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Tanaka K, Yasuda M, Tachi T, Teshigawara Y, Inoue S, Ino Y, Kitagawa J, Noguchi Y, Yoshimura T, Teramachi H, Kasahara S. Quality of life assessment and cost‑utility analysis of initial chemotherapy for patients with non‑Hodgkin's lymphoma: A prospective analysis. Oncol Lett 2024; 28:430. [PMID: 39049984 PMCID: PMC11268091 DOI: 10.3892/ol.2024.14564] [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: 04/25/2024] [Accepted: 06/26/2024] [Indexed: 07/27/2024] Open
Abstract
Chemotherapy has helped prolong survival in patients with malignant lymphoma, enhancing their quality of life (QOL). Despite the eventual decline in the QOL of patients, the impact of initial chemotherapy remains poorly understood. A prospective patient-reported QOL survey among patients with malignant lymphoma receiving initial chemotherapy was conducted, targeting those treated at Gifu Municipal Hospital (Gifu, Japan) between January 2021 and December 2022. Surveys were conducted pre- and post-chemotherapy based on the EuroQol 5 dimensions. Drug costs were calculated using official prices and analyzed from the cost payer's perspective via cost-utility analysis. Among the 60 patients included in the present study, 28 had diffuse large B-cell lymphoma. Cyclophosphamide, doxorubicin, vincristine, prednisolone ± rituximab therapy was the most common treatment (38 patients) and demonstrated superior cost-effectiveness due to its lowest cost and change in utility value. Initial chemotherapy for patients with malignant lymphoma generally improved the QOL. Clinical trial registration: UMIN000042868 (registered on December 28, 2020).
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Affiliation(s)
- Kazuhide Tanaka
- Department of Pharmacy, Gifu Municipal Hospital, Gifu, Gifu 500-8513, Japan
- Laboratory of Pharmaceutical Health Care and Promotion, Gifu Pharmaceutical University, Gifu, Gifu 500-8513, Japan
| | - Masahiro Yasuda
- Department of Pharmacy, Gifu Municipal Hospital, Gifu, Gifu 500-8513, Japan
- Laboratory of Pharmaceutical Health Care and Promotion, Gifu Pharmaceutical University, Gifu, Gifu 500-8513, Japan
| | - Tomoya Tachi
- Department of Pharmacy, Gifu Municipal Hospital, Gifu, Gifu 500-8513, Japan
- Laboratory of Pharmaceutical Health Care and Promotion, Gifu Pharmaceutical University, Gifu, Gifu 500-8513, Japan
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Gifu 501-1196, Japan
- Department of Clinical Pharmacy, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Aichi 467-8603, Japan
| | - Yuta Teshigawara
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Gifu 501-1196, Japan
| | - Seiji Inoue
- Department of Pharmacy, Gifu Municipal Hospital, Gifu, Gifu 500-8513, Japan
| | - Yoko Ino
- Department of Pharmacy, Gifu Municipal Hospital, Gifu, Gifu 500-8513, Japan
- Laboratory of Pharmaceutical Health Care and Promotion, Gifu Pharmaceutical University, Gifu, Gifu 500-8513, Japan
| | - Junichi Kitagawa
- Department of Hematology, Gifu Municipal Hospital, Gifu, Gifu 500-8513, Japan
| | - Yoshihiro Noguchi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Gifu 501-1196, Japan
| | - Tomoaki Yoshimura
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Gifu 501-1196, Japan
| | - Hitomi Teramachi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Gifu 501-1196, Japan
| | - Senji Kasahara
- Laboratory of Pharmaceutical Health Care and Promotion, Gifu Pharmaceutical University, Gifu, Gifu 500-8513, Japan
- Department of Hematology, Gifu Municipal Hospital, Gifu, Gifu 500-8513, Japan
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2
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Perthus A, Colin F, Charton E, Anota A, Lhomme F, Manson G, De Guibert S, Daufresne P, Bellec A, Le Bars L, De Barros S, Ysebaert L, Merceur M, Cogné M, Lamy De La Chapelle T, Houot R, Moignet A. Remission after CAR T-cell therapy: Do lymphoma patients recover a normal life? Hemasphere 2024; 8:e72. [PMID: 38803454 PMCID: PMC11129324 DOI: 10.1002/hem3.72] [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: 01/12/2024] [Revised: 03/14/2024] [Accepted: 03/28/2024] [Indexed: 05/29/2024] Open
Abstract
Chimeric antigen receptor T cells (CAR T cells) can induce prolonged remission in a substantial subset of patients with relapse/refractory lymphoma. However, little is known about patients' life after CAR T-cell therapy. We prospectively assessed the multidimensional recovery of lymphoma patients in remission, before leukapheresis, before CAR T-cell infusion, and 3, 6, and 12 months thereafter. Validated tools were used to measure lymphoma-related and global health-related quality of life (HRQoL; Functional Assessment of Cancer Therapy-Lymphoma [FACT-Lym] and EQ-5D-5L), cognitive complaint (FACT-Cognition), fatigue (FACIT-Fatigue subscale), psychological status (Hospital Anxiety and Depression Scale, Post-Traumatic Check List Scale), and sexuality (Relationship and Sexuality Scale). Beyond 12 months of remission, we also surveyed physical, professional, sexual, and general life status. At 3, 6, and 12 months, 53, 35, and 23 patients were evaluable, respectively. Improvement in lymphoma-related HRQoL was clinically relevant at 3, 6, and 12 months with a mean change from baseline of 10.9 (95% confidence interval [CI]: 5.8; 16.1), 12.2 (95% CI: 4.2; 20.1), and 11.72 (95% CI: 2.06; 21.38), respectively. Improvement in global HRQoL, fatigue, and anxiety was clinically relevant, but 20%-40% of patients experienced persistent fatigue, psychological distress, and cognitive complaints over time. Beyond 12 months after CAR T cells, 81.8% of 22 evaluable patients were satisfied with their daily life. Physical activity, professional, sexual, and global well-being had returned to prediagnosis levels in nearly half of the patients. We found an improvement in HRQoL after CAR T-cell therapy including anxiety, depression, sexual satisfaction, and general well-being. However, not all patients recover a "normal life." Further research is needed to determine which patients are at risk of quality-of-life impairment to improve recovery after CAR T-cell infusion.
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Affiliation(s)
- Alya Perthus
- Service d'Hématologie—CHU Pontchaillou, Department of HematologyUniversity Hospital of RennesRennesFrance
| | - Fanny Colin
- Service d'Hématologie—CHU Pontchaillou, Department of HematologyUniversity Hospital of RennesRennesFrance
| | - Emilie Charton
- Human and Social Sciences DepartmentLeon Berard CenterLyonFrance
| | - Amélie Anota
- Human and Social Sciences DepartmentLeon Berard CenterLyonFrance
- Department of Clinical Research and InnovationLeon Berard CenterLyonFrance
| | - Faustine Lhomme
- Service d'Hématologie—CHU Pontchaillou, Department of HematologyUniversity Hospital of RennesRennesFrance
| | - Guillaume Manson
- Service d'Hématologie—CHU Pontchaillou, Department of HematologyUniversity Hospital of RennesRennesFrance
| | - Sophie De Guibert
- Service d'Hématologie—CHU Pontchaillou, Department of HematologyUniversity Hospital of RennesRennesFrance
| | - Pierre Daufresne
- Service d'Hématologie—CHU Pontchaillou, Department of HematologyUniversity Hospital of RennesRennesFrance
| | - Adeline Bellec
- Service d'Hématologie—CHU Pontchaillou, Department of HematologyUniversity Hospital of RennesRennesFrance
| | - Laetitia Le Bars
- Service d'Hématologie—CHU Pontchaillou, Department of HematologyUniversity Hospital of RennesRennesFrance
| | - Sandra De Barros
- Department of HematologyCancer University Institute of Toulouse OncopoleToulouseFrance
| | - Loïc Ysebaert
- Department of HematologyCancer University Institute of Toulouse OncopoleToulouseFrance
| | - Marianne Merceur
- Department of Physical and Rehabilitation MedicineUniversity Hospital of RennesRennesFrance
| | - Mélanie Cogné
- Department of Physical and Rehabilitation MedicineUniversity Hospital of RennesRennesFrance
| | - Thierry Lamy De La Chapelle
- Service d'Hématologie—CHU Pontchaillou, Department of HematologyUniversity Hospital of RennesRennesFrance
- UMR U1236, INSERMUniversity of RennesRennesFrance
| | - Roch Houot
- Service d'Hématologie—CHU Pontchaillou, Department of HematologyUniversity Hospital of RennesRennesFrance
- UMR U1236, INSERMUniversity of RennesRennesFrance
| | - Aline Moignet
- Service d'Hématologie—CHU Pontchaillou, Department of HematologyUniversity Hospital of RennesRennesFrance
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3
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Bromberg JEC, Issa S, van der Holt B, van der Meulen M, Dirven L, Minnema MC, Seute T, Durian M, Cull G, van der Poel MWM, Stevens WBC, Zijlstra JM, Brandsma D, Nijland M, Mason KD, Beeker A, Abrahamse-Testroote MCJ, van den Bent MJ, de Jong D, Doorduijn JK. Survival, neurocognitive function, and health-related quality of life outcomes after rituximab-methotrexate, BCNU, teniposide, and prednisolone for primary CNS lymphoma: Final results of the HOVON 105/ALLG NHL 24 study. Neuro Oncol 2024; 26:724-734. [PMID: 38037691 PMCID: PMC10995504 DOI: 10.1093/neuonc/noad224] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Studies on the efficacy of rituximab in primary CNS lymphoma (PCNSL) reported conflicting results. Our international randomized phase 3 study showed that the addition of rituximab to high-dose methotrexate, BCNU, teniposide, and prednisolone (MBVP) in PCNSL was not efficacious in the short term. Here we present long-term results after a median follow-up of 82.3 months. METHODS One hundred and ninety-nine eligible newly diagnosed, nonimmunocompromised patients with PCNSL aged 18-70 years with WHO performance status 0-3 was randomized between treatment with MBVP chemotherapy with or without rituximab, followed by high-dose cytarabine consolidation in responding patients, and reduced-dose WBRT in patients aged ≤ 60 years. Event-free survival was the primary endpoint. Overall survival rate, neurocognitive functioning (NCF), and health-related quality of life (HRQoL) were additionally assessed, with the IPCG test battery, EORTC QLQ-C30 and QLQ-BN20 questionnaires, respectively. RESULTS For event-free survival, the hazard ratio was 0.85, 95% CI 0.61-1.18, P = .33. Overall survival rate at 5 years for MBVP and R-MBVP was 49% (39-59) and 53% (43-63) respectively. In total, 64 patients died in the MBVP arm and 55 in the R-MBVP arm, of which 69% were due to PCNSL. At the group level, all domains of NCF and HRQoL improved to a clinically relevant extent after treatment initiation, and remained stable thereafter up to 60 months of follow-up, except for motor speed which deteriorated between 24 and 60 months. Although fatigue improved initially, high levels persisted in the long term. CONCLUSIONS Long-term follow-up confirms the lack of added value of rituximab in addition to MBVP and HD-cytarabine for PCNSL.
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Affiliation(s)
- Jacoline E C Bromberg
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Samar Issa
- Department of Hematology, Middlemore Hospital, Auckland, New Zealand
| | - Bronno van der Holt
- HOVON Foundation, Rotterdam, The Netherlands
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Monique C Minnema
- Department of Hematology, University Medical Center Utrecht, The Netherlands
| | - Tatjana Seute
- Department of Neurology, University Medical Center, Utrecht, The Netherlands
| | - Marc Durian
- Department of Hematology, ETZ Hospital, Tilburg, The Netherlands
| | - Gavin Cull
- Sir Charles Gairdner Hospital and PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
- Department of Hematology, University of Western Australia, Crawley, Western Australia, Australia
| | - Marjolein W M van der Poel
- Department of Internal Medicine, Division of Hematology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Wendy B C Stevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Josee M Zijlstra
- Department of Hematology, Amsterdam UMC, VUMC, Amsterdam, The Netherlands
| | - Dieta Brandsma
- Department of Neuro-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marcel Nijland
- Department of Hematology, UMCG, Groningen, The Netherlands
| | - Kylie D Mason
- Department of Hematology, Royal Melbourne Hospital, Melbourne, Australia
| | - Aart Beeker
- Department of Hematology, Spaarne Gasthuis, Haarlem, The Netherlands
| | | | - Martin J van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Daphne de Jong
- Department of Pathology and HOVON Pathology, Facility and Biobank, Amsterdam UMC, VUMC, Amsterdam, The Netherlands
| | - Jeanette K Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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4
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Yang YP, Pan SJ, Qiu SL, Tung TH. Effects of physical exercise on the quality-of-life of patients with haematological malignancies and thrombocytopenia: A systematic review and meta-analysis. World J Clin Cases 2022; 10:3143-3155. [PMID: 35647113 PMCID: PMC9082692 DOI: 10.12998/wjcc.v10.i10.3143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/02/2021] [Accepted: 01/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Annually, there are an estimated 1187000 new patients worldwide diagnosed with haematological malignancies. Effective strategies are needed to alleviate side effects and prevent the physical and psychosocial degeneration of patients in active treatment for haematological malignancies.
AIM To explore the effects of physical exercise on quality of life (QoL) of patients with haematological malignancies and thrombocytopenia.
METHODS Cochrane Library, PubMed and Embase were searched for all relevant articles reporting randomized controlled trials (RCTs) that were published up to 31 July 2021. Two authors independently selected articles in accordance with the inclusion criteria, evaluated their quality, and collected information. Any controversy was resolved through discussion with a third senior author. The PRISMA 2009 checklist was followed.
RESULTS Seven RCTs were selected in the systematic review and three were included in the final meta-analysis. There were significant differences in QoL between physical exercise groups [mean score difference = 8.81; 95% confidence interval (CI): 1.81-15.81, P = 0.01], especially in emotional functioning (mean score difference = 12.34; 95%CI: 4.64-20.04, P = 0.002) and pain (mean score difference = –12.77; 95%CI: -3.91 to -21.63, P = 0.005).
CONCLUSION Physical exercise has clinical effects on QoL and improves emotional function and pain indices of patients with haematological malignancies and thrombocytopenia.
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Affiliation(s)
- Yu-Pei Yang
- Department of Hematology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Shuang-Jun Pan
- Department of Neurosurgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Shu-Lin Qiu
- Institute for Hospital Management, Tsing Hua University, Shenzhen 518055, Guangdong Province, China
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
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5
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Ekels A, van de Poll-Franse LV, Posthuma EFM, Kieffer J, Issa DE, Koster A, Nijziel MR, Pruijt JHFM, Stevens WBC, Tick LW, Oerlemans S. Persistent symptoms of fatigue, neuropathy and role-functioning impairment among indolent non-Hodgkin lymphoma survivors: A longitudinal PROFILES registry study. Br J Haematol 2022; 197:590-601. [PMID: 35365860 DOI: 10.1111/bjh.18139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 11/27/2022]
Abstract
Little is known about the long-term health-related quality of life (HRQoL) and persistence of symptoms among patients with indolent non-Hodgkin lymphoma (iNHL). This large population-based longitudinal study therefore investigated the long-term HRQoL and persistence of symptoms and identified associated sociodemographic, clinical and psychological factors. Patients diagnosed between 1999 and 2014 and four or more months after diagnosis were invited to participate in a longitudinal survey. Sociodemographic and clinical data were obtained from the Netherlands Cancer Registry. The EORTC QLQ-C30 and CLL-16 were completed by 669 patients (74% response rate). Patients completed on average four questionnaires. Primary treatment was active surveillance (52%), systemic therapy (31%) or radiotherapy (13%). Respectively, 36% reported persistent fatigue, 33% persistent neuropathy and 25% persistent role-functioning impairment. This was 2-3 times higher than in the age- and sex-matched normative population. Up to 10 years after diagnosis, scores remained relatively stable without clinically relevant changes. Comorbidities, psychological distress, shorter time since diagnosis, systemic therapy, younger age, education level and having no partner were associated with worse outcomes (all ps < 0.05). Up to a third of patients with iNHL experience long-term persistent symptoms which do not improve over time. Early recognition of symptoms will help in providing tailored supportive care for those in need.
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Affiliation(s)
- Afke Ekels
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | | | - Jacobien Kieffer
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Djamila E Issa
- Department of Internal Medicine, Jeroen Bosch Hospital, s-Hertogenbosch, The Netherlands
| | - Adrianus Koster
- Department of Internal Medicine, VieCuri Medical Centre, Venlo and Venray, The Netherlands
| | - Marten R Nijziel
- Department of Hemato-Oncology, Catharina Cancer Institute, Catharina Hospital, Eindhoven, The Netherlands
| | - Johannes H F M Pruijt
- Department of Internal Medicine, Jeroen Bosch Hospital, s-Hertogenbosch, The Netherlands
| | - Wendy B C Stevens
- Department of Haematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lidwine W Tick
- Department of Internal Medicine, Máxima Medical Centre, Eindhoven, The Netherlands
| | - Simone Oerlemans
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
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6
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Paunescu AC, Copie CB, Malak S, Gouill SL, Ribrag V, Bouabdallah K, Sibon D, Rumpold G, Preau M, Mounier N, Haioun C, Jardin F, Besson C. Quality of life of survivors 1 year after the diagnosis of diffuse large B-cell lymphoma: a LYSA study. Ann Hematol 2022; 101:317-332. [PMID: 34617134 PMCID: PMC8494456 DOI: 10.1007/s00277-021-04689-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/28/2021] [Indexed: 12/20/2022]
Abstract
Health-related quality of life (HRQoL) is a multidimensional concept including physical, emotional, social, and cognitive functions, disease symptoms, and side effects of treatment. Differences in HRQoL due to gender, existence of comorbidities, and number of chemotherapy cycles are little explored in diffuse large B-cell lymphoma (DLBCL) survivors. Our objective was to investigate whether differences in HRQoL in function of these factors exist 1 year after the diagnosis of DLBCL. One hundred and one patients, enrolled in the RT3 (Real-Time Tailored Therapy) Study, answered self-administrated European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), EORTC High-Grade Non-Hodgkin Lymphoma (NHL-HG29), Hospital Anxiety and Depression Scale (HADS), Post Traumatic Growth Inventory (PTGI), and Multidimensional Fatigue Inventory (MFI) questionnaires. Adjusted means of scores were calculated in multivariate linear regression models. Fifty-seven survivors (mean age of 58.5 years) answered all questionnaires. Women have significantly higher scores of posttraumatic growth and lower physical functioning than men (P < 0.04). Survivors with comorbidities have increased physical fatigue and symptom burden, increased emotional impact, mental fatigue and depression, and reduced physical functioning and global health status (all P < 0.05). A greater number of cycles of chemotherapy increase the level of symptoms (pain, neuropathy, and dyspnoea; P < 0.05). The various aspects related to HRQoL should be discussed with DLBCL patients and investigated, with the aim of developing strategies to ensure appropriate psychosocial and supportive care and to improve the HRQoL in these patients.
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Affiliation(s)
| | | | | | - Steven Le Gouill
- Service d’hématologie clinique du CHU de Nantes, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, Nantes, France
| | - Vincent Ribrag
- DITEP and Hematology department, Gustave Roussy, Villejuif, France
| | - Krimo Bouabdallah
- Department Hematology, University Hospital of Bordeaux, Pessac, France
- Hôpitaux de Bordeaux CHU, Bordeaux, France
| | - David Sibon
- INSERM UMR 1163 & CNRS URL 8254, Hematology Department, Necker University Hospital, APHP, Paris, France
| | - Gerhard Rumpold
- Department of Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Marie Preau
- UR GRePS, Université Lumière Lyon 2, Institut de Psychologie, Bron, France
| | - Nicolas Mounier
- Department of Onco-Hematology, Archet Hospital, Nice, France
| | - Corinne Haioun
- Lymphoid Malignancies Unit, Henri Mondor University Hospital, AP-HP, UPEC, Creteil, France
| | - Fabrice Jardin
- Department of Hematology, Centre Henri Becquerel, Rouen, France
| | - Caroline Besson
- Inserm CESP U1018, Gustave Roussy, 114 Rue Édouard Vaillant, 94805 Villejuif, France
- Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay, 177 Rue de Versailles, 78157 Versailles, France
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7
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LeBlanc MR, Zimmerman S, LeBlanc TW, Bryant AL, Hudson K, Smith SK. Persistent fatigue among long-term non-Hodgkin lymphoma survivors. Leuk Lymphoma 2022; 63:344-352. [PMID: 34612771 PMCID: PMC9049187 DOI: 10.1080/10428194.2021.1984450] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study describes the prevalence and persistence of fatigue among a cohort of long-term non-Hodgkin lymphoma (NHL) survivors. Mailed surveys assessed quality-of-life including fatigue (SF-36) at baseline and five years. Logistic regression was used to identify factors associated with prevalence of fatigue at baseline and persistence of fatigue across timepoints. More than one-quarter (27.7%) of the 555 NHL survivors reported clinically meaningful fatigue at baseline and 18.7% reported persistent fatigue at five years. One-third (34.4%) reported clinically meaningful worsening of fatigue over time. Independent associations with persistent fatigue included female gender, less education, past chemotherapy, increased comorbidities, and posttraumatic stress symptoms (P <.05). Our findings suggest that one in three NHL survivors experience clinically meaningful fatigue long after their diagnosis and initial treatment. Furthermore, we found that fatigue worsens or persists for many, highlighting the need for vigilance in assessing and treating fatigue in this population.
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Affiliation(s)
- Matthew R. LeBlanc
- University of North Carolina Lineberger Cancer Center, Chapel Hill, NC, USA
| | - Sheryl Zimmerman
- Cecil. G. Sheps Center for Health Services Research and University of North Carolina at Chapel Hill Schools of Social Work and Public Health, Chapel Hill, NC USA
| | | | - Ashley Leak Bryant
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC USA
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8
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Nerich V, Guyeux C, Henry-Amar M, Couturier R, Thieblemont C, Ribrag V, Tilly H, Haioun C, Casasnovas RO, Morschhauser F, Feugier P, Sibon D, Ysebaert L, Nicolas-Virelizier E, Broussais-Guillaumot F, Damaj GL, Jais JP, Salles G, Woronoff-Lemsi M, Mounier N. Economic burden in non-Hodgkin lymphoma survivors: The French Lymphoma Study Association SIMONAL cross-sectional study. Cancer 2021; 128:519-528. [PMID: 34605020 DOI: 10.1002/cncr.33938] [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] [Received: 06/08/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND No study has focused on the economic burden in non-Hodgkin lymphoma (NHL) survivors, even though this knowledge is essential. This study reports on health care resource use and associated health care costs as well as related factors in a series of 1671 French long-term NHL survivors. METHODS Health care costs were measured from the payer perspective. Only direct medical costs (medical consultations, outpatient treatments, hospitalizations, and medical transport) in the past 12 months were included (reference year 2015). Multiple linear regression was used to search for explanatory factors of health care costs. RESULTS In total, 1100 survivors (66%) reported having used at least 1 health care resource, and 867 (52%) reported having used at least 1 outpatient treatment. After the authors accounted for missing data, the mean health care cost was estimated at €702 ± €2221. Hospitalizations and outpatient treatments were the main cost drivers. Sensitivity analyses confirmed the robustness of the results. For the 1100 survivors who reported using at least 1 health care resource, the mean health care cost was €1067 ± €2268. Several factors demonstrated statistically significant relationships with health care costs. For instance, cardiovascular disorders increased costs by 66% ± 16%. In contrast, rituximab or autologous stem cell transplantation as initial therapy had no effect on health care costs. CONCLUSIONS The consideration of economic constraints in health care is now a reality. This retrospective study reports on a better understanding of health care resource use and associated health care costs as well as related factors. It may help health care professionals in their ongoing efforts to design person-centered health care pathways.
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Affiliation(s)
- Virginie Nerich
- Department of Pharmacy, University Hospital, Besançon, France.,INSERM, EFS-BFC, UMR1098, University of Franche-Comté, Besançon, France
| | - Christophe Guyeux
- Femto-ST Institute, UMR 6174 CNRS, University of Bourgogne Franche-Comté, Besançon, France
| | - Michel Henry-Amar
- French Center on eHealth, North-West Region Data Processing Center and French National League Against Cancer Clinical Research Platform, CCC François Baclesse, Caen, France
| | - Raphaël Couturier
- Femto-ST Institute, UMR 6174 CNRS, University of Bourgogne Franche-Comté, Besançon, France
| | - Catherine Thieblemont
- Hemato-Oncology Unit, Saint-Louis University Hospital Center, Public Hospital Network of Paris, Paris, France
| | - Vincent Ribrag
- Hematology Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Hervé Tilly
- Hematology Department and French Institute of Health and Medical Research Unit 1243, Henri Becquerel Center, Rouen, France
| | - Corinne Haioun
- Lymphoid Malignancies Unit, Henri Mondor University Hospital Center, Public Hospital Network of Paris, Créteil, France
| | - René-Olivier Casasnovas
- Hematology Unit and French Institute of Health and Medical Research Unit 1231, Bocage Hospital, Dijon Bourgogne Regional University Hospital Center, Dijon, France
| | - Franck Morschhauser
- Hematology Transfusion Institute, Claude Huriez Hospital, Lille Regional University Hospital Center, Lille, France
| | - Pierre Feugier
- Hematology Unit, Brabois Hospital, Nancy University Hospital Center, Vandoeuvre-lès-Nancy, France
| | - David Sibon
- Hematology Unit, Necker University Hospital for Sick Children, Public Hospital Network of Paris, Paris, France
| | - Loic Ysebaert
- Oncopole, Toulouse University Cancer Institute, Toulouse, France
| | | | | | - Gandhi L Damaj
- Basse-Normandy Hematology Institute, Côte de Nacre Regional University Hospital Center, Caen, France
| | - Jean-Philippe Jais
- Laboratory of Biostatistics, Paris V University-Descartes, Paris, France
| | - Gilles Salles
- Faculty of Medicine, Claude Bernard University, Lyon, France.,Hematology Department, Lyon South Hospital Center, Pierre-Bénite, France
| | - Macha Woronoff-Lemsi
- INSERM, EFS-BFC, UMR1098, University of Franche-Comté, Besançon, France.,Department of Clinical Research and Innovation, University Hospital, Besançon, France
| | - Nicolas Mounier
- Onco-Hematology Unit, l'Archet Hospital, Nice University Hospital Center, University of Côte d'Azur, Nice, France
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9
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Light Therapy for Cancer-Related Fatigue in (Non-)Hodgkin Lymphoma Survivors: Results of a Randomized Controlled Trial. Cancers (Basel) 2021; 13:cancers13194948. [PMID: 34638428 PMCID: PMC8508131 DOI: 10.3390/cancers13194948] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Cancer-related fatigue (CRF) is one of the most frequently reported symptoms with prevalence rates of 25 to 60 percent in (non-)Hodgkin lymphoma survivors. Several (pilot) studies showed promising effects of light therapy to reduce CRF. The aim of the current study is to evaluate the short- and long-term efficacy of light therapy on CRF and associated symptoms in chronically fatigued (non-)Hodgkin lymphoma survivors. Eighty-three survivors were exposed to bright white light (intervention) and another 83 survivors were exposed to dim white light (comparison). Results showed that all participants, irrespective of light condition, reported reduced levels of fatigue after the completion of light therapy. Similar results were found for depression, sleep quality, and some aspects of quality of life. No effect was found on circadian rhythms or objectively assessed sleep. Therefore, it is important to further investigate which aspects of intervention are associated with the improvements observed after light therapy. Abstract Purpose: To evaluate the short- and long-term effects of light therapy on fatigue (primary outcome) and sleep quality, depression, anxiety, quality of life, and circadian rhythms (secondary outcomes) in survivors of (non-)Hodgkin lymphoma presenting with chronic cancer-related fatigue. Methods: We randomly assigned 166 survivors (mean survival 13 years) to a bright white light intervention (BWL) or dim white light comparison (DWL) group. Measurements were completed at baseline (T0), post-intervention (T1), at three (T2), and nine (T3) months follow-up. A mixed-effect modeling approach was used to compare linear and non-linear effects of time between groups. Results: There were no significant differences between BWL and DWL in the reduction in fatigue over time. Both BWL and DWL significantly (p < 0.001) improved fatigue levels during the intervention followed by a slight reduction in this effect during follow-up (EST0-T1 = −0.71; EST1-T3 = 0.15). Similar results were found for depression, sleep quality, and some aspects of quality of life. Light therapy had no effect on circadian rhythms. Conclusions: BWL was not superior in reducing fatigue compared to DWL in HL and DLBCL survivors. Remarkably, the total sample showed clinically relevant and persistent improvements on fatigue not commonly seen in longitudinal observational studies in these survivors.
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10
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Li YF, Liu DQ, Nie JY, Chen DD, Yan M, Zuo Z, Liu LX, Wang WY, Zhu MS, Li WH. ATAS Acupuncture Reduces Chemotherapy Induced Fatigue in Breast Cancer Through Regulating ADROA1 Expression: A Randomized Sham-Controlled Pilot Trial. Onco Targets Ther 2020; 13:11743-11754. [PMID: 33244238 PMCID: PMC7683828 DOI: 10.2147/ott.s272747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/22/2020] [Indexed: 12/21/2022] Open
Abstract
Objective To investigate the feasibility and effectiveness of ATAS acupuncture (Acupoints-Time-Space Acupuncture) as a non-pharmacological intervention to prevent or relieve chemotherapy-induced fatigue in breast cancer patients undergoing taxane chemotherapy. Methods A pilot study in Kunming center with the aim of evaluating 40 patients randomized to 3 groups: ATAS, sham and non-acupuncture with an unequal randomization of 2:1:1. Participants with stage I–III breast cancer were scheduled to receive adjuvant EC4P4 chemotherapy. Participants in the ATAS and sham acupuncture arms received 20 sessions of acupuncture over 20 weeks, non-acupuncture arm received usual care. Evaluation scales, including VAS-F, MFI-20, HDAS, ISI, and blood samples were collected at four timepoints (T1-T4). mRNA sequencing was performed to detect the mechanism of acupuncture. Results A total of 581 sessions of acupuncture were performed on patients in the acupuncture group. There was no difference between the three groups in terms of clinical characteristics. Patients randomized to ATAS acupuncture had improved symptoms including fatigue, anxiety and insomnia during the whole process of chemotherapy compared with the other two groups. The VAS-F score of ATAS acupuncture group was decreased compared with non-acupuncture group (P=0.004). The score of MFI-20 in ATAS acupuncture group was kept at low level, while the other two groups’ scores kept climbing during chemotherapy (P=0.016; P=0.028, respectively). The mechanism of ATAS acupuncture which reduced fatigue and depression may be related to ADROA1, by regulating cGMP/PKG pathway. Conclusion This pilot study has demonstrated that ATAS acupuncture can significantly reduce fatigue induced by chemotherapy. Trial Registration Chinese Clinical Trials Registry, ChiCTR-IPR-17,013,652, registered Dec 3, 2017. http://www.chictr.org.cn/. Protocol Version Version 3.2 dated from 2018/04/20.
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Affiliation(s)
- Yun-Fen Li
- The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Hospital, Breast Cancer Surgery Department, Kunming, People's Republic of China
| | - De-Quan Liu
- The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Hospital, Breast Cancer Surgery Department, Kunming, People's Republic of China
| | - Jian-Yun Nie
- The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Hospital, Breast Cancer Surgery Department, Kunming, People's Republic of China
| | - De-Dian Chen
- The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Hospital, Breast Cancer Surgery Department, Kunming, People's Republic of China
| | - Mei Yan
- The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Hospital, Breast Cancer Surgery Department, Kunming, People's Republic of China
| | - Zhen Zuo
- Yunnan University of Traditional Chinese Medicine, College of Acupuncture, Kunming, People's Republic of China
| | - Liang-Xian Liu
- Kunming Hospital of Traditional Chinese Medicine/The Third Affiliated Hospital of Yunnan University Traditional Chinese Medicine, Acupuncture Department, Kunming, People's Republic of China
| | - Wei-Yu Wang
- Servbus Technology (Beijing) Co., Ltd., Technical Service Department, Beijing, People's Republic of China
| | - Mian-Sheng Zhu
- Yunnan University of Traditional Chinese Medicine, College of Acupuncture, Kunming, People's Republic of China.,ARIATAS, Association Pour la Recherche et l'Information de l'Acupuncture Time-Acupoints-Space, College of Acupuncture, Paris, France
| | - Wen-Hui Li
- The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Hospital, Breast Cancer Surgery Department, Kunming, People's Republic of China
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11
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Weide R, Schnell R, Schardt C, Koenigsmann M, Otremba B, Zahn MO, Wierecky J, Braun U, Hensel M, Klausmann M, Fleckenstein D, Ehscheidt P, Feiten S. Health status and infections in patients with symptomatic primary and secondary immunoglobulin G (IgG) deficiencies receiving intravenous IgG replacement. BMC Immunol 2020; 21:39. [PMID: 32600256 PMCID: PMC7325170 DOI: 10.1186/s12865-020-00368-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/17/2020] [Indexed: 11/16/2022] Open
Abstract
Background The effects of intravenous immunoglobulin G replacement on perceived health and infection susceptibility of patients suffering from immunoglobulin G (IgG) deficiencies should be evaluated in a prospective analysis. Methods Patients with symptomatic primary or secondary IgG deficiencies were interviewed prior to the first IgG infusion (t0) and over the course of their treatment (t1 - t6). The respondents rated their current health using a 100 point scale (EQ-5D-5L), ranging from 0 (‘worst imaginable health’) to 100 (‘best imaginable health’). The patients also provided information on the frequency of infections and of infections requiring antibiotics in the past 8 weeks. A healthy control group (CG) without oncologic diseases answered the questions once. Results One hundred six patients with a median age of 65 years (21–85 years) were investigated. The median serum IgG concentration changed from 500 mg/dl (t0) to 772 mg/dl (t6). The mean number of infections and of infections requiring antibiotics decreased during IgG replacement significantly. Current health according to EQ-5D-5L improved from 57 (t0) to 68 (t6), compared to 73 in the CG. Conclusion During the course of IgG replacement patients reported fewer and less severe infections. Their health assessment improved but still was inferior to the healthy CG.
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Affiliation(s)
- Rudolf Weide
- Praxis für Hämatologie und Onkologie Koblenz, Neversstr. 5, 56068, Koblenz, Germany.
| | - Roland Schnell
- pioh - Praxis Internistischer Onkologie und Hämatologie, Frechen, Germany
| | - Christof Schardt
- Onkologische Gemeinschaftspraxis und Tagesklinik, Gelsenkirchen, Germany
| | | | | | | | - Jan Wierecky
- Überörtliche Gemeinschaftspraxis, Dres. Verpoort, Wierecky & Brandl, Schwerpunkt Onkologie & Hämatologie, Hamburg, Germany
| | - Ute Braun
- Gemeinschaftspraxis für Hämatologie und Onkologie, Ludwigshafen, Germany
| | | | | | | | | | - Stefan Feiten
- Institut für Versorgungsforschung in der Onkologie, Koblenz, Germany
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12
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Thieblemont C, Howlett S, Casasnovas RO, Mounier N, Perrot A, Morschhauser F, Fruchart C, Daguindau N, van Eygen K, Obéric L, Bouabdallah R, Pica GM, Nicolas-Virezelier E, Abraham J, Fitoussi O, Snauwaert S, Eisenmann JC, Lionne-Huyghe P, Bron D, Tricot S, Deeren D, Gonzalez H, Costello R, Le Du K, da Silva MG, Grosicki S, Trotman J, Catalano J, Caballero D, Greil R, Cohen AM, Gaulard P, Roulin L, Takeshita K, Casadebaig ML, Tilly H, Coiffier B. Lenalidomide maintenance for diffuse large B-cell lymphoma patients responding to R-CHOP: quality of life, dosing, and safety results from the randomised controlled REMARC study. Br J Haematol 2019; 189:84-96. [PMID: 31702836 PMCID: PMC7154674 DOI: 10.1111/bjh.16300] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/13/2019] [Indexed: 12/11/2022]
Abstract
Lenalidomide maintenance therapy prolonged progression‐free survival (PFS) versus placebo in elderly patients with diffuse large B‐cell lymphoma (DLBCL) responding to induction chemotherapy in the phase 3 REMARC study. This subpopulation analysis assessed the impact of lenalidomide maintenance and treatment‐emergent adverse events (TEAEs) on health‐related quality of life (HRQOL). Global health status (GHS), and physical functioning and fatigue subscales were evaluated in patients who completed the European Organisation for Research and Treatment of Cancer quality‐of‐life questionnaire‐C30 v3.0. The impact of TEAEs classified post hoc as subjective (patients can feel) or observable (only measurable by physicians) on dose reductions and discontinuations was assessed. Among 457 patients (lenalidomide, n = 229; placebo, n = 228), mean (standard deviation) GHS was similar between treatment arms [68·2 (20·7) Versus 72·0 (17·8)] at randomisation and remained similar during maintenance. Patients receiving lenalidomide experienced no meaningful changes in GHS, physical functioning, or fatigue. Observable TEAEs were more common (81·1% Versus 66·3%) and more likely to lead to dose reductions, than subjective TEAEs in both arms. PFS was superior in the lenalidomide arm regardless of dose reduction. Lenalidomide maintenance prolonged PFS and did not negatively impact HRQOL in patients with DLBCL despite TEAEs being more common, when compared with placebo.
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Affiliation(s)
| | | | - René-Olivier Casasnovas
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Dijon and INSERM UMR1231, Dijon, France
| | - Nicolas Mounier
- Hématologie, Centre Hospitalier Universitaire de Nice - Hôpital de l'Archet, Nice, France
| | - Aurore Perrot
- Service d'Hématologie, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Franck Morschhauser
- Institute of Hematology-Transfusion, Centre Hospitalier Universitaire Régional de Lille, Lille, France
| | - Christophe Fruchart
- Service d'Hématologie, Institut d'Hématologie de Basse-Normandie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Nicolas Daguindau
- Service d'Hématologie Clinique, Centre Hospitalier Annecy Genevois, Annecy, France
| | - Koen van Eygen
- Oncologisch Centrum, AZ Groeninge Hospital, Kortrijk, Belgium
| | - Lucie Obéric
- Hôpital de Purpan, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Reda Bouabdallah
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | | | | | - Julie Abraham
- Centre Hospitalier Universitaire Dupuytren, Limoges, France
| | - Olivier Fitoussi
- Hematology/Oncology, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | | | | | | | | | - Sabine Tricot
- Centre Hospitalier de Valenciennes, Valenciennes, France
| | | | | | | | | | | | | | - Judith Trotman
- Concord Repatriation General Hospital, University of Sydney, Concord, NSW, Australia
| | - John Catalano
- Frankston Hospital and Monash University, Frankston, Vic., Australia
| | | | - Richard Greil
- Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute, Salzburg, Austria
| | - Amos M Cohen
- Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | | | - Louise Roulin
- Lymphoid Malignancies Unit, AP-HP, Groupe Hospitalier Mondor, Créteil, France
| | | | | | - Hervé Tilly
- Department of Hematology, Centre Henri Becquerel, UNIROUEN, INSERMU1245, Rouen, France
| | - Bertrand Coiffier
- Department of Hematology, INSERM U1052 Hospices Civils de Lyon, Pierre-Bénite, France
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