIDS-Related/complications
- Lymphoma, AIDS-Related/drug therapy
- Lymphoma, AIDS-Related/mortality
- Lymphoma, AIDS-Related/virology
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/mortality
- Lymphoma, Non-Hodgkin/virology
- Prednisone/therapeutic use
- Rituximab
- Survival Analysis
- Treatment Outcome
- Vincristine/therapeutic use
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Serrano D, Miralles P, Balsalobre P, Kwon M, Rodriguez-Macias G, Gayoso J, Anguita J, Buño I, Berenguer J, Díez-Martín JL. Graft-versus-tumor effect after allogeneic stem cell transplantation in HIV-positive patients with high-risk hematologic malignancies. AIDS Res Hum Retroviruses 2013; 29:1340-5. [PMID: 23800257 DOI: 10.1089/aid.2013.0001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) is a well-established therapeutic option for hematological malignancies. Combination antiretroviral therapy (cART) has enabled the treatment of medical conditions in patients infected with the human immunodeficiency virus (HIV) in the same way as in the general population. Moreover, improvements in supportive care have allowed HIV-infected patients with life-threatening hematological disorders to be treated with Allo-HSCT. We report on four HIV-infected patients with hematological malignancies receiving an Allo-HSCT in our institution, and on the use of donor lymphocyte infusions to successfully treat post-Allo-HSCT relapse. Of note, one of them is the first HIV(+) patient to receive a "dual transplant" (unrelated umbilical cord blood stem cells combined with mobilized T cell-depleted CD34(+) stem cells from a mismatched third party donor). cART drugs interactions were satisfactorily managed. This approach provided long-term control of the hematological disease. Nevertheless, despite adequate immune reconstitution, infections were the main cause of morbidity and mortality after Allo-HSCT.
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Affiliation(s)
- David Serrano
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Pilar Miralles
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
- Infectious Diseases Unit, H.G.U. Gregorio Marañón, Madrid, Spain
| | - Pascual Balsalobre
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Mi Kwon
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Gabriela Rodriguez-Macias
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Jorge Gayoso
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Javier Anguita
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Ismael Buño
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Juan Berenguer
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
- Infectious Diseases Unit, H.G.U. Gregorio Marañón, Madrid, Spain
| | - José L. Díez-Martín
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
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Gopal S, Patel MR, Yanik EL, Cole SR, Achenbach CJ, Napravnik S, Burkholder GA, Reid EG, Rodriguez B, Deeks SG, Mayer KH, Moore RD, Kitahata MM, Eron JJ, Richards KL. Temporal trends in presentation and survival for HIV-associated lymphoma in the antiretroviral therapy era. J Natl Cancer Inst 2013; 105:1221-9. [PMID: 23892362 PMCID: PMC3748003 DOI: 10.1093/jnci/djt158] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 05/01/2013] [Accepted: 05/02/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Lymphoma is the leading cause of cancer-related death among HIV-infected patients in the antiretroviral therapy (ART) era. METHODS We studied lymphoma patients in the Centers for AIDS Research Network of Integrated Clinical Systems from 1996 until 2010. We examined differences stratified by histology and diagnosis year. Mortality and predictors of death were analyzed using Kaplan-Meier curves and Cox proportional hazards. RESULTS Of 23 050 HIV-infected individuals, 476 (2.1%) developed lymphoma (79 [16.6%] Hodgkin lymphoma [HL]; 201 [42.2%] diffuse large B-cell lymphoma [DLBCL]; 56 [11.8%] Burkitt lymphoma [BL]; 54 [11.3%] primary central nervous system lymphoma [PCNSL]; and 86 [18.1%] other non-Hodgkin lymphoma [NHL]). At diagnosis, HL patients had higher CD4 counts and lower HIV RNA than NHL patients. PCNSL patients had the lowest and BL patients had the highest CD4 counts among NHL categories. During the study period, CD4 count at lymphoma diagnosis progressively increased and HIV RNA decreased. Five-year survival was 61.6% for HL, 50.0% for BL, 44.1% for DLBCL, 43.3% for other NHL, and 22.8% for PCNSL. Mortality was associated with age (adjusted hazard ratio [AHR] = 1.28 per decade increase, 95% confidence interval [CI] = 1.06 to 1.54), lymphoma occurrence on ART (AHR = 2.21, 95% CI = 1.53 to 3.20), CD4 count (AHR = 0.81 per 100 cell/µL increase, 95% CI = 0.72 to 0.90), HIV RNA (AHR = 1.13 per log10copies/mL, 95% CI = 1.00 to 1.27), and histology but not earlier diagnosis year. CONCLUSIONS HIV-associated lymphoma is heterogeneous and changing, with less immunosuppression and greater HIV control at diagnosis. Stable survival and increased mortality for lymphoma occurring on ART call for greater biologic insights to improve outcomes.
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Affiliation(s)
- Satish Gopal
- Departments of Medicine and Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Castillo JJ, Winer ES, Olszewski AJ. Population-based prognostic factors for survival in patients with Burkitt lymphoma: an analysis from the Surveillance, Epidemiology, and End Results database. Cancer 2013; 119:3672-9. [PMID: 23913575 DOI: 10.1002/cncr.28264] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 05/17/2013] [Accepted: 06/07/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Burkitt lymphoma (BL) is an aggressive but potentially curable lymphoma, previously described in small, single-institution studies. This study evaluated prognostic factors for survival in adult patients with BL and a potential outcome improvement over the past decade in a population-based cohort. METHODS Adult patients with BL diagnosed between 1998 and 2009 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Prognostic factors were identified in a multivariate model for relative survival (RS), and trends in survival were evaluated using period analysis. RESULTS The study cohort included 2284 patients, with a median age of 49 years and male predominance (2.6:1). Gastrointestinal tract and the head and neck were the most common sites of extranodal disease. Older age, black race/ethnicity, and advanced stage were associated with a worse survival. In the period analysis, trends in improved survival between 1998 and 2009 were seen, except for patients older than 60 years and black patients, whose survival did not improve. A prognostic score divided patients into 4 groups: low-risk (5-year RS: 71%), low-intermediate (5-year RS: 55%), high-intermediate (5-year RS: 41%), and high-risk (5-year RS: 29%; P < .001). CONCLUSIONS The outcome of patients younger than 60 years with BL improved over the past decade. Age, race, and stage have a prognostic role for survival. The proposed score can help inform prognosis in newly diagnosed patients and stratify participants in future trials.
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Affiliation(s)
- Jorge J Castillo
- Division of Hematology and Oncology, Alpert Medical School of Brown University, Rhode Island Hospital/The Miriam Hospital, Providence, Rhode Island
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45
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Wästerlid T, Brown PN, Hagberg O, Hagberg H, Pedersen LM, D'Amore F, Jerkeman M. Impact of chemotherapy regimen and rituximab in adult Burkitt lymphoma: a retrospective population-based study from the Nordic Lymphoma Group. Ann Oncol 2013; 24:1879-1886. [PMID: 23446093 DOI: 10.1093/annonc/mdt058] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Standard treatment of adult Burkitt lymphoma is not defined due to the lack of randomised trials. In this situation, population-based data may represent a useful contribution in order to identify an optimal treatment strategy. PATIENTS AND METHODS The aims of this study were to investigate the outcome for adult HIV-negative BL with different chemotherapy regimens, and to assess possible improvement within the time frame of the study. The study population was identified through the Swedish and Danish lymphoma registries 2000-2009. RESULTS A total of 258 patients were identified. Since 2000, overall survival (OS) improved significantly only for younger patients (<65 years). Intensive regimens such as the Berlin-Frankfurt-Münster, hyper-fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) and cyclophosphamide, vincristine, doxorubicin, methotrexate, ifosfamide, etoposide, and cytarabine (CODOX-M/IVAC) were associated with a favourable 2-year OS of 82%, 83%, and 69%, respectively. The low-intensive CHOP/CHOEP regimens achieved a 2-year OS of 38.8%, confirming their inadequacy for the treatment of BL. In a multivariate analysis, rituximab was not significantly associated with improved OS. CONCLUSIONS In this population-based retrospective series of adult BL, intensive chemotherapy regimens were associated with favourable outcome. The impact of the addition of rituximab remains uncertain and warrants further investigation.
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Affiliation(s)
- T Wästerlid
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - P N Brown
- Department of Haematology, Rigshospitalet, Copenhagen, Denmark
| | - O Hagberg
- Department of Tumour Epidemiology, Skåne University Hospital, Lund
| | - H Hagberg
- Department of Oncology, Akademiska University Hospital, Uppsala, Sweden
| | - L M Pedersen
- Department of Haematology, Roskilde Hospital, Roskilde
| | - F D'Amore
- Department of Haematology, Århus University Hospital, Århus, Denmark
| | - M Jerkeman
- Department of Oncology, Skåne University Hospital, Lund, Sweden.
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Aurer I, Bašić-Kinda S, Radman I, Ilić I, Grah JJ. Burkitt lymphomas failing dose-adjusted R-EPOCH (DA-R-EPOCH). Ann Hematol 2013; 93:177-8. [DOI: 10.1007/s00277-013-1771-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/22/2013] [Indexed: 11/25/2022]
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Trends in survival of patients with Burkitt lymphoma/leukemia in the USA: an analysis of 3691 cases. Blood 2013; 121:4861-6. [PMID: 23641015 DOI: 10.1182/blood-2012-12-475558] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
It is unknown whether the high rates of cure reported for Burkitt lymphoma/leukemia (BL) patients treated with chemoimmunotherapy can be verified outside published series and clinical trials. We used the Surveillance Epidemiology and End Results (SEER) database to describe time trends in outcomes of BL in the United States. Cases were divided into 2 eras based on year of diagnosis, reflecting improvements in HIV management, BL treatment, and supportive care. There was a marked improvement in survival among BL cases diagnosed in the 2002-2008 era (n = 1922) relative to 1973-2001 (n = 1769) with 5-year relative survival estimates of 56% and 43%, respectively (P < .001). Five-year relative survival improved from 71% to 87% for ages 0 to 19 (n = 970), 35% to 60% for ages 20 to 39 (n = 897), 28% to 48% for ages 40 to 59 (n = 1047), and from 25% to 33% for ages ≥60 (n = 777). In multivariable analysis, the 2002-2008 era (HR = 0.76, P < .001) was associated with lower mortality. Conversely, older age, black race, and advanced stage were associated with higher mortality. More effective therapies are needed for older patients with BL, along with improved access to modern therapy for younger patients.
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48
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Ribera JM, García O, Grande C, Esteve J, Oriol A, Bergua J, González-Campos J, Vall-llovera F, Tormo M, Hernández-Rivas JM, García D, Brunet S, Alonso N, Barba P, Miralles P, Llorente A, Montesinos P, Moreno MJ, Hernández-Rivas JÁ, Bernal T. Dose-intensive chemotherapy including rituximab in Burkitt's leukemia or lymphoma regardless of human immunodeficiency virus infection status. Cancer 2013; 119:1660-1668. [DOI: 10.1002/cncr.27918] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Spagnuolo V, Travi G, Galli L, Cossarini F, Guffanti M, Gianotti N, Salpietro S, Lazzarin A, Castagna A. Clinical, virologic, and immunologic outcomes in lymphoma survivors and in cancer-free, HIV-1-infected patients: a matched cohort study. Cancer 2013; 119:2710-9. [PMID: 23625649 DOI: 10.1002/cncr.28119] [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: 11/21/2012] [Revised: 03/11/2013] [Accepted: 03/20/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND The objective of this study was to compare immunologic, virologic, and clinical outcomes between living human immunodeficiency virus (HIV)-infected individuals who had a diagnosis of lymphoma versus outcomes in a control group of cancer-free, HIV-infected patients. METHODS In this matched cohort study, patients in the case group were survivors of incident lymphomas that occurred between 1997 and June 2010. Controls were living, cancer-free, HIV-infected patients who were matched to cases at a 4:1 ratio by age, sex, nadir CD4 cell count, and year of HIV diagnosis. The date of lymphoma diagnosis served as the baseline in cases and in the corresponding controls. RESULTS In total, 62 patients (cases) who had lymphoma (20 with Hodgkin disease [HD] and 42 with non-Hodgkin lymphoma [NHL]) were compared with 211 controls. The overall median follow-up was 4.8 years (interquartile range, 2.0-7.9 years). The CD4 cell count at baseline was 278 cells/mm³ (interquartile range, 122-419 cells/mm³) in cases versus 421 cells/mm³ (interquartile range, 222-574 cells/mm³) in controls (P = .003). At the last available visit, the CD4 cell count was 412 cells/mm³ (range, 269-694 cells/mm³) in cases versus 518 cells/mm³ (interquartile range, 350-661 cells/mm³) in controls (P = .087). The proportion of patients who achieved virologic success increased from 30% at baseline to 74% at the last available visit in cases (P = .008) and from 51% to 81% in controls (P = .0286). Patients with HD reached higher CD4 cell counts at their last visit than patients with NHL (589 cells/mm³ [range, 400-841 cells/mm³] vs 332 cells/mm³ [interquartile range, 220-530 cells/mm³], respectively; P = .003). Virologic success was similar between patients with HD and patients with NHL at the last visit. Forty cases (65%) and 76 controls (36%) experienced at least 1 clinical event after baseline (P < .0001); cases were associated with a shorter time to occurrence of the first clinical event compared with controls (P < .0001). CONCLUSIONS HIV-infected lymphoma survivors experienced more clinical events than controls, especially during the first year of follow-up, but they reached similar long-term immunologic and virologic outcomes.
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Affiliation(s)
- Vincenzo Spagnuolo
- Infectious Disease Department, San Raffaele Scientific Institute, Milan, Italy.
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50
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Montoto S, Shaw K, Okosun J, Gandhi S, Fields P, Wilson A, Shanyinde M, Cwynarski K, Marcus R, de Vos J, Young AM, Tenant-Flowers M, Orkin C, Johnson M, Chilton D, Gribben JG, Bower M. HIV status does not influence outcome in patients with classical Hodgkin lymphoma treated with chemotherapy using doxorubicin, bleomycin, vinblastine, and dacarbazine in the highly active antiretroviral therapy era. J Clin Oncol 2012; 30:4111-6. [PMID: 23045581 DOI: 10.1200/jco.2011.41.4193] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The prognosis of HIV-infected patients with non-Hodgkin lymphoma in the highly active antiretroviral therapy (HAART) era approaches that of the general population when they are treated with the same protocols. We analyzed the outcome of patients with Hodgkin lymphoma (HL) treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) in the HAART era according to HIV serostatus to establish whether this also holds true for HL. PATIENTS AND METHODS From 1997 to 2010, 224 patients newly diagnosed with HL, of whom 93 were HIV positive, were consecutively treated with ABVD chemotherapy. HIV-positive patients had more high-risk disease according to the International Prognostic Score (IPS) than HIV-negative patients (IPS≥3: 68% v 26%, respectively; P<.001). Forty-seven HIV-positive patients had a CD4 count less than 200/μL, and 92 patients received HAART during chemotherapy. RESULTS The complete response rate was 74% for HIV-positive patients and 79% for HIV-negative patients (P=not significant). After a median follow-up of 60 months (range, 8 to 174 months), 23 patients (16 HIV-negative and seven HIV-positive patients) have experienced relapse at a median time of 6 months (range, 1 to 106 months). Five-year event-free survival (EFS) was 59% (95% CI, 47% to 70%) for HIV-positive patients and 66% (95% CI, 57% to 74%) for HIV-negative patients (P=not significant). Five-year overall survival (OS) was 81% (95% CI, 69% to 89%) and 88% (95% CI, 80% to 93%) for HIV-positive and HIV-negative patients, respectively (P=not significant). HIV status did not predict OS or EFS on multivariate analysis including IPS and HIV status. CONCLUSION This mature study demonstrates that HIV-positive patients with HL have more extensive disease with more adverse prognostic factors than HIV-negative patients, but when treated with ABVD, HIV infection does not adversely affect OS or EFS.
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Affiliation(s)
- Silvia Montoto
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, Chelsea and Westminster Hospital, 45 Little Britain, EC1A 7BE, London, United Kingdom.
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