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Tobin JWD, Hapgood G, Johnston A, Cheah CY, Lee ST, Trotman J, Inam S, Campbell BA, Norris D, MacManus M, Hertzberg M, Hawkes E. Diagnosis, management and follow-up of follicular lymphoma: a consensus practice statement from the Australasian Lymphoma Alliance. Intern Med J 2024; 54:1384-1395. [PMID: 39099075 DOI: 10.1111/imj.16454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 05/30/2024] [Indexed: 08/06/2024]
Abstract
Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma subtype, accounting for 15-20% of all lymphoma diagnoses. Although typically slow-growing and responsive to frontline therapies, advanced-stage FL remains incurable with current treatments and typically follows a chronic relapsing/remitting course with increasingly shorter responses to subsequent lines of therapy. Outcomes are highly variable; some patients experience prolonged first remissions that may approximate a 'functional cure'. By contrast, a significant minority of patients experience disease progression shortly after frontline treatment resulting in high rates of lymphoma-related mortality. Reflecting on the heterogeneous natural history of FL, clinical practice varies widely, particularly in controversial areas, including appropriate disease staging, selection of management strategies and duration of clinical follow-up. This position statement presents an evidence-based synthesis of the literature for application in Australasian practice.
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Affiliation(s)
- Joshua W D Tobin
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Greg Hapgood
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Anna Johnston
- The Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Chan Y Cheah
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | - Sze T Lee
- Austin Health, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Judith Trotman
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | | | - Belinda A Campbell
- University of Melbourne, Melbourne, Victoria, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Michael MacManus
- University of Melbourne, Melbourne, Victoria, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Mark Hertzberg
- University of Sydney, Sydney, New South Wales, Australia
- Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Eliza Hawkes
- Austin Health, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
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2
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Gunther JR, Pinnix CC. Measurable residual disease-driven therapy after radiotherapy for early-stage follicular lymphoma. Lancet Haematol 2024; 11:e472-e473. [PMID: 38937019 DOI: 10.1016/s2352-3026(24)00177-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Jillian R Gunther
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Chelsea C Pinnix
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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3
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Zhong Q, Liu Y, Wu Y, Liu X, Chen S, Chen B, Su F, Li G, Xu Y, Liu L, Chen F, Qi S, Li Y. Impact of age on long-term relative survival benefit of radiotherapy for early-stage grade I-II follicular lymphoma from the SEER database (2000-2015). Leuk Lymphoma 2024; 65:312-322. [PMID: 37987687 DOI: 10.1080/10428194.2023.2283296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/07/2023] [Indexed: 11/22/2023]
Abstract
The aim of this study was to investigate the effect of age on long-term mortality and net survival benefit of radiotherapy (RT) for early-stage grade I-II FL. Five thousand three hundred and five patients with early-stage grade I-II FL in the SEER database (2000-2015) were identified. Primary therapy included RT alone (RT, 20.7%), chemotherapy alone (CT, 27.6%), combined modality therapy (CMT, 5.9%), and observation (45.8%). Inverse probability of treatment weighting (IPTW) was conducted to balance the treatment arms. Relative survival (RS), the standardized mortality ratio (SMR), and transformed Cox regression were used to compare survival differences between treatments. RT with or without CT had significantly higher 10-year OS (approximately 78%) and RS (>95%), but lower SMR (1.47-1.76), compared with CT (67.8%; 86.3%; 2.35; ps < .001), observation (70.2%; 91.2%; 1.82; ps < .05). RT was an independent predictor of better OS and RS in multivariate analyses (p < .001). No significant interaction between age and RT was identified for RS (Pinteraction = .509) or OS (Pinteraction = .769), indicating similar survival benefits across all-ages patients. RT was associated with long-term OS and net survival benefits in patients with early-stage grade I-II FL, irrespective of age.HighlightsThe pattern and incidence of mortality varied by age-group as elderly patients often die of other diseases other than FL beyond 5 years.Radiotherapy was associated with higher long-term OS/RS and better SMR compared with other approaches, regardless of age.
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Affiliation(s)
- Qiuzi Zhong
- Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Ye Liu
- Peking University Fifth School of Clinical Medicine, Beijing, PR China
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, PR China
| | - Yunpeng Wu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, PR China
| | - Xin Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, PR China
| | - Siye Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, PR China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, PR China
| | - Fei Su
- Institute of Geriatric Medicine, Clinical Biobank, Beijing Hospital, National Center of Gerontology, National Health Commission, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Gaofeng Li
- Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Yonggang Xu
- Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Lipin Liu
- Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Fan Chen
- Affiliated Hospital of Qinghai University, Qinghai, PR China
| | - Shunan Qi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, PR China
| | - Yexiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, PR China
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4
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Galunic Bilic L, Santek F, Grah JJ, Basic-Kinda S, Mandac Smoljanovic I, Ostojic Kolonic S, Mitrovic Z, Vodanovic M, Dujmovic D, Aurer I. Efficacy and toxicity of infradiaphragmal radiotherapy fields in lymphoma patients: a single-centre experience. LA RADIOLOGIA MEDICA 2023; 128:492-500. [PMID: 36920724 DOI: 10.1007/s11547-023-01615-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE Data on efficacy and toxicity of infradiaphragmal radiotherapy fields in lymphoma patients are scarce. We therefore performed this retrospective study to analyse our experience with radiotherapy exclusively to infradiaphragmal fields. MATERIALS AND METHODS we retrospectively evaluated 101 patients treated between 2003 and 2014. Median dose was 36 Gy, range 4 to 54 Gy. Medium dose per fraction was 2 Gy, range 1.5 to 7 Gy. RESULTS After a median follow-up of 66 months (range 1-211 months), we observed lymphoma recurrence in 38 patients (38%), five in the RT field and 33 out-of-field. Recurrences were significantly more frequent in the salvage group (17 out-of-field and 4 in-field in 31 patients) than in adjuvant group (16 out-of-field and 1 in-field in 70 patients; p < 0.001). The 2-, 5- and 10-year event-free survival (EFS) rates were 62%, 56% and 54%. The 2-, 5- and 10-year overall survival (OS) rates for the entire group of patients are 73%, 60% and 54%, respectively. Acute side effects occurred in 43 (43%) patients, most frequent gastrointestinal in 26 (26%) patients. Late side effects occurred in 12 (12%) of all patients, 6 of 23 (26%) followed up for more than 10 years. Six patients developed secondary cancers, four gastrointestinal disturbances, two diabetes mellitus and three renal failure. CONCLUSION Radiotherapy is an effective and safe treatment option for patients with infradiaphragmatic lymphoma providing excellent local disease control with minimal late toxicity. Infradiaphragmatic lymphoma localization should not be regarded as a contraindication for use of radiotherapy. However, patients should be monitored for a secondary malignancy.
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Affiliation(s)
- Lea Galunic Bilic
- Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
| | - Fedor Santek
- Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Josip J Grah
- Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
- Department for Radiotherapy, Univ. Klinik Für Strahlentherapie-Radioonkologie- LKH Graz, Graz, Austria
| | - Sandra Basic-Kinda
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Inga Mandac Smoljanovic
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Merkur, Zagreb, Croatia
| | - Slobodanka Ostojic Kolonic
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Merkur, Zagreb, Croatia
| | - Zdravko Mitrovic
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Marijo Vodanovic
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Dino Dujmovic
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Igor Aurer
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
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5
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Fischer L, Dreyling M. Follicular lymphoma: an update on biology and optimal therapy. Leuk Lymphoma 2023; 64:761-775. [PMID: 37061956 DOI: 10.1080/10428194.2023.2174804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Follicular lymphoma (FL) is a mature B-cell neoplasm with a mostly indolent course. Genetic hallmark characteristics are Bcl-2 overexpression based on a t(14;18) translocation and additional secondary genetic and epigenetic aberrations. Standard treatment for early-stage patients has curative intent and usually consists of radiotherapy with or without rituximab. In the advanced stage, the main therapeutic focus is on prolonged remissions. Therefore, treatment in asymptomatic patients is usually deferred. Symptomatic patients are subject to immunochemotherapy induction followed by antibody maintenance. Importantly, about one in five patients subsequently experiences a more rapid clinical course, achieving only short remissions with multiple relapses (POD24). In those patients, there is still an urgent need for improved therapeutic options. Accordingly, a plethora of targeted and immunotherapeutic options, including immunomodulatory drugs, small molecule inhibitors, monoclonal antibodies as well as bispecific T-cell engager antibodies and CAR-T cell products have been recently evaluated in such relapsed high-risk patients.
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Affiliation(s)
- Luca Fischer
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Martin Dreyling
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
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6
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Fenlon JB, Hutten RJ, Johnson SB, Hu B, Shah H, Stephens DM, Maity A, Gaffney DK, Tao R. Evaluating patterns of care for early-stage low-grade follicular lymphoma in the rituximab era. Leuk Lymphoma 2023; 64:356-363. [PMID: 36408967 DOI: 10.1080/10428194.2022.2148215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Radiotherapy (RT) utilization for early-stage, low-grade follicular lymphoma (FL) is low despite treatment guideline recommendations. We compare treatment trends for early-stage FL in the era of involved-site RT and rituximab. We identified 11,645 patients in the National Cancer Database (NCDB) with stage I-II, grade 1-2 nodal or extranodal FL diagnosed 2011-2017, with median follow-up of 44 months. From 2011 to 2017, RT utilization rates decreased from 33.4% to 22.4%, observation decreased from 65.3% to 49.7%, chemoimmunotherapy increased from 0.5% to 15.0%, immuno-monotherapy increased from 0.6% to 10.2%, and RT + systemic therapy increased from 0.6% to 2.5%. RT utilization remains low in the involved-site RT and rituximab era.
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Affiliation(s)
- Jordan B Fenlon
- Department of Radiation Oncology, University of Utah Health, Salt Lake City, UT, USA
| | - Ryan J Hutten
- Department of Radiation Oncology, University of Utah Health, Salt Lake City, UT, USA
| | - Skyler B Johnson
- Department of Radiation Oncology, University of Utah Health, Salt Lake City, UT, USA
| | - Boyu Hu
- Division of Hematology/Hematologic Malignancies Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, USA
| | - Harsh Shah
- Division of Hematology/Hematologic Malignancies Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, USA
| | - Deborah M Stephens
- Division of Hematology/Hematologic Malignancies Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, USA
| | - Amit Maity
- Department of Radiation Oncology, University of Utah Health, Salt Lake City, UT, USA
| | - David K Gaffney
- Department of Radiation Oncology, University of Utah Health, Salt Lake City, UT, USA
| | - Randa Tao
- Department of Radiation Oncology, University of Utah Health, Salt Lake City, UT, USA
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7
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Los-de Vries GT, Stevens WBC, van Dijk E, Langois-Jacques C, Clear AJ, Stathi P, Roemer MGM, Mendeville M, Hijmering NJ, Sander B, Rosenwald A, Calaminici M, Hoster E, Hiddemann W, Gaulard P, Salles G, Horn H, Klapper W, Xerri L, Burton C, Tooze RM, Smith AG, Buske C, Scott DW, Natkunam Y, Advani R, Sehn LH, Raemaekers J, Gribben J, Kimby E, Kersten MJ, Maucort-Boulch D, Ylstra B, de Jong D. Genomic and microenvironmental landscape of stage I follicular lymphoma, compared with stage III/IV. Blood Adv 2022; 6:5482-5493. [PMID: 35816682 PMCID: PMC9631713 DOI: 10.1182/bloodadvances.2022008355] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/18/2022] Open
Abstract
Although the genomic and immune microenvironmental landscape of follicular lymphoma (FL) has been extensively investigated, little is known about the potential biological differences between stage I and stage III/IV disease. Using next-generation sequencing and immunohistochemistry, 82 FL nodal stage I cases were analyzed and compared with 139 FL stage III/IV nodal cases. Many similarities in mutations, chromosomal copy number aberrations, and microenvironmental cell populations were detected. However, there were also significant differences in microenvironmental and genomic features. CD8+ T cells (P = .02) and STAT6 mutations (false discovery rate [FDR] <0.001) were more frequent in stage I FL. In contrast, programmed cell death protein 1-positive T cells, CD68+/CD163+ macrophages (P < .001), BCL2 translocation (BCL2trl+) (P < .0001), and KMT2D (FDR = 0.003) and CREBBP (FDR = 0.04) mutations were found more frequently in stage III/IV FL. Using clustering, we identified 3 clusters within stage I, and 2 clusters within stage III/IV. The BLC2trl+ stage I cluster was comparable to the BCL2trl+ cluster in stage III/IV. The two BCL2trl- stage I clusters were unique for stage I. One was enriched for CREBBP (95%) and STAT6 (64%) mutations, without BLC6 translocation (BCL6trl), whereas the BCL2trl- stage III/IV cluster contained BCL6trl (64%) with fewer CREBBP (45%) and STAT6 (9%) mutations. The other BCL2trl- stage I cluster was relatively heterogeneous with more copy number aberrations and linker histone mutations. This exploratory study shows that stage I FL is genetically heterogeneous with different underlying oncogenic pathways. Stage I FL BCL2trl- is likely STAT6 driven, whereas BCL2trl- stage III/IV appears to be more BCL6trl driven.
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Affiliation(s)
- G. Tjitske Los-de Vries
- Department of Pathology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Erik van Dijk
- Department of Pathology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Carole Langois-Jacques
- Université Lyon 1, Villeurbanne, France, Centre National de la Recherche Scientifique (CNRS), Unité Mixte de recherche (UMR) 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France
| | - Andrew J. Clear
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary, University of London, London, United Kingdom
| | - Phylicia Stathi
- Department of Pathology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Margaretha G. M. Roemer
- Department of Pathology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Matias Mendeville
- Department of Pathology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Nathalie J. Hijmering
- Department of Pathology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Birgitta Sander
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Rosenwald
- Institute of Pathology, University of Würzburg, Würzburg, and Comprehensive Cancer Center Mainfranken, Germany
| | - Maria Calaminici
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary, University of London, London, United Kingdom
| | - Eva Hoster
- Department of Medicine III, University Hospital Grosshadern, Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU University, Munich, Germany
| | - Wolfgang Hiddemann
- Department of Medicine III, University Hospital Grosshadern, Munich, Germany
| | - Philippe Gaulard
- Department of Pathology, Henri Mondor University Hospital, Assistance Pyblique- Hospitaux de Paris (APHP), INSERM U955, Université Paris-Est, Créteil, France
| | - Gilles Salles
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heike Horn
- Institute for Clinical Pathology, Robert-Bosch-Krankenhaus, Dr. Margarete Fischer-Bosch-Institut für Klinische Pharmakologie, Stuttgart, Germany
| | - Wolfram Klapper
- Institute of Pathology, University of Schleswig-Holstein, Kiel, Germany
| | - Luc Xerri
- Département de Biopathologie, Institut Paoli-Calmettes, Marseille, France
| | - Catherine Burton
- Haematological Malignancy Diagnostic Service, St. James University Hospital, Leeds, United Kingdom
| | - Reuben M. Tooze
- Division of Haematology & Immunology, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Alexandra G. Smith
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Christian Buske
- Institute of Experimental Cancer Research, Comprehensive Cancer Center (CCC) Ulm, Universitätsklinikum Ulm, Ulm, Germany
| | - David W. Scott
- BC Cancer Centre for Lymphoid Cancer and The University of British Columbia, Vancouver, BC, Canada
| | | | - Ranjana Advani
- Department of Hematology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA
| | - Laurie H. Sehn
- BC Cancer Centre for Lymphoid Cancer and The University of British Columbia, Vancouver, BC, Canada
| | - John Raemaekers
- Department of Hematology, Radboudumc Nijmegen, Nijmegen, The Netherlands
| | - John Gribben
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary, University of London, London, United Kingdom
| | - Eva Kimby
- Department of Medicine, Division of Hematology, Karolinska Institute, Stockholm, Sweden; and
| | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Center (UMC), University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Delphine Maucort-Boulch
- Université Lyon 1, Villeurbanne, France, Centre National de la Recherche Scientifique (CNRS), Unité Mixte de recherche (UMR) 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France
| | - Bauke Ylstra
- Department of Pathology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Daphne de Jong
- Department of Pathology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
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8
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Coutte A, Pointreau Y. [Hematological pathologies: the most successful model of de-escalation in radiotherapy]. Cancer Radiother 2022; 26:925-930. [PMID: 35965244 DOI: 10.1016/j.canrad.2022.06.003] [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: 05/31/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 10/15/2022]
Abstract
The proportion of patients irradiated in the context of malignant hematological pathologies decreased over the last decades. The main causes are the late side effects of the historical series and the new therapeutic strategies aiming to relay radiotherapy to the rank of option. At the same time, radiotherapy has been modernised, target volumes and total doses have been drastically reduced. Hodgkin's lymphomas, indolent follicular lymphomas and primary cerebral lymphomas are the main witnesses of this therapeutic deflation.
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Affiliation(s)
- A Coutte
- Service de radiothérapie, CHU Amiens Picardie, 1, rond-point du Professeur Christian Cabrol, 80054 Amiens, France.
| | - Y Pointreau
- Institut inter-régionaL de Cancérologie (ILC) - Centre Jean Bernard, 9, Rue Beauverger, 72000 Le Mans, France; Service de radiothérapie, centre régional universitaire de cancérologie Henry-S.-Kaplan, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; COLIB, Club des Oncologues LIBéraux, 72000 Le Mans, France
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9
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Jeong SH. Treatment of indolent lymphoma. Blood Res 2022; 57:120-129. [PMID: 35483936 PMCID: PMC9057664 DOI: 10.5045/br.2022.2022054] [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: 03/01/2022] [Revised: 04/08/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
Treatment of indolent lymphoma has improved significantly in recent decades since the advent of rituximab (anti-CD20 monoclonal antibody). Although, some patients with limited disease can be cured with radiation therapy alone, most patients experience disease progression and recurrence during follow-up despite early initiation of treatment. Thus, watch-and-wait is still regarded the standard for asymptomatic patients. Patients with indolent lymphoma have a significant heterogeneity in terms of tumor burden, symptoms (according to anatomical sites) and the need for instant therapy. Therefore, the initiation of treatment and treatment option should be decided with a clear goal in each patient according to the need for therapy and clinical benefits with the chosen treatment. In this review, we cover the current treatment of follicular lymphoma and marginal zone lymphoma.
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Affiliation(s)
- Seong Hyun Jeong
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
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10
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Clinical outcomes with use of radiation therapy and risk of transformation in early-stage follicular lymphoma. Blood Cancer J 2022; 12:29. [PMID: 35145059 PMCID: PMC8831497 DOI: 10.1038/s41408-022-00620-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/12/2022] [Accepted: 01/19/2022] [Indexed: 11/12/2022] Open
Abstract
Between 1998 and 2009, a total of 295 patients (median age 58, 53% females) with newly diagnosed early-stage follicular lymphoma (FL) were managed at Memorial Sloan Kettering Cancer Center. Approximately half of patients (137, 46%) underwent initial observation and half (158, 54%) immediate treatment: radiation alone (n = 108), systemic treatment alone (n = 29), or combined modality treatment (n = 21). Median follow-up was 8.4 years (range 0.3-17.2), and 10-year overall survival (OS) was 87.2%. OS was similar between initially-observed and immediately-treated patients (hazard ratio [HR]: 1.25, 95% CI: 0.67-2.36, p = 0.49). For patients receiving radiation alone, 5-year OS was 98.0%. Patients selected for systemic therapy alone had high-risk baseline features and had shorter OS than patients treated with radiation alone (HR 3.38, 95% CI 1.29-8.86, p = 0.01). Combined modality treatment did not yield superior survival compared with radiation alone (P > 0.05) but was associated with better progression-free survival (HR 0.36, 95% CI 0.14-0.90, p = 0.03). The rate of transformation increased steadily over time and was 4.2% at 5 years and 10.8% at 10 years. This modern-era analysis rationalized the role of initial observation in patients with early-stage FL although patients receiving radiation therapy also demonstrate excellent outcome.
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11
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Hadi I, Schummer A, Dreyling M, Eze C, Bodensohn R, Roengvoraphoj O, Belka C, Li M. Effectiveness and tolerability of radiotherapy for patients with indolent non-Hodgkin's lymphoma: a monocenter analysis. Sci Rep 2021; 11:22586. [PMID: 34799601 PMCID: PMC8604980 DOI: 10.1038/s41598-021-01851-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 10/26/2021] [Indexed: 12/30/2022] Open
Abstract
To analyze the effectiveness and toxicities of radiotherapy in indolent non-Hodgkin's lymphoma (iNHL) patients treated in our institution. Patients with iNHL treated with radiotherapy between 1999 and 2016 were included. The primary endpoint was progression-free survival (PFS). Secondary endpoints were local control (LC), overall survival (OS) and toxicities. PFS, LC, and OS were analyzed using Kaplan-Meier method. Log-rank test was used to investigate the differences between subgroups. Cox proportional hazard model was used for univariate continuous analysis. Seventy-five patients were identified in our institutional database between 1999 and 2016. Fifty-eight (77.3%) had stage I after Ann-Arbor and 17 patients (22.7%) had stage II. The median follow-up was 87 months (95% CI 72-102 months). Median single dose per fraction was 2.0 Gy (range 1.5-2 Gy) and median total dose was 30.6 Gy (range 16-45 Gy). Radiotherapy was performed in 2D (n = 10; 13.3%), 3D (n = 63; 84.0%) and VMAT (n = 2; 2.7%) techniques, respectively. The median PFS was 14.0 years (95% CI 8.3-19.7 years). The estimated PFS after 5 and 10 years were 73.0% and 65.5% in Kaplan-Meier analysis, respectively. The 5- and 10-year LC were 94.9% and 92.3%, respectively. The 5- and 10-year OS were 88.6% and 73.9%. In univariate analyses of PFS, younger patients (≤ 60 years old) had significantly superior PFS to those older than 60 years old (5-year PFS 81.9% vs. 65.1%, p = 0.021). Dose escalation > 36.0 Gy had no prognostic influence in term of PFS (p = 0.425). Extranodal involvement, stage and histology had no prognostic impact on PFS. Depending on the site of lymphomas, the most common acute side effects were: dermatitis CTCAE° I-II (8.0%), xerostomia CTC° I (8.0%), cataract CTC° I (12.0%) and dry eyes CTC° I-II (14.6%). No adverse event CTC° III was reported. Most acute side effects recovered at 3 to 6 months after radiotherapy except for CTC° I cataract and xerostomia. Local Radiotherapy was highly effective for treatment of early stage iNHL with no serious side effects in our cohort. The most acute CTCAE° I-II side effects recovered 3 to 6 months later. Technique advances seem to have further improved effectiveness and tolerability of radiotherapy.Trial registration: Local ethics committee of Ludwig-Maximilian-University (LMU) Munich approved this retrospective analysis on the May 7th, 2019 (Nr. 19-137).
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Affiliation(s)
- I Hadi
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany
| | - A Schummer
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany
| | - M Dreyling
- Department of Internal Medicine III - Oncology, University Hospital, LMU Munich, Munich, Germany
| | - C Eze
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany
| | - R Bodensohn
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany
| | | | - C Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany.,German Cancer Consortium DKTK, Munich, Germany
| | - M Li
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany.
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12
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Chelius M, Chau K, Yang J, Hajj C, Imber B, Yahalom J. Low grade, indolent lymphomas of the head and neck: Comparative toxicity of standard versus very low dose radiation therapy. Hematol Oncol 2021; 39:304-312. [PMID: 33733514 PMCID: PMC10018679 DOI: 10.1002/hon.2865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/19/2021] [Accepted: 03/06/2021] [Indexed: 11/12/2022]
Abstract
National Comprehensive Cancer Network guidelines recommend radiation therapy (RT) for localized indolent non-Hodgkin lymphomas (iNHL). Many referring physicians avoid RT to the head and neck (HN) due to fears of toxicity. Very low-dose radiation (4 Gy) for select patients produces sustained local control and recently gained popularity. We compared early and late toxicities of standard 24-30 Gy to 4 Gy in patients with HN iNHL. We retrospectively analyzed 266 consecutive patients with HN iNHL receiving RT from 1994 to 2017. Patient characteristics, outcomes, and toxicities were collected from medical records. Early (≤2 months post-RT) and late (>2 months post-RT) toxicities were graded per Common Terminology Criteria for Adverse Events version 4. Grades 1-2 were defined as "low-grade" and 3-4 "high-grade." Toxicity incidence was compared between 4 and >4 Gy, grouped by treated site (orbit, nonorbital head, neck, skin) and early versus late. Median follow-up was 23 months (2-145) and 68 months (2-256) for 4Gy and >4 Gy cohorts, respectively. Median dose for the >4 Gy cohort was 30 Gy (10.5-54 Gy). Early and late toxicity incidences were lower in the 4 Gy cohort compared to >4 Gy across all RT-sites: early toxicity, orbit, 42% versus 96%; nonorbital head, 24% versus 96%; neck, 22% versus 94%; skin, 31% versus 87%; late toxicity, orbit, 20% versus 71%; nonorbital head, 6% versus 66%; neck, 6% versus 57%; skin, 0% versus 46% (4 Gy vs. >4 Gy, respectively). Toxicities among both cohorts were largely low-grade. High-grade early and late toxicities did not occur in the 4 Gy cohort. There was 1 high-grade early toxicity (Grade 3 dry mouth) and 17 high-grade late toxicities (Grade 3 cataracts) in the >4 Gy cohort. RT to HN for iNHL is associated with minimal short- and long-term toxicity and excellent local control among 4 Gy and >4 Gy treatments. In this setting, "toxicity" concerns should not deter oncologists from potentially curative RT. In select patients where toxicity remains a concern, very low dose 4 Gy could be considered.
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Affiliation(s)
- Monica Chelius
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Karen Chau
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joanna Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Carla Hajj
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brandon Imber
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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13
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Tobin JWD, Crothers A, Ma TE, Mollee P, Gandhi MK, Scuffham P, Hapgood G. A cost-effectiveness analysis of front-line treatment strategies in early-stage follicular lymphoma. Leuk Lymphoma 2021; 62:3484-3492. [PMID: 34323129 DOI: 10.1080/10428194.2021.1957866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Recent data suggest the use of radiotherapy alone (RT) in Early-Stage Follicular Lymphoma is declining. Cost-effectiveness analysis of treatments has not been performed. We constructed a partitioning model (15-year horizon) to compare RT, combined-modality therapy (CMT) and immunochemotherapy with rituximab maintenance (ICT + RM) from a PET-staged cohort from the Australian Lymphoma Alliance. Lifetime direct health care costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. AUD $75,000 was defined as the willingness-to-pay threshold (WTP). The direct healthcare costs were: RT $12,791, CMT $29,391 and ICT + RM $42,644. Compared with RT, CMT demonstrated minimal improvement in QALYs (+0.01) and an ICER well above the WTP threshold ($1,535,488). Compared with RT, ICT + RM demonstrated an improvement in QALYs (+0.41) with an ICER of $73,319. Modeling a 25% cost reduction with a rituximab biosimilar led to further ICER reductions with ICT + RM ($52,476). ICT + RM is cost-effective in early-stage FL from the Australian taxpayer perspective.
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Affiliation(s)
- Joshua W D Tobin
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Anna Crothers
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Ti Eric Ma
- Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Peter Mollee
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Maher K Gandhi
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Paul Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Greg Hapgood
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Abstract
Radiotherapy (RT) plays a diverse and essential role in the contemporary management of non-Hodgkin lymphoma (NHL) and remains the single most powerful monotherapeutic intervention for both aggressive and indolent subtypes. Over the past decade, there have been significant advancements in radiation oncology practice, which have made modern treatments safer and more conformal. Despite this sophistication and evidence supporting a continued role for RT, numerous data suggest that utilization is on the decline. In this review, we discuss the rationale for RT in 4 commonly encountered scenarios: combined modality therapy for limited-stage aggressive NHL, consolidation therapy for advanced-stage aggressive NHL, and the changing roles of salvage RT for relapsed/refractory NHL in an era of new frontiers such as cellular therapies. We also evaluate current strategies to treat indolent histologies. We conclude with perspectives on how RT for the hematological malignancies may continue to evolve.
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15
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Girard J, Karimi Y, Carty S, Wilcox R, Kaminiski M, Malek S, Phillips T. Targeted Therapies for Follicular Lymphoma. Curr Hematol Malig Rep 2021; 16:25-31. [PMID: 33754292 DOI: 10.1007/s11899-021-00614-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 11/28/2022]
Abstract
Follicular lymphoma (FL) is the 2nd most common lymphoma in the USA/Western Europe. While incurable, the majority of patients are able to survive at least a decade with this disease. Response duration though varies, and subset of patients will relapse within 24 months of initial therapy (POD24). These patients have shortened survival compared to those who achieve more durable responses. Treatment interventions for patients are varied and include observation, radiation, or systemic therapies. Treatment outcomes have improved considerably over the last several decades with the introduction of new agents such as the CD 20 antibody rituximab and more recently with the advent of more targeted therapy. Most of the newer agents work differently from cytotoxic chemotherapy and either inhibit tumor-specific mutations, survival pathways, or harness the immune systems. While outcomes with traditional cytotoxic agents have been historically poor in certain subtypes such as POD24 and rituximab refractory disease, the reported outcomes with the newer agents have been encouraging as evident by several new drug approvals in FL. The biggest impact has been in the relapsed/refractory setting where we have approval of the immunomodulatory agent lenalidomide given in combination with rituximab. Based on the AUGMENT study, this agent has been approved for patients with R/R FL after one previous line of therapy. The EZH2 inhibitor, tazemetostat, was approved recently for patients with a known EZH2 mutation after one prior line of therapy or for FL patients who are deemed intolerant to other agents given the impressive safety profile in all patients. Finally, there is a plethora of agents that are designed to harness the immune system to combat this lymphoma. The data for these agents is still very early but nonetheless very impressive. In summary, FL is an incurable lymphoma without any standard of care options but has numerous treatments that have demonstrated some degree of efficacy. Recently we have made enormous strides in the understanding of some of the biological drivers of this disease which has allowed for refinement of treatment options. Moving forward, I would anticipate that we will continue to explore the use of agents that target specific mutations or utilize the immune system to hopefully one day achieve a cure.
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Affiliation(s)
- Jennifer Girard
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48130, USA
| | - Yasmin Karimi
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48130, USA
| | - Shannon Carty
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48130, USA
| | - Ryan Wilcox
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48130, USA
| | - Mark Kaminiski
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48130, USA
| | - Sami Malek
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48130, USA
| | - Tycel Phillips
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48130, USA.
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16
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Long-term outcomes for patients with limited-stage follicular lymphoma: update of a population-based study. Blood 2021; 136:1006-1010. [PMID: 32321165 DOI: 10.1182/blood.2019004588] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
With a median follow-up of 16.6 years, Lo and colleagues report excellent long-term outcomes with primary radiotherapy for limited-stage follicular lymphoma in this month’s CME article.
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17
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Cencini E, Fabbri A, Mecacci B, Bocchia M. How to manage early-stage follicular lymphoma. Expert Rev Hematol 2020; 13:1093-1105. [PMID: 32869685 DOI: 10.1080/17474086.2020.1818226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Early-stage follicular lymphoma (FL) is characterized by good prognosis and can be cured with involved-field radiotherapy (IF-RT) in most cases. PET scan is a milestone of diagnostic work-up, with the aim of identifying a truly localized disease; however, staging in most of the studies was without PET. AREAS COVERED We have searched in MEDLINE (inclusive dates 1994-2020) data about localized FL management. While high-quality evidence is lacking, current guidelines recommend IFRT or involved-site RT as first-line treatment in limited stages FL. Since a significant proportion of disease relapse occurred in non-irradiated areas, it has been hypothesized that occult disease could be present at diagnosis and could persist after RT, contributing to relapse. Available treatment options include watch-and-wait, chemotherapy, RT plus chemo- or chemo-immunotherapy, and RT combined with rituximab (R). EXPERT OPINION RT combined with chemotherapy could increase PFS, but a clear OS benefit is lacking and toxic effects could be unacceptable. A promising strategy is represented by R combined with IF-RT, with low relapse rate outside the radiation fields and without the toxicity reported with chemotherapy. The study of prognostic factors in PET-staged patients, the reduction of RT fields and doses, and a response-adapted strategy represent new perspectives to investigate.
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Affiliation(s)
- Emanuele Cencini
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese & University of Siena , Siena, Italy
| | - Alberto Fabbri
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese & University of Siena , Siena, Italy
| | - Bianca Mecacci
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese & University of Siena , Siena, Italy
| | - Monica Bocchia
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese & University of Siena , Siena, Italy
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18
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Wirth A, Mikhaeel NG, Aleman BM, Pinnix CC, Constine LS, Ricardi U, Illidge TM, Eich HT, Hoppe BS, Dabaja B, Ng AK, Kirova Y, Berthelsen AK, Dieckmann K, Yahalom J, Specht L. Involved Site Radiation Therapy in Adult Lymphomas: An Overview of International Lymphoma Radiation Oncology Group Guidelines. Int J Radiat Oncol Biol Phys 2020; 107:909-933. [DOI: 10.1016/j.ijrobp.2020.03.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/11/2020] [Indexed: 12/15/2022]
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19
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Romancik JT, Cohen JB. Is Limited-Stage Mantle Cell Lymphoma Curable and How Is It Best Managed? Hematol Oncol Clin North Am 2020; 34:849-859. [PMID: 32861282 DOI: 10.1016/j.hoc.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Limited-stage (stage I-II) mantle cell lymphoma (MCL) is rarely encountered. There is no standard approach to treatment and available data to guide management decisions mainly are retrospective studies. A thorough staging evaluation, including positron emission tomography/computed tomography, bone marrow biopsy, and gastrointestinal evaluation, should be completed because disseminated disease is common. Radiation therapy is effective for local control, and, although prolonged remission can be achieved, distant relapses are common and there are insufficient data to say that patients can be cured using this treatment. This article reviews literature pertaining to management of patients with limited-stage MCL and discusses approach to treatment.
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Affiliation(s)
- Jason T Romancik
- Department of Hematology and Medical Oncology, Emory University - Winship Cancer Institute, 1365C Clifton Road, Northeast, Suite B4000D, Atlanta, GA 30322, USA
| | - Jonathon B Cohen
- Department of Hematology and Medical Oncology, Emory University - Winship Cancer Institute, 1365C Clifton Road, Northeast, Suite B4000D, Atlanta, GA 30322, USA.
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20
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König L, Herfarth K, Hörner-Rieber J, Dietrich S, Wiegel T, Debus J, Viardot A. Oncological outcome and recurrence pattern analysis after involved-field irradiation in combination with rituximab for early-stage nodal and extranodal follicular lymphoma. Strahlenther Onkol 2020; 196:705-714. [PMID: 32377821 PMCID: PMC7385027 DOI: 10.1007/s00066-020-01624-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 04/15/2020] [Indexed: 11/25/2022]
Abstract
Purpose Combined radioimmunotherapy (RIT) in follicular lymphomas (FL) has shown promising treatment efficacy in the Mabthera® and Involved field Radiation (MIR) study. Aim of this study was to analyze treatment efficacy and recurrence patterns after RIT in early-stage nodal and extranodal FL. Methods We reviewed 107 patients who were treated with combined RIT in two centers. Treatment consisted of 4 × rituximab followed by RIT with 4 × rituximab and involved field (IF) radiotherapy with 30/40 Gy. Median follow-up period was 71 months. In contrast to the MIR study, extranodal involvement and grade 3A histology were included in the analysis. Results Extranodal involvement and grade 3A histology were present in 21.8% and 13.1%, respectively. Overall response rate (ORR) after 4 × rituximab, after completion of RIT, and after 6 months was 78.1%, 98.8%, and 98.8%, respectively, with increasing rates of complete remissions (CR). Predictive factors associated with superior PFS were tumor size, completely excised lymphomas, and response to first 4 × rituximab. 5‑year PFS rate was 87.3%, with mostly outfield recurrences (94.1%). Second-line treatment was effective, with 53.3% CR and 46.7% partial remissions (PR). 5‑year OS was 98.1%. RIT was tolerated well, with mainly grade 1–2 acute side effects. Conclusion The real-world efficacy of RIT is comparable with the results of the MIR study. Additionally, this analysis shows that extranodal involvement and grade 3A histology are not associated with inferior PFS.
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Affiliation(s)
- Laila König
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.
- National Center for Tumor diseases (NCT), Heidelberg, Germany.
| | - Klaus Herfarth
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Sascha Dietrich
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Andreas Viardot
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
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Durable Complete Remission and Long-Term Survival in FDG-PET Staged Patients with Stage III Follicular Lymphoma, Treated with Wide-Field Radiation Therapy. Cancers (Basel) 2020; 12:cancers12040991. [PMID: 32316464 PMCID: PMC7226391 DOI: 10.3390/cancers12040991] [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: 03/05/2020] [Revised: 04/07/2020] [Accepted: 04/15/2020] [Indexed: 11/16/2022] Open
Abstract
Advanced-stage follicular lymphoma (FL) is generally considered incurable with conventional systemic therapies, but historic series describe long-term disease-free survival in stage III disease treated with wide-field radiation therapy (WFRT), encompassing all known disease sites. We report outcomes for patients staged with 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) and treated with CT-planned WFRT, given as either comprehensive lymphatic irradiation (CLI) or total nodal irradiation (TNI). This analysis of a prospective cohort includes PET-staged patients given curative-intent WFRT as a component of initial therapy, or as sole treatment for stage III FL. Thirty-three PET-staged patients with stage III FL received WFRT to 24–30Gy between 1999 and 2017. Fifteen patients also received planned systemic therapy (containing rituximab in 11 cases) as part of their primary treatment. At 10 years, overall survival and freedom from progression (FFP) were 100% and 75%, respectively. None of the 11 rituximab-treated patients have relapsed. Nine relapses occurred; seven patients required treatment, and all responded to salvage therapies. A single death occurred at 16 years. The principal acute toxicity was transient hematologic; one patient had residual grade two toxicity at one year. With FDG-PET staging, most patients with stage III FL experience prolonged FFP after WFRT, especially when combined with rituximab.
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22
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Saleh K, Michot JM, Schernberg A, Lazarovici J, Chahine C, Danu A, Khalife-Saleh N, Rossignol J, Ghez D, Martin V, Mazeron R, Fermé C, Boros A, Ribrag V, Girinsky T. Repeated courses of low-dose 2 × 2 Gy radiation therapy in patients with indolent B-cell non-Hodgkin lymphomas. Cancer Med 2020; 9:3725-3732. [PMID: 32249547 PMCID: PMC7286454 DOI: 10.1002/cam4.2796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/09/2019] [Accepted: 12/06/2019] [Indexed: 11/12/2022] Open
Abstract
Purpose In patients with indolent B‐cell non‐Hodgkin's lymphoma (B‐NHL), one course of low‐dose radiotherapy (LD‐RT) 2 × 2 Gy is emerging as new option of therapy in palliative setting. Efficacy of LD‐RT when repeated remains to be determinate. This study aims to assess the efficacy of repeated LD‐RT given in patients with indolent B‐NHL. Materials and Methods All consecutive adult patients who received two or more courses of LD‐RT 2 × 2 Gy for indolent B‐NHL at Gustave Roussy institution, during the period 1990‐2015 were retrospectively investigated. Results Thirty‐three patients received two or more courses of LD‐RT for indolent B‐NHL during the study period. The median age was 57 (range 37‐80) years, histological types were distributed among follicular lymphoma (n = 24 pts; 73%), marginal‐zone lymphoma (n = 6 pts; 18%), and primary cutaneous follicle center lymphoma (n = 3 pts; 9%). The median number of low‐dose radiation therapy courses given per patients was 2 (range 2‐6). The overall response rates following the first and the second course of LD‐RT were 96% and 88%, respectively (P = .31). The 1‐ and 2‐years local control rates following the first courses of LD‐RT were 94% (CI 95: 86‐100) and 94% (CI 95: 86‐98); and were 91% (CI 95: 82‐100) and 88% (CI 95: 77‐100) following the second course of LD‐RT (P = .39). Conclusion The repeated courses of LD‐RT offered similar efficacy compare with the first course in patients with indolent B‐NHL. LD‐RT repeated is a simple, easy to give, and non‐toxic asset that could be investigated as treatment option in patients with indolent B‐NHL.
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Affiliation(s)
- Khalil Saleh
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Jean-Marie Michot
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Drug Development Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Antoine Schernberg
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Julien Lazarovici
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Claude Chahine
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Alina Danu
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Nadine Khalife-Saleh
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Julien Rossignol
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - David Ghez
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Valentine Martin
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Renaud Mazeron
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Christophe Fermé
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Angela Boros
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Vincent Ribrag
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Drug Development Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Theodore Girinsky
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
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Patient-level Factors Associated With the Initial Management of Older Adults Diagnosed With Follicular Lymphoma: A Surveillance, Epidemiology, and End Results-Medicare Analysis. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:e184-e194. [PMID: 31956071 DOI: 10.1016/j.clml.2019.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/03/2019] [Accepted: 12/14/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION We evaluated patient-level factors associated with the initial management of older adults diagnosed with follicular lymphoma (FL). MATERIALS AND METHODS Using linked Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) data; we identified 11,500 beneficiaries aged ≥ 66 years, diagnosed with FL between 2000 and 2013. A logistic regression model was used to estimate adjusted odds ratios (AORs) for factors associated with the receipt of active treatment versus watchful waiting (WW) as an initial management strategy. A multinomial logistic regression model was used to predict factors associated with receipt of specific active treatments, namely chemoimmunotherapy, rituximab monotherapy, chemotherapy, or radiation as compared with WW. RESULTS Overall, the initial management strategies adopted were WW (49%), chemoimmunotherapy (25%), radiation (10%), rituximab monotherapy (9%), and chemotherapy (7%). In reference to WW, grade III FL (AOR, 2.21; 95% confidence interval [CI], 1.99-2.46), increasing disease stage (Stage IV AOR, 1.80; 95% CI, 1.62-2.00), and use of preventive services (AOR, 1.18; 95% CI, 1.07-1.30) were associated with increased odds of active treatment receipt. Age > 80 years (AOR, 0.79; 95% CI, 0.71-0.87), Non-Hispanic African-American race (AOR, 0.64; 95% CI, 0.50-0.80), and state buy-in coverage (AOR, 0.81; 95% CI, 0.70-0.94) were associated with decreased odds of active treatment receipt. In reference to WW, the multinomial logistic regression model displayed differences in the receipt of rituximab-based therapies by age and comorbidity burden. Non-Hispanic African-American race and state buy-in coverage were associated with decreased odds of receiving rituximab-based therapies. CONCLUSION The present analysis identifies disparities in the initial management of older adults with FL owing to race and socioeconomic status. Future research should examine implications for subsequent treatment and health outcomes.
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Campbell BA, Plastaras JP, Savage KJ. Keeping Our Finger on the Pulse: Reaffirming the Role of Radiation Therapy in the Curative Management of Early Stage Follicular Lymphoma. Int J Radiat Oncol Biol Phys 2019; 105:459-465. [DOI: 10.1016/j.ijrobp.2019.06.2505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/04/2019] [Accepted: 06/08/2019] [Indexed: 11/25/2022]
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Abstract
Radiation therapy plays a critical role in the management of a wide range of hematologic malignancies. The optimal radiation dose and target volume, and safe and effective ways of integrating radiation with systemic agents, vary depending on the histologic subtypes, stage at presentation, patient performance status, response to systemic therapy if given, treatment intent, and patient preferences. Limiting doses to surrounding organs without sacrificing disease control is of paramount importance. Reducing radiation doses and treatment volume in selected cases, and the use of advanced radiotherapy technology, can improve the therapeutic ratio of patients receiving radiation therapy for hematologic malignancies.
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Affiliation(s)
- Yolanda D Tseng
- Department of Radiation Oncology, Seattle Cancer Care Alliance Proton Therapy Center, University of Washington School of Medicine, 1570 North 115th Street, Seattle, WA 98133, USA
| | - Andrea K Ng
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Tobin JWD, Rule G, Colvin K, Calvente L, Hodgson D, Bell S, Dunduru C, Gallo J, Tsang ES, Tan X, Wong J, Pearce J, Campbell R, Tneh S, Shorten S, Ng M, Cochrane T, Tam CS, Abro E, Hawkes E, Hodges G, Kansara R, Talaulikar D, Gilbertson M, Johnston AM, Savage KJ, Villa D, Morris K, Ratnasingam S, Janowski W, Kridel R, Cheah CY, MacManus M, Matigian N, Mollee P, Gandhi MK, Hapgood G. Outcomes of stage I/II follicular lymphoma in the PET era: an international study from the Australian Lymphoma Alliance. Blood Adv 2019; 3:2804-2811. [PMID: 31570492 PMCID: PMC6784528 DOI: 10.1182/bloodadvances.2019000458] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/04/2019] [Indexed: 01/17/2023] Open
Abstract
Management practices in early-stage (I/II) follicular lymphoma (FL) are variable and include radiation (RT), systemic therapy, or combined modality therapy (CMT). There is a paucity of data regarding maintenance rituximab in this cohort. We conducted an international retrospective study of patients with newly diagnosed early-stage FL staged with positron emission tomography (PET)-computed tomography and bone marrow biopsy. Three hundred sixty-five patients (stage I, n = 221), median age 63 years, treated from 2005-2017 were included, with a median follow-up of 45 months. Management included watchful waiting (WW; n = 85) and active treatment (n = 280). The latter consisted of RT alone (n = 171) or systemic therapy (immunochemotherapy [n = 63] or CMT [n = 46]). Forty-nine systemically treated patients received maintenance rituximab; 72.7% of stage I patients received RT alone, compared to 42.6% with stage II (P < .001). Active therapies yielded comparable overall response rates (P = .87). RT alone and systemic therapy without maintenance rituximab yielded similar progression-free survival (PFS) (hazard ratio [HR], 1.32; 95% confidence interval [CI], 0.77-2.34; P = .96). Maintenance rituximab improved PFS (HR, 0.24; 95% CI, 0.095-0.64; P = .017). The incidence of transformation was lower with systemic therapy compared to RT or WW (HR, 0.20; 95% CI, 0.070-0.61; P = .034). Overall survival was similar among all practices, including WW (P = .40). In the largest comparative assessment of management practices in the modern era, variable practices each resulted in similar excellent outcomes. Randomized studies are required to determine the optimal treatment in early-stage FL.
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Affiliation(s)
- Joshua W D Tobin
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Gabrielle Rule
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Katherine Colvin
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Lourdes Calvente
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - David Hodgson
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Stephen Bell
- Department of Haematology, Calvary Mater Health, Newcastle, NSW, Australia
| | - Chengetai Dunduru
- Department of Haematology, Andrew Love Cancer Centre, University Hospital Geelong, Geelong, VIC, Australia
| | - James Gallo
- Department of Haematology, Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - Erica S Tsang
- Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Xuan Tan
- Department of Haematology, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Jonathan Wong
- Department of Clinical Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Jessica Pearce
- Department of Haematology, Townsville Hospital, Townsville, QLD, Australia
| | - Robert Campbell
- Department of Oncology and Clinical Haematology, Austin Hospital, Melbourne, VIC, Australia
| | - Shao Tneh
- Department of Haematology, Mater Hospital Brisbane, Brisbane, QLD, Australia
| | - Sophie Shorten
- Department of Haematology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Melissa Ng
- Department of Haematology, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Tara Cochrane
- Department of Haematology, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Constantine S Tam
- Department of Haematology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Emad Abro
- Department of Haematology, Mater Hospital Brisbane, Brisbane, QLD, Australia
| | - Eliza Hawkes
- Department of Oncology and Clinical Haematology, Austin Hospital, Melbourne, VIC, Australia
| | - Georgina Hodges
- Department of Haematology, Townsville Hospital, Townsville, QLD, Australia
| | - Roopesh Kansara
- Section of Medical Oncology and Haematology, University of Manitoba, Winnipeg, MB, Canada
| | - Dipti Talaulikar
- Department of Haematology, Canberra Hospital, Canberra, ACT, Australia
| | - Michael Gilbertson
- Department of Clinical Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Anna M Johnston
- Department of Haematology, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Kerry J Savage
- Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Diego Villa
- Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Kirk Morris
- Department of Haematology, Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - Sumi Ratnasingam
- Department of Haematology, Andrew Love Cancer Centre, University Hospital Geelong, Geelong, VIC, Australia
| | - Wojt Janowski
- Department of Haematology, Calvary Mater Health, Newcastle, NSW, Australia
| | - Robert Kridel
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | | | - Nicholas Matigian
- QFAB Bioinformatics, Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD, Australia
| | - Peter Mollee
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Maher K Gandhi
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Greg Hapgood
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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Pulsoni A, Della Starza I, Cappelli LV, Tosti ME, Annechini G, Cavalli M, De Novi LA, D’Elia GM, Grapulin L, Guarini A, Del Giudice I, Foà R. Minimal residual disease monitoring in early stage follicular lymphoma can predict prognosis and drive treatment with rituximab after radiotherapy. Br J Haematol 2019; 188:249-258. [DOI: 10.1111/bjh.16125] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/21/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Alessandro Pulsoni
- Haematology, Department of Translational and Precision Medicine Sapienza University RomeItaly
| | - Irene Della Starza
- Haematology, Department of Translational and Precision Medicine Sapienza University RomeItaly
| | - Luca V. Cappelli
- Haematology, Department of Translational and Precision Medicine Sapienza University RomeItaly
| | - Maria E. Tosti
- National Centre for Global Health Istituto Superiore di Sanità RomeItaly
| | - Giorgia Annechini
- Haematology, Department of Translational and Precision Medicine Sapienza University RomeItaly
| | - Marzia Cavalli
- Haematology, Department of Translational and Precision Medicine Sapienza University RomeItaly
| | - Lucia A. De Novi
- Haematology, Department of Translational and Precision Medicine Sapienza University RomeItaly
| | - Gianna M. D’Elia
- Haematology, Department of Translational and Precision Medicine Sapienza University RomeItaly
| | - Lavinia Grapulin
- Department of Radiology and Radiotherapy Sapienza University RomeItaly
| | - Anna Guarini
- Department of Molecular Medicine Sapienza University Rome Italy
| | - Ilaria Del Giudice
- Haematology, Department of Translational and Precision Medicine Sapienza University RomeItaly
| | - Robin Foà
- Haematology, Department of Translational and Precision Medicine Sapienza University RomeItaly
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El-Galaly TC, Cheah CY, Villa D. Real world data as a key element in precision medicine for lymphoid malignancies: potentials and pitfalls. Br J Haematol 2019; 186:409-419. [PMID: 31140600 DOI: 10.1111/bjh.15965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Molecular genetic studies of lymphoma have led to refinements in disease classification in the most recent World Health Organization update. Nevertheless, a 'one-size-fits-most' treatment strategy based on morphology remains widely used for lymphoma despite significant molecular heterogeneity within histopathologically-defined subtypes. Precision medicine aims to improve patient outcomes by leveraging disease- and patient-specific information to optimise treatment strategies, but implementation of precision medicine strategies is challenged by the biological diversity and rarity of lymphomas. In this review, we explore existing and emerging real-world data sources that can be used to facilitate the development of precision medicine strategies in lymphoma. We provide illustrative examples of the use of real-world analyses to refine treatment strategies, provide comparators for clinical trials, improve risk-stratification to identify patients with unmet clinical needs and describe long-term and rare toxicities.
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Affiliation(s)
- Tarec C El-Galaly
- Department of Haematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital and Pathwest Laboratory Medicine, Nedlands, WA, Australia
| | - Diego Villa
- Division of Medical Oncology and Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
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Ayoub Z, Andraos T, Milgrom SA, Pinnix CC, Dabaja BS, Ng SP, Gunther JR, Khoury JD, Fowler NH, Neelapu SS, Samaniego F, Fayad LE, Nastoupil LJ. Limited stage grade 3 follicular lymphoma patients can experience favorable outcomes with combined modality therapy. Leuk Lymphoma 2019; 60:2432-2440. [PMID: 30942648 DOI: 10.1080/10428194.2019.1597081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Controversy exists regarding the optimal management of limited stage grade 3 follicular lymphoma (FL3). We assessed the treatment outcomes of 190 consecutive patients with stage I-II FL. Fifty two patients had FL3 disease, in whom the median age was 55 years. At a median follow-up of 65 months, 5-year progression-free survival (PFS) and overall survival (OS) rates were 76.6% and 87.6%, respectively. Patients receiving systemic therapy followed by radiation therapy (RT) had a significantly better PFS (p=.003) than those treated with RT alone, but similar OS (p = .476). Patients treated with RT had 100% local control. Compared to 132 patients with grade 1-2 FL, those with FL3 had similar PFS (p = .493) and OS (p = .330). Patients with FL3 can experience favorable outcomes when treated with a combination of systemic therapy and RT, comparable to low grade FL.
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Affiliation(s)
- Zeina Ayoub
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Therese Andraos
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Sarah A Milgrom
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Chelsea C Pinnix
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Bouthaina S Dabaja
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Sweet Ping Ng
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Jillian R Gunther
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Joseph D Khoury
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Nathan H Fowler
- Division of Cancer Medicine, University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Satva S Neelapu
- Division of Cancer Medicine, University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Felipe Samaniego
- Division of Cancer Medicine, University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Luis E Fayad
- Division of Cancer Medicine, University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Loretta J Nastoupil
- Division of Cancer Medicine, University of Texas MD Anderson Cancer Center , Houston , TX , USA
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Bolukbasi Y, Sezen D, Saglam Y, Selek U. Lymphoma. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-97145-2_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Definitive radiotherapy for localized follicular lymphoma staged by 18F-FDG PET-CT: a collaborative study by ILROG. Blood 2018; 133:237-245. [PMID: 30446493 DOI: 10.1182/blood-2018-04-843540] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/31/2018] [Indexed: 12/12/2022] Open
Abstract
Radiotherapy (RT) can be curative in patients with localized follicular lymphoma (FL), with historical series showing a 10-year disease-free survival of 40 to 50%. As 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography with computerized tomography (PET-CT) upstages 10 to 60% of patients compared to CT, we sought to evaluate outcomes in patients staged by PET-CT, to determine if more accurate staging leads to better patient selection and results. We conducted a multicenter retrospective study under the direction of the International Lymphoma Radiation Oncology Group (ILROG). Inclusion criteria were: RT alone for untreated stage I to II FL (grade 1-3A) with dose equivalent ≥24 Gy, staged by PET-CT, age ≥18 years, and follow-up ≥3 months. End points were freedom from progression (FFP), local control, and overall survival (OS). A total of 512 patients treated between 2000 and 2017 at 16 centers were eligible for analysis; median age was 58 years (range, 20-90); 410 patients (80.1%) had stage I disease; median RT dose was 30 Gy (24-52); and median follow-up was 52 months (3.2-174.6). Five-year FFP and OS were 68.9% and 95.7%. For stage I, FFP was 74.1% vs 49.1% for stage II (P < .0001). Eight patients relapsed in-field (1.6%). Four had marginal recurrences (0.8%) resulting in local control rate of 97.6%. On multivariable analysis, stage II (hazard ratio [HR], 2.11; 95% confidence interval [CI], 1.44-3.10) and BCL2 expression (HR, 1.62; 95% CI, 1.07-2.47) were significantly associated with less favorable FFP. Outcome after RT in PET-CT staged patients appears to be better than in earlier series, particularly in stage I disease, suggesting that the curative potential of RT for truly localized FL has been underestimated.
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MacManus M, Fisher R, Roos D, O’Brien P, Macann A, Davis S, Tsang R, Christie D, McClure B, Joseph D, Jayamohan J, Seymour JF. Randomized Trial of Systemic Therapy After Involved-Field Radiotherapy in Patients With Early-Stage Follicular Lymphoma: TROG 99.03. J Clin Oncol 2018; 36:2918-2925. [DOI: 10.1200/jco.2018.77.9892] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Follicular lymphoma (FL) is curable by involved-field radiotherapy (IFRT) in < 50% of patients with stage I to II disease. We hypothesized that adding systemic therapy to IFRT would improve long-term progression-free survival (PFS). Patients and Methods A multicenter randomized controlled trial enrolled patients with stage I to II low-grade FL after staging computed tomography scans and bone marrow biopsies. 18F-labeled fluorodeoxyglucose–positron emission tomography (PET) was not mandatory. Patients were randomly assigned to either arm A (30 Gy IFRT alone) or arm B (IFRT plus six cycles of cyclophosphamide, vincristine, and prednisolone [CVP]). From 2006, rituximab was added to arm B (R-CVP). Results Between 2000 and 2012, 150 patients were enrolled, 75 per arm. In arm B, 44 patients were allocated to receive CVP and 31 were allocated to receive R-CVP. At randomization, 75% had stage I, the median age was 57 years, 52% were male, and 48% were PET staged. With a median follow-up of 9.6 years (range, 3.1 to 15.8 years), PFS was superior in arm B (hazard ratio, 0.57; 95% CI, 0.34 to 0.95; P = .033). Ten-year PFS rates were 59% (95% CI, 46% to 74%) and 41% (95% CI, 30% to 57%) for arms B and A, respectively. Patients in arm B who received R-CVP had markedly superior PFS compared with contemporaneous patients in arm A (hazard ratio, 0.26; 95% CI, 0.07 to 0.97; P = .045). Fewer involved regions ( P = .047) and PET staging ( P = .056) were associated with better PFS. Histologic transformation occurred in four and 10 patients in arms B and A, respectively ( P = .1). Ten deaths occurred in arm A versus five in arm B, but overall survival was not significantly different ( P = .40; 87% and 95% at 10 years, respectively). Conclusion Systemic therapy with R-CVP after IFRT reduced relapse outside radiation fields and significantly improved PFS. IFRT followed by immunochemotherapy is more effective than IFRT in early-stage FL.
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Affiliation(s)
- Michael MacManus
- Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O’Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph
| | - Richard Fisher
- Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O’Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph
| | - Daniel Roos
- Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O’Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph
| | - Peter O’Brien
- Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O’Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph
| | - Andrew Macann
- Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O’Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph
| | - Sidney Davis
- Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O’Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph
| | - Richard Tsang
- Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O’Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph
| | - David Christie
- Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O’Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph
| | - Bev McClure
- Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O’Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph
| | - David Joseph
- Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O’Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph
| | - Jayasingham Jayamohan
- Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O’Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph
| | - John F. Seymour
- Michael MacManus, Richard Fisher, Bev McClure, and John F. Seymour, Peter MacCallum Cancer Centre; Michael MacManus and John F. Seymour, University of Melbourne; Melbourne; Sidney Davis, The Alfred Hospital, Prahran, Victoria; Daniel Roos, The Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia; Peter O’Brien, Genesis Cancer Care, Newcastle; Jayasingham Jayamohan, Westmead Hospital, Sydney, New South Wales; David Christie, Genesis Cancer Care, Tugun, Queensland; David Joseph
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Gonzalez-Lugo JD, Kabarriti R, Mantzaris I. Osteoradionecrosis of the jaw in a patient with lymphoma treated with rituximab and concomitant involved field radiation therapy. Adv Radiat Oncol 2018; 3:701-704. [PMID: 30370372 PMCID: PMC6200873 DOI: 10.1016/j.adro.2018.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/12/2018] [Accepted: 05/31/2018] [Indexed: 11/12/2022] Open
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Yang JC, Yahalom J. Early-Stage Follicular Lymphoma: What Is the Preferred Treatment Strategy? J Clin Oncol 2018; 36:2904-2906. [PMID: 30153098 DOI: 10.1200/jco.2018.79.3075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Joanna C Yang
- Joanna C. Yang and Joachim Yahalom, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joachim Yahalom
- Joanna C. Yang and Joachim Yahalom, Memorial Sloan Kettering Cancer Center, New York, NY
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36
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Sorigue M, Tuset V, Sancho JM. Treatment of localized-stage follicular lymphoma. Eur J Haematol 2018; 101:245-256. [PMID: 29754401 DOI: 10.1111/ejh.13093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2018] [Indexed: 12/15/2022]
Abstract
Follicular lymphoma (FL) is the most common indolent lymphoma, and it most frequently presents in an advanced stage. Therapeutic considerations for advanced stage are different from those of localized-stage FL, in which radiotherapy (RT) is generally recommended. However, the available evidence suffers from shortcomings that are relatively specific to this clinical entity due to its rarity and long survival with all available treatment modalities, including that most of the existing evidence originated at a time when diagnostic classifications, staging procedures and radiotherapeutic standards were different from those available today and when anti-CD20 monoclonal antibodies were not available. Available treatment modalities include observation, systemic therapy only, RT only and RT in combination with systemic therapy. We review the evidence available with each of them and the data from present-day clinical practice studies as well as briefly discuss what diagnostic and therapeutic developments may take place in the next few years.
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Affiliation(s)
- Marc Sorigue
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Victòria Tuset
- Department of Radiation Oncology, ICO Badalona, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Juan-Manuel Sancho
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
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Grignano É, Deau-Fischer B, Loganadane G, Breton M, Burroni B, Bouscary D, Kirova YM. Radiotherapy of relapse-refractory follicular lymphoma. Cancer Radiother 2018; 22:126-130. [PMID: 29477304 DOI: 10.1016/j.canrad.2017.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/24/2017] [Accepted: 09/06/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the efficacy of treatment and outcomes of patients with relapsed or refractory follicular lymphoma treated with external beam irradiation. PATIENTS AND METHODS Fifteen patients who received external beam radiotherapy for relapsed or refractory follicular lymphoma were studied. The median age was 68.3 years (range: 37.9-87.08 years) with four men and 11 women. Seven patients had early stage (I or II); eight advanced stage (III or IV). Median FLIPI score was 2. Two patients had high tumour bulk disease. Six patients had extranodal invasion, with five patients having bone marrow invasion. RESULTS The median time of follow-up after relapse or first-line treatment in case of refractory disease was 61.9 months (range: 9.1-119.7 months). Complete response after external beam radiotherapy was seen in 11 cases (73%) and partial response in two (13%), with a median dose of 30Gy (range: 2-40Gy) and median number of fractions of 15 (range: 2-20). Eight patients (53%) relapsed after external beam radiation therapy in a median of 20.2 months, mostly out of irradiated volumes. Most patients (66%) had a disease control after one or two courses of external beam radiation therapy. At last follow-up, 86% of patients were in remission including those with salvage chemotherapy. The toxicity profile was favourable with toxicity higher than grade 1. In univariate analysis, a Follicular Lymphoma International Prognostic Index (FLIPI) score above 2 was the only predicting factor for non-control disease. CONCLUSION For relapsed and refractory follicular lymphoma, external beam radiotherapy should be considered as an effective modality when integrated in a multimodality approach. Randomised studies are warranted to validate this strategy.
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Affiliation(s)
- É Grignano
- Department of radiation oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - B Deau-Fischer
- Hôpital Cochin, rue du Faubourg-Saint-Jacques, 75005 Paris, France
| | - G Loganadane
- Department of radiation oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - M Breton
- Department of radiation oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - B Burroni
- Hôpital Cochin, rue du Faubourg-Saint-Jacques, 75005 Paris, France
| | - D Bouscary
- Hôpital Cochin, rue du Faubourg-Saint-Jacques, 75005 Paris, France
| | - Y M Kirova
- Department of radiation oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
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Bentur OS, Gurion R, Gafter-Gvili A, Gatt M, Shvidel L, Horowitz NA, Ram R, Herishanu Y, Sarid N, Paltiel O, Ganzel C, Kreiniz N, Dally N, Gutwein O, Raanani P, Avivi I, Perry C. Treatment and prognosis of stage I follicular lymphoma in the modern era - does PET matter? Leuk Lymphoma 2017; 59:1163-1171. [PMID: 28901817 DOI: 10.1080/10428194.2017.1375102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Follicular lymphoma (FL) is the most common subtype of indolent non-Hodgkin lymphoma. Patients with stage I disease are usually treated with radiotherapy (RT). In previous studies, mostly from the pre positron emission tomography-computed tomography (PET-CT) era, the 5 year progression-free survival (PFS) and overall survival (OS) rates of stage I disease were 60-80% and 80-93%, respectively. This study retrospectively evaluated the outcome of stage I FL which was treated with involved field RT in the PET-CT era between 2002 and 2015. Ninety-one patients were enrolled. Five year PFS and OS rates were 73% and 97%, respectively. Relapse occurred in 19 (21%) patients, 74% occurring outside the radiation field. In conclusion, PET-CT staging of clinical stage I FL may contribute to the improved prognosis in patients treated with RT compared to historical cohorts, possibly due to better identification of "genuine" stage I disease.
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Affiliation(s)
- Ohad S Bentur
- a Department of Hematology , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - Ronit Gurion
- b Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center , Petah-Tikva , Israel.,c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Anat Gafter-Gvili
- b Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center , Petah-Tikva , Israel.,c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,d Department of Medicine A , Rabin Medical Center , Petah-Tikva , Israel
| | - Moshe Gatt
- e Hadassah Medical Center , Jerusalem , Israel.,f Faculty of Medicine , Hebrew University of Jerusalem , Jerusalem , Israel
| | - Lev Shvidel
- f Faculty of Medicine , Hebrew University of Jerusalem , Jerusalem , Israel.,g Kaplan Medical Center , Rehovot , Israel
| | - Netanel A Horowitz
- h Rambam Medical Center and Rappaport Faculty of Medicine - Technion , Israel
| | - Ron Ram
- a Department of Hematology , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel.,c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Yair Herishanu
- a Department of Hematology , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel.,c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Nadav Sarid
- a Department of Hematology , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - Ora Paltiel
- e Hadassah Medical Center , Jerusalem , Israel.,f Faculty of Medicine , Hebrew University of Jerusalem , Jerusalem , Israel
| | - Chezi Ganzel
- f Faculty of Medicine , Hebrew University of Jerusalem , Jerusalem , Israel.,i Shaare Zedek Medical Center , Jerusalem , Israel
| | | | - Najib Dally
- k Faculty of Medicine, Ziv Medical Center and Bar Ilan University , Safed , Israel
| | - Odit Gutwein
- c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,l Assaf Harofe Medical Center , Tel Aviv , Israel
| | - Pia Raanani
- b Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center , Petah-Tikva , Israel.,c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Irit Avivi
- a Department of Hematology , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel.,c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Chava Perry
- a Department of Hematology , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel.,c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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39
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Demoor-Goldschmidt C, Agape P, Barillot I, Mahé MA. [Radiotherapy in localized stages of follicular and diffuse non-Hodgkin's lymphomas]. Cancer Radiother 2016; 20:530-4. [PMID: 27614527 DOI: 10.1016/j.canrad.2016.07.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 07/22/2016] [Indexed: 11/25/2022]
Abstract
Treatment with monoclonal antibodies, especially rituximab, is more and more frequent and questions the interest of radiotherapy in limited stages of diffuse B-cell large cell and follicular non-Hodgkin's lymphomas. From a review of literature, it appears that radiotherapy is of interest in bulky disease, patients with incomplete metabolic response, elderly patients receiving short chemotherapy and those with recurrence after exclusive chemotherapy. Finally, this article gives recommendations on available techniques of radiotherapy and doses to be delivered.
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Affiliation(s)
- C Demoor-Goldschmidt
- Inserm, UMRS 1018, institut Gustave-Roussy, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - P Agape
- Département d'oncologie médicale, institut de cancérologie de l'Ouest-René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - I Barillot
- Centre universitaire de cancérologie Henry-s-Kaplan, CHU, 37000 Tours, France
| | - M A Mahé
- Département de radiothérapie, institut de cancérologie de l'Ouest-René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France.
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40
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Limited Stage Follicular Lymphoma: Current Role of Radiation Therapy. Mediterr J Hematol Infect Dis 2016; 8:e2016041. [PMID: 27648204 PMCID: PMC5016012 DOI: 10.4084/mjhid.2016.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/18/2016] [Indexed: 12/04/2022] Open
Abstract
Radiation therapy (RT) alone has been considered for a long time as the standard therapeutic option for limited stage FL, due to its high efficacy in terms of local disease control with a quite significant proportion of “cured” patients (without further relapses at 10–15 years). Multiple therapeutic choices are currently accepted for the management of early stage FL at diagnosis, and better staging procedures as well as better systemic therapy partially modified the role of RT in this setting. RT has also changed in terms of prescribed dose as well as treatment volumes. In this review, we present and discuss the current role of RT for limited stage FL in light of the historical data and the modern RT concepts along with the possible combination with systemic therapy.
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41
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Reagan PM, Friedberg JW. Follicular lymphoma: first-line treatment without chemotherapy for follicular lymphoma. Curr Treat Options Oncol 2016; 16:32. [PMID: 26031546 DOI: 10.1007/s11864-015-0351-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Opinion statement: The optimal initial treatment of follicular lymphoma (FL) is not known, and initial management of patients varies considerably between providers and institutions. The assertion that patients with low tumor burden can be observed for a period of time is being challenged owing to the safety and tolerability of novel therapeutics and the movement of the field away from traditional chemotherapy agents. Single agent rituximab has become increasingly popular as initial management of patients with low tumor burden disease, and there is evidence that prolonged treatment with rituximab can improve progression-free survival (PFS) when compared to induction with rituximab or observation. Radioimmunotherapy (RIT) has similarly shown efficacy in low tumor burden disease. Novel agents such as lenalidomide, idelalisib, and ibrutinib are being studied in the first-line setting. Importantly, none of these strategies have demonstrated an improved overall survival in a randomized study versus observation. It is the opinion of the authors that endpoints such as PFS alone, while important, should not drive changes in management with limited resources. Composite endpoints including quality of life are more informative on the true impact of treatments on patients with follicular lymphoma. Providers should encourage all patients to be treated in the context of an appropriate clinical trial when possible. If a patient is not a clinical trial candidate, we typically treat patients with advanced stage and high tumor burden with chemoimmunotherapy. The decision to give maintenance rituximab is individualized to the patient, as there is no overall survival benefit. In patients with early stage disease, we favor consideration of radiation therapy if the patient is a candidate. Our initial recommendation to patients with advanced stage, low tumor burden disease, is close observation or "watch and wait." We have observed that most patients become comfortable over time with an observation approach. If a patient is not comfortable with this recommendation, we will use single agent rituximab. If the patient responds to therapy, we do not recommend maintenance rituximab in low tumor burden disease but rather prefer a retreatment strategy or an extended schedule of four additional doses of rituximab.
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Affiliation(s)
- Patrick M Reagan
- University of Rochester Medical Center, 601 Elmwood Ave, Box 704, Rochester, NY, 14642, USA,
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42
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Gastaud L, Rossignol B, Peyrade F, Ré D, Thariat J, Thyss A, Doyen J. Place de la radiothérapie dans la prise en charge des lymphomes malins non hodgkiniens. Cancer Radiother 2016; 20:236-47. [DOI: 10.1016/j.canrad.2016.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 12/27/2015] [Accepted: 01/29/2016] [Indexed: 12/11/2022]
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43
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Kus T, Aktas G, Kalender ME, Sari I, Ulker E, Camci C. Collision tumor consisting of primary follicular lymphoma and adenocarcinoma in the cecum: A case report and literature review. Oncol Lett 2016; 11:2801-2805. [PMID: 27073555 PMCID: PMC4812099 DOI: 10.3892/ol.2016.4310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 02/04/2016] [Indexed: 12/18/2022] Open
Abstract
The present study reports the case of a collision tumor consisting of follicular lymphoma (FL) and adenocarcinoma in the cecum of a 73-year-old man. To the best of our knowledge, the present study is the 11th case of a collision tumor consisting of colon adenocarcinoma and lymphoma to be reported in the literature, and the first case of cecum adenocarcinoma with low grade FL in the same segment of the cecum and the same regional lymph node to be reported. The present study reviewed the literature to determine treatment options for patients with collision tumors. The present patient was administered with adjuvant chemotherapy for T3N1M0 colon cancer following surgery, due to the dominance of colon adenocarcinoma in the collision tumor. Following the completion of treatment, progression of the untreated FL was observed. In the literature, patients with collision tumors are administered with chemotherapy for stage IV FL, and following the completion of treatment patients have presented with a recurrence of early stage colon adenocarcinoma. The recommended treatment for collision tumors is dependent on the dominant tumor; however, the treatment options for collision tumors in the literature appeared to exacerbate the other tumor. The characteristics of the tumors altered following chemotherapy, and immunological alterations in the tumors due to chemotherapy appear to have contributed to the exacerbation of the tumors. Therefore, patients with early-stage tumors should be considered at risk of recurrence of other malignancies, which are present in collision tumors.
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Affiliation(s)
- Tulay Kus
- Division of Medical Oncology, Faculty of Medicine, Gaziantep University, Gaziantep, Anatolia 27310, Turkey
| | - Gokmen Aktas
- Division of Medical Oncology, Faculty of Medicine, Gaziantep University, Gaziantep, Anatolia 27310, Turkey
| | - Mehmet Emin Kalender
- Division of Medical Oncology, Faculty of Medicine, Gaziantep University, Gaziantep, Anatolia 27310, Turkey
| | - Ibrahim Sari
- Division of Pathology, Faculty of Medicine, Gaziantep University, Gaziantep, Anatolia 27310, Turkey
| | - Esra Ulker
- Division of Internal Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Anatolia 27310, Turkey
| | - Celaletdin Camci
- Division of Medical Oncology, Faculty of Medicine, Gaziantep University, Gaziantep, Anatolia 27310, Turkey
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44
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Sancho JM, García O, Mercadal S, Pomares H, Fernández-Alvarez R, González-Barca E, Tapia G, González-García E, Moreno M, Domingo-Domènech E, Sorigué M, Navarro JT, Motlló C, Fernández-de-Sevilla A, Feliu E, Ribera JM. The long term follow-up of early stage follicular lymphoma treated with radiotherapy, chemotherapy or combined modality treatment. Leuk Res 2015; 39:853-8. [DOI: 10.1016/j.leukres.2015.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
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45
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The concept and evolution of involved site radiation therapy for lymphoma. Int J Clin Oncol 2015; 20:849-54. [DOI: 10.1007/s10147-015-0863-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/14/2015] [Indexed: 01/22/2023]
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46
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Barzenje DA, Cvancarova Småstuen M, Liestøl K, Fosså A, Delabie J, Kolstad A, Holte H. Radiotherapy Compared to Other Strategies in the Treatment of Stage I/II Follicular Lymphoma: A Study of 404 Patients with a Median Follow-Up of 15 Years. PLoS One 2015; 10:e0131158. [PMID: 26147646 PMCID: PMC4492987 DOI: 10.1371/journal.pone.0131158] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/31/2015] [Indexed: 01/04/2023] Open
Abstract
Purpose To investigate outcome for patients with follicular lymphoma (FL) stage I-II treated at a population-based referral institution with a median follow-up of 15 years. Overall and cause-specific survival was compared to that of a sex, age and residency matched individuals from normal population. Material and Methods 404 patients with early stage FL treated between 1980 and 2005 were retrospectively analyzed. Two of three patients had stage I disease. Based on clinical characteristics, first line treatments were radiotherapy (RT) (48% of patients), chemotherapy (CT) (16%), combined chemo-and radiotherapy (CRT) (16%) or observation (OBS) (15%). Survival was modeled with Kaplan-Meier methodology. Multivariate analyses were performed with the Cox model. Results Fifteen years overall survival (OS), progression free survival (PFS) and time to next treatment (TNT) were 50% (95% confidence interval [CI]: 45–55), 42% (95% CI: 36–47) and 48% (95% CI, 42–54), respectively. For patients treated with RT 97% achieved a complete remission, and 15 year OS, PFS and TNT were 57% (95% CI, 50–64), 46% (95% CI, 39–54) and 49% (95% CI, 42–57), respectively. Relapse rate after RT and CRT was 49% and 36%, respectively. Only 2% of patients who received RT or CRT relapsed inside the radiation field and 5% had isolated near-field relapse. No statistical differences were found between treatment groups regarding death from cardiovascular disease or incidence of second cancer. Compared to a matched normal population, non-lymphoma cancer mortality was higher among patients given RT, hazard ratio 1.66 (95% CI: 1.14–2.42; P<0.01). Compared to other treatment modalities, patients selected for observation without treatment did not have inferior outcome. Conclusions A differentiated treatment strategy in early stage FL results in long term survival for the majority of patients. OBS is a valid initial choice for selected patients without lymphoma-related symptoms.
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Affiliation(s)
| | | | - Knut Liestøl
- Center for Cancer Biomedicine, University of Oslo, Oslo, Norway
- Department of informatics, University of Oslo, Oslo, Norway
| | - Alexander Fosså
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Jan Delabie
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Arne Kolstad
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Harald Holte
- Department of Oncology, Oslo University Hospital, Oslo, Norway
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Vargo JA, Gill BS, Balasubramani GK, Beriwal S. What is the optimal management of early-stage low-grade follicular lymphoma in the modern era? Cancer 2015; 121:3325-34. [PMID: 26042364 DOI: 10.1002/cncr.29491] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/02/2015] [Accepted: 04/30/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Despite international practice guidelines endorsing radiotherapy (RT) as the preferred initial therapy, treatment approaches vary for patients with early-stage follicular lymphoma. The authors engaged the National Cancer Data Base to analyze patterns of care and survival outcomes for patients with early-stage follicular lymphoma in the era of modern therapy. METHODS A National Cancer Data Base retrospective cohort study was conducted of 35,961 patients with lymph node and extranodal, American Joint Committee on Cancer stage I to II, WHO grade 1 to 2 follicular lymphoma who were diagnosed between 1998 and 2012. Univariate and multivariable analyses were performed to identify sociodemographic, treatment, and tumor characteristics that were predictive of overall survival (OS) and treatment use. Propensity score-adjusted Cox proportional hazards ratios for survival in patients treated for follicular lymphoma were used. RESULTS Of the 35,961 patients with follicular lymphoma included in the current study, 63% had stage I disease, 79% were without extranodal disease, and 61% were aged >60 years. RT use decreased from 37% in 1999 to 24% in 2012 (P<.0001), with corresponding significant increases in observation and single-agent chemotherapy. Patients who received RT had 5-year and 10-year OS rates of 86% and 68%, respectively, compared with 74% and 54%, respectively, for those who did not receive RT (P<.0001). On multivariable survival analysis, including a propensity score to account for potential uncaptured confounding variables due to a lack of randomization, upfront RT remained independently associated with improved OS (hazard ratio of death, 0.54; 95% confidence interval, 0.47-0.63 [P<.0001]). CONCLUSIONS RT is an increasingly underused treatment approach in the era of modern therapy for patients with early-stage follicular lymphoma. The use of RT appears to improve OS and should remain standard practice as encouraged by clinical practice guidelines.
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Affiliation(s)
- John A Vargo
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Beant S Gill
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Goundappa K Balasubramani
- Department of Epidemiology, Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
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Iwamuro M, Okada H, Kawano S, Shiode J, Takenaka R, Imagawa A, Inaba T, Suzuki S, Nishimura M, Mizuno M, Araki M, Mannami T, Ueki T, Kobashi H, Fukatsu H, Tanaka S, Omoto A, Kawai Y, Kitagawa T, Toyokawa T, Takata K, Yoshino T, Takaki A, Yamamoto K. A multicenter survey of enteroscopy for the diagnosis of intestinal follicular lymphoma. Oncol Lett 2015; 10:131-136. [PMID: 26170988 DOI: 10.3892/ol.2015.3251] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 04/27/2015] [Indexed: 12/19/2022] Open
Abstract
The importance of enteroscopy examinations to investigate the entire length of the small intestines has been emphasized in follicular lymphoma patients with intestinal involvement. The aim of the present study was to determine the current state of enteroscopy examinations, including the performance rate, and the prevalence of small intestinal lesions in a patient population in Japan. A retrospective multicenter survey of 17 institutions collected the case information of 110 follicular lymphoma patients with gastrointestinal involvement. The results of the enteroscopy examinations were reviewed, and in order to identify potential factors affecting the performance rate of enteroscopy, patient gender, age at lymphoma diagnosis, histopathological grade, clinical stage, the date of the initial diagnosis and the annual volume of enteroscopy at the institution were compared between the patients who underwent one or more enteroscopy procedures and the patients who did not undergo enteroscopy. A total of 34 patients (30.9%) underwent enteroscopy, and 24 of these (70.6%) presented with involvement in the jejunum and/or ileum. It was found that more patients diagnosed in recent years and more patients treated at an ultra-high volume institution (≥101 enteroscopy examinations/year) underwent an enteroscopy. In conclusion, although the prevalence of small intestinal lesions was high (70.6%) in the follicular lymphoma patients presenting with intestinal involvement, the performance rate of enteroscopy was only 30.9%, and thus the majority of the patients have not undergone enteroscopy examinations. Further investigation is required to define the clinical significance of enteroscopy at the initial diagnostic work-up and during the follow-up period of these patients.
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Affiliation(s)
- Masaya Iwamuro
- Department of Molecular Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Hiroyuki Okada
- Department of Endoscopy, Okayama University Hospital, Okayama 700-8558, Japan
| | - Seiji Kawano
- Department of Endoscopy, Okayama University Hospital, Okayama 700-8558, Japan
| | - Junji Shiode
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama 700-8511, Japan
| | - Ryuta Takenaka
- Department of Internal Medicine, Tsuyama Chuo Hospital, Tsuyama 708-0841, Japan
| | - Atsushi Imagawa
- Department of Gastroenterology, Mitoyo General Hospital, Kanonji 769-1695, Japan
| | - Tomoki Inaba
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu 760-8557, Japan
| | - Seiyu Suzuki
- Department of Internal Medicine, Sumitomo Besshi Hospital, Niihama 792-8543, Japan
| | - Mamoru Nishimura
- Department of Internal Medicine, Okayama City Hospital, Okayama 700-8557, Japan
| | - Motowo Mizuno
- Department of Internal Medicine, Hiroshima City Hospital, Hiroshima 730-8518, Japan
| | - Masashi Araki
- Department of Internal Medicine, Kagawa Rosai Hospital, Marugame 763-8502, Japan
| | - Tomohiko Mannami
- Department of Internal Medicine, Chugoku Central Hospital, Fukuyama 720-0001, Japan
| | - Toru Ueki
- Department of Internal Medicine, Fukuyama City Hospital, Fukuyama 721-8511, Japan
| | - Haruhiko Kobashi
- Department of Hepatology, Japanese Red Cross Okayama Hospital, Okayama 700-8607, Japan
| | - Haruka Fukatsu
- Department of Internal Medicine, St. Mary's Hospital, Himeji 670-0801, Japan
| | - Shouichi Tanaka
- Department of Gastroenterology, Iwakuni Clinical Center, Iwakuni 740-8510, Japan
| | - Akiyoshi Omoto
- Department of Internal Medicine, Ako Central Hospital, Ako 678-0241, Japan
| | - Yoshinari Kawai
- Department of Gastroenterology, Onomichi Municipal Hospital, Onomichi 722-8503, Japan
| | - Takashi Kitagawa
- Department of Surgery, Kitagawa Hospital, Okayama 709-0497, Japan
| | - Tatsuya Toyokawa
- Department of Gastroenterology, Fukuyama Medical Center, Fukuyama 720-8520, Japan
| | - Katsuyoshi Takata
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Akinobu Takaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Kazuhide Yamamoto
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
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Kuruvilla J, Assouline S, Hodgson D, MacDonald D, Stewart D, Christofides A, Komolova M, Connors J. A Canadian Evidence-Based Guideline for the First-Line Treatment of Follicular Lymphoma: Joint Consensus of the Lymphoma Canada Scientific Advisory Board. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:59-74. [DOI: 10.1016/j.clml.2014.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/18/2014] [Accepted: 07/29/2014] [Indexed: 11/30/2022]
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50
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Samaniego F, Berkova Z, Romaguera JE, Fowler N, Fanale MA, Pro B, Shah JJ, McLaughlin P, Sehgal L, Selvaraj V, Braun FK, Mathur R, Feng L, Neelapu SS, Kwak LW. 90Y-ibritumomab tiuxetan radiotherapy as first-line therapy for early stage low-grade B-cell lymphomas, including bulky disease. Br J Haematol 2014; 167:207-13. [PMID: 25040450 DOI: 10.1111/bjh.13021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 06/05/2014] [Indexed: 02/03/2023]
Abstract
(90) Y-ibritumomab-tiuxetan ((90) YIT) was used as a first-line therapy for patients with early-stage follicular lymphoma (FL) or marginal zone B-cell lymphoma (MZL). Thirty-one patients were treated, with an overall 3-month response rate of 100% (68% complete response, 29% unconfirmed complete response and 3% partial response). At a median follow-up of 56 months, ten patients (32%) had disease relapse or progression. The progression-free rates at 3 and 5 years were lower in males, patients with FL, stage II disease and non-bulky disease, although they did not reach statistical significance. Grade 3-4 neutropenia, thrombocytopenia and anaemia were 61%, 35%, and 3%, respectively. (90) YIT was well tolerated, including in those patients over 60 years old, and achieved high response rates in patients with early-stage low-grade B-cell lymphomas. Bulky disease did not adversely affect tumour response.
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Affiliation(s)
- Felipe Samaniego
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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