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Riasi F, Ataei Azimi S, Allahyari A, Moeini Nodeh M, Shakeri MT, Kamandi M. Prognosis and complete remission rate of diffuse large B-cell lymphoma patients in standard R-CHOP with reduction of vincristine: A retrospective study. Health Sci Rep 2023; 6:e1716. [PMID: 38033714 PMCID: PMC10684988 DOI: 10.1002/hsr2.1716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/02/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Background and Aims The effect of stopping or reducing the dose of vincristine in diffuse large B-cell lymphoma (DLBCL) on the outcome and prognosis of the disease is still in doubt. The present study aimed to investigate and compare the prognosis and complete remission of two R-CHOP treatment regimens with and without vincristine reduction in DLBCL patients. Methods This retrospective study was conducted on newly diagnosed DLBCL patients during 2018-2021. The patients were over 18 years of age, had been histologically confirmed by a pathologist, and were under treatment with R-CHOP regimen. The clinical information of the subjects as well as the number of treatment courses were extracted from their medical records and then compared. Results Overall, 269 patients with DLBCL were included in this study, 15.99% of whom (n = 43) had vincristine reduction. There was no significant difference between the studied factors regarding the reduction of vincristine and the complete R-CHOP regimen (p > 0.05). Besides, no difference was observed in the 1-year overall survival (OS) and progression-free survival (PFS) of the patients in the two groups treated with R-CHOP regimen with and without vincristine reduction (p > 0.05). The complete remission rates of the patients treated with R-CHOP regimen with and without vincristine (p > 0.05) were not different either. The results of the Cox multivariate regression showed that reducing the dose of vincristine from the R-CHOP treatment regimen had no relationship with the 1-year OS and PFS of the DLBCL patients (hazard ratio [HR]OS = 1.59, 95% confidence interval [CI]: 3.67-0.690, HRPFS = 1.67, 95% CI: 0.798-3.82). Conclusion The results of this study showed that the reduction of vincristine from the R-CHOP regimen in the DLBCL patients was not likely to make a difference in the 1-year OS and PFS of the patients. However, further studies are needed on the issue.
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Affiliation(s)
- Fatemeh Riasi
- Department of Internal Medicine, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Sajjad Ataei Azimi
- Department of Internal Medicine, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | | | - Mohammad Moeini Nodeh
- Department of Internal Medicine, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Mohammad T. Shakeri
- Department of Biostatistics, School of HealthMashhad University of Medical SciencesMashhadIran
| | - Mostafa Kamandi
- Department of Internal Medicine, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
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Bewarder M, Kaddu-Mulindwa D, Kos IA, Lesan V, Held G, Poeschel V, Thurner L, Bittenbring JT, Schmitz N, Truemper L, Pfreundschuh M, Christofyllakis K, Loeffler M, Altmann B, Ziepert M. Impact of vincristine dose reduction on outcomes of patients with aggressive B-cell lymphoma treated with (R)-CHOP. Haematologica 2023; 108:2844-2849. [PMID: 36815369 PMCID: PMC10543194 DOI: 10.3324/haematol.2022.282126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 02/15/2023] [Indexed: 02/24/2023] Open
Affiliation(s)
- Moritz Bewarder
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical Center, Homburg/Saar.
| | - Dominic Kaddu-Mulindwa
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical Center, Homburg/Saar
| | - Igor Age Kos
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical Center, Homburg/Saar
| | - Vadim Lesan
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical Center, Homburg/Saar
| | - Gerhard Held
- Department of Internal Medicine 1, Westpfalz-Klinikum, Kaiserslautern
| | - Viola Poeschel
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical Center, Homburg/Saar
| | - Lorenz Thurner
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical Center, Homburg/Saar
| | - Joerg Thomas Bittenbring
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical Center, Homburg/Saar
| | - Norbert Schmitz
- Department of Medicine A, University Hospital Muenster, Muenster
| | - Lorenz Truemper
- Department of Hematology and Oncology, Georg August University of Goettingen, Goettingen
| | - Michael Pfreundschuh
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical Center, Homburg/Saar
| | - Konstantinos Christofyllakis
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical Center, Homburg/Saar
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Leipzig
| | - Bettina Altmann
- Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Leipzig
| | - Marita Ziepert
- Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Leipzig
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Foda AAM, Atia T, Sakr HI, Abd Elaziz Ahmed Elnaghi K, Abdelhay WM, Enan ET. Clinicopathological Characteristics and Prognosis of Diffuse Large B-Cell Lymphoma in Relation to CA-125 and CA 19-9 Expression. J Evid Based Integr Med 2023; 28:2515690X231198315. [PMID: 37654084 PMCID: PMC10475264 DOI: 10.1177/2515690x231198315] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/26/2023] [Accepted: 08/02/2023] [Indexed: 09/02/2023] Open
Abstract
Background: Some epithelial tumors express the carbohydrate antigen 125 (Cancer antigen-125, CA-125) and CA 19-9, especially ovarian and pancreatic tumors. Patients with non-Hodgkin lymphoma (NHL) were reported to have a close association between serum CA-125 levels and adverse prognostic factors with worse survival. We aimed to investigate CA-125 and 19-9 expression in nodal diffuse large B-cell lymphoma, not otherwise specified (DLBCL NOS) tissues using immunohistochemistry (IHC) and their relations to clinicopathological manifestations and patients' survival. Methods: 65 cases of DLBCL NOS were examined. A modified mechanical pencil tip was used to construct Manual Tissue Micro-array (TMA) blocks. Immunohistochemical staining for CA-125 and CA 19-9 was performed and scored semi-quantitatively. All relations were analyzed using established statistical methodologies. Results: Aberrant expression of CA 19-9 was detected in 12% of cases without any expression of CA-125. Moreover, 75% of the CA 19-9 positive cases were statistically significantly associated with anemia and performance status 1. Also, 75% of the CA 19-9 positive cases were females. Conclusions: CA 19-9 was aberrantly expressed in 12% of nodal DLBCL NOS cases and significantly related to anaemia and performance status but not to survival. In cases of DLBCL NOS, CA 19-9 expression cannot be considered an independent prognostic factor. CA-125 was not expressed in nodal DLBCL NOS tissues, necessitating re-evaluation studies. Therefore, it is advised to conduct more research to clarify the potential correlation between serum and tissue CA 19-9 levels and other clinic-pathological characteristics of nodal and extranodal DLBCL NOS patients.
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Affiliation(s)
- Abd AlRahman Mohammad Foda
- Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Pathology Department, General Medicine Practice, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Tarek Atia
- Department of Histology and Cytology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Hader I. Sakr
- Department of Medical Physiology, Faculty of Medicine, Cairo University, Cairo, Egypt
- Department of Medical Physiology, Medicine Program, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Khaled Abd Elaziz Ahmed Elnaghi
- Oncology Centre, Medical Oncology unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Medical Oncology Unit, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Wagih M. Abdelhay
- Department of Histology and Cytology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Eman T. Enan
- Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Falgàs A, Garcia-León A, Núñez Y, Serna N, Sánchez-Garcia L, Unzueta U, Voltà-Durán E, Aragó M, Álamo P, Alba-Castellón L, Sierra J, Gallardo A, Villaverde A, Vázquez E, Mangues R, Casanova I. A diphtheria toxin-based nanoparticle achieves specific cytotoxic effect on CXCR4 + lymphoma cells without toxicity in immunocompromised and immunocompetent mice. Biomed Pharmacother 2022; 150:112940. [PMID: 35421785 DOI: 10.1016/j.biopha.2022.112940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/27/2022] [Accepted: 04/06/2022] [Indexed: 11/02/2022] Open
Abstract
High rates of relapsed and refractory diffuse large B-cell lymphoma (DLBCL) patients and life-threatening side effects associated with immunochemotherapy make an urgent need to develop new therapies for DLBCL patients. Immunotoxins seem very potent anticancer therapies but their use is limited because of their high toxicity. Accordingly, the self-assembling polypeptidic nanoparticle, T22-DITOX-H6, incorporating the diphtheria toxin and targeted to CXCR4 receptor, which is overexpressed in DLBCL cells, could offer a new strategy to selectively eliminate CXCR4+ DLBCL cells without adverse effects. In these terms, our work demonstrated that T22-DITOX-H6 showed high specific cytotoxicity towards CXCR4+ DLBCL cells at the low nanomolar range, which was dependent on caspase-3 cleavage, PARP activation and an increase of cells in early/late apoptosis. Repeated nanoparticle administration induced antineoplastic effect, in vivo and ex vivo, in a disseminated immunocompromised mouse model generated by intravenous injection of human luminescent CXCR4+ DLBCL cells. Moreover, T22-DITOX-H6 inhibited tumor growth in a subcutaneous immunocompetent mouse model bearing mouse CXCR4+ lymphoma cells in the absence of alterations in the hemogram, liver or kidney injury markers or on-target or off-target organ histology. Thus, T22-DITOX-H6 demonstrates a selective cytotoxicity towards CXCR4+ DLBCL cells without the induction of toxicity in non-lymphoma infiltrated organs nor hematologic toxicity.
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Affiliation(s)
- Aïda Falgàs
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain; Josep Carreras Leukaemia Research Institute (IJC), Barcelona 08916, Spain; CIBER de Bioingeniería Biomateriales y Nanomedicina (CIBER-BBN), Madrid 28029, Spain
| | - Annabel Garcia-León
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain; Josep Carreras Leukaemia Research Institute (IJC), Barcelona 08916, Spain
| | - Yáiza Núñez
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain; Josep Carreras Leukaemia Research Institute (IJC), Barcelona 08916, Spain
| | - Naroa Serna
- CIBER de Bioingeniería Biomateriales y Nanomedicina (CIBER-BBN), Madrid 28029, Spain; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona 08193, Spain; Institute of Biotechnology and Biomedicine (IBB), Universitat Autònoma de Barcelona, Barcelona 08193, Spain
| | - Laura Sánchez-Garcia
- CIBER de Bioingeniería Biomateriales y Nanomedicina (CIBER-BBN), Madrid 28029, Spain; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona 08193, Spain; Institute of Biotechnology and Biomedicine (IBB), Universitat Autònoma de Barcelona, Barcelona 08193, Spain
| | - Ugutz Unzueta
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain; Josep Carreras Leukaemia Research Institute (IJC), Barcelona 08916, Spain; CIBER de Bioingeniería Biomateriales y Nanomedicina (CIBER-BBN), Madrid 28029, Spain; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona 08193, Spain
| | - Eric Voltà-Durán
- CIBER de Bioingeniería Biomateriales y Nanomedicina (CIBER-BBN), Madrid 28029, Spain; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona 08193, Spain; Institute of Biotechnology and Biomedicine (IBB), Universitat Autònoma de Barcelona, Barcelona 08193, Spain
| | - Marc Aragó
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain
| | - Patricia Álamo
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain; Josep Carreras Leukaemia Research Institute (IJC), Barcelona 08916, Spain; CIBER de Bioingeniería Biomateriales y Nanomedicina (CIBER-BBN), Madrid 28029, Spain
| | - Lorena Alba-Castellón
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain; Josep Carreras Leukaemia Research Institute (IJC), Barcelona 08916, Spain
| | - Jorge Sierra
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain; Josep Carreras Leukaemia Research Institute (IJC), Barcelona 08916, Spain; Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain.
| | - Alberto Gallardo
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain
| | - Antonio Villaverde
- CIBER de Bioingeniería Biomateriales y Nanomedicina (CIBER-BBN), Madrid 28029, Spain; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona 08193, Spain; Institute of Biotechnology and Biomedicine (IBB), Universitat Autònoma de Barcelona, Barcelona 08193, Spain
| | - Esther Vázquez
- CIBER de Bioingeniería Biomateriales y Nanomedicina (CIBER-BBN), Madrid 28029, Spain; Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona 08193, Spain; Institute of Biotechnology and Biomedicine (IBB), Universitat Autònoma de Barcelona, Barcelona 08193, Spain.
| | - Ramon Mangues
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain; Josep Carreras Leukaemia Research Institute (IJC), Barcelona 08916, Spain; CIBER de Bioingeniería Biomateriales y Nanomedicina (CIBER-BBN), Madrid 28029, Spain.
| | - Isolda Casanova
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain; Josep Carreras Leukaemia Research Institute (IJC), Barcelona 08916, Spain; CIBER de Bioingeniería Biomateriales y Nanomedicina (CIBER-BBN), Madrid 28029, Spain
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5
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Miura K, Takahashi H, Nakagawa M, Hamada T, Uchino Y, Iizuka K, Ohtake S, Iriyama N, Hatta Y, Nakamura H. Ideal dose intensity of R-CHOP in diffuse large B-cell lymphoma. Expert Rev Anticancer Ther 2022; 22:583-595. [PMID: 35472312 DOI: 10.1080/14737140.2022.2071262] [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: 11/04/2022]
Abstract
INTRODUCTION The standard of care for diffuse large B-cell lymphoma (DLBCL) is rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). However, its ideal dose intensity varies among cases. AREAS COVERED This review provides the latest insights on the dose intensity of R-CHOP for DLBCL patients. Specifically, we discussed the optimal dose intensity for elderly patients, the optimal number of treatment cycles for limited or advanced-stage diseases, and the role of dose-intensified therapies or adding targeted inhibitors. EXPERT OPINION Performing a comprehensive or simplified geriatric assessment can distinguish elderly DLBCL patients who will likely benefit from curative R-CHOP. Very elderly or medically unfit patients may need dose reduction in R-CHOP; the Age, Comorbidities, and Albumin index may aid decision-making. Four cycles of R-CHOP followed by two rituximab cycles comprise a new standard for low-risk, limited-stage DLBCL patients. Compared to eight cycles, six cycles of R-CHOP have similar efficacy and fewer toxicities for advanced-stage DLBCL. Dose-intensified therapy is not recommended in most DLBCL cases but may be considered for patients with double (or triple)-hit lymphoma. Applying targeted inhibitors and not merely escalating R-CHOP dose intensity through molecular subtyping will improve the treatment outcome for DLBCL.
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Affiliation(s)
- Katsuhiro Miura
- Tumor Center, Nihon University Itabashi Hospital (Director); 2Department of Hematology and Rheumatology, Nihon University School of Medicine (Associate Professor), Tokyo, Japan.,Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Hiromichi Takahashi
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan.,Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine (Assistant Professor), Tokyo, Japan
| | - Masaru Nakagawa
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan.,Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine (Assistant Professor), Tokyo, Japan
| | - Takashi Hamada
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshihito Uchino
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Kazuhide Iizuka
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan.,Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine (Assistant Professor), Tokyo, Japan
| | - Shimon Ohtake
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Noriyoshi Iriyama
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshihiro Hatta
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Hideki Nakamura
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
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Elshamy AM, Salem OM, Safa MAE, Barhoma RAE, Eltabaa EF, Shalaby AM, Alabiad MA, Arakeeb HM, Mohamed HA. Possible protective effects of CO Q10 against vincristine‐induced peripheral neuropathy: Targeting oxidative stress, inflammation, and sarmoptosis. J Biochem Mol Toxicol 2021; 36:e22976. [DOI: 10.1002/jbt.22976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/02/2021] [Accepted: 12/10/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Amira M. Elshamy
- Department of Medical Biochemistry, Faculty of Medicine Tanta University Tanta Egypt
| | - Ola M. Salem
- Department of Phramacology, Faculty of Medicine Tanta University Tanta Egypt
| | - Mohamed A. E. Safa
- Department of Internal Medicine, Faculty of Medicine Tanta University Tanta Egypt
| | | | - Eman F. Eltabaa
- Department of Physiology, Faculty of Medicine Tanta University Tanta Egypt
| | | | | | - Heba M. Arakeeb
- Department of Anatomy, Faculty of Medicine Tanta University Tanta Egypt
| | - Hoda A. Mohamed
- Department of Medical Biochemistry, Faculty of Medicine Tanta University Tanta Egypt
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Egan-Sherry D, Bhuta R, Cole PD, Gennarini LM, Kahn JM, Sulis ML, DeNardo BD, Welch JJG. Severe Vincristine-related Neurotoxicity in 5 Patients With Pediatric Acute Lymphoblastic Leukemia Requiring Discontinuation of Vincristine: A Description of Long-term Outcome. J Pediatr Hematol Oncol 2021; 43:e997-e999. [PMID: 34001785 DOI: 10.1097/mph.0000000000002114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/14/2021] [Indexed: 11/26/2022]
Abstract
Vincristine, a key agent in the treatment of many pediatric malignancies, causes sensory, motor and autonomic neuropathy. We report the clinical courses of 5 patients who required cessation of vincristine after developing severe neurotoxicity during treatment for acute lymphoblastic leukemia. All 5 patients lost the ability to ambulate and 3 had additional severe neurotoxic side effects including vision loss and vocal cord dysfunction. Although prior literature reports poor outcomes for children in whom vincristine was discontinued during acute lymphoblastic leukemia therapy, all 5 patients described here achieved and have maintained complete continuous remission.
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Affiliation(s)
| | - Roma Bhuta
- Department of Pediatrics, Division of Hematology/Oncology, Brown University and Hasbro Children's Hospital, Providence, RI
| | - Peter D Cole
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Lisa M Gennarini
- Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore, Bronx
| | - Justine M Kahn
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University Irving Medical Center
| | - Maria Luisa Sulis
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bradley D DeNardo
- Department of Pediatrics, Division of Hematology/Oncology, Brown University and Hasbro Children's Hospital, Providence, RI
| | - Jennifer J G Welch
- Department of Pediatrics, Division of Hematology/Oncology, Brown University and Hasbro Children's Hospital, Providence, RI
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Impact of R-CHOP dose intensity on survival outcomes in diffuse large B-cell lymphoma: a systematic review. Blood Adv 2021; 5:2426-2437. [PMID: 33961018 DOI: 10.1182/bloodadvances.2021004665] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/26/2021] [Indexed: 12/20/2022] Open
Abstract
The dilemma of whether to treat elderly patients with diffuse large B-cell lymphoma (DLBCL) with a full or reduced dose intensity (DI) of R-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone+rituximab) is often faced by clinicians. We conducted a systematic review assessing the impact of R-CHOP DI on DLBCL survival outcomes, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols (PRISMA-P) guidelines. We searched MEDLINE, EMBASE, and Cochrane CENTRAL for studies with ≥100 patients treated with R-CHOP/R-CHOP-like therapies published from January 2002 through November 2020. Studies were included if they reported the impact of R-CHOP DI on survival outcomes. We screened records, extracted data, and reviewed all the studies for quality and statistical appraisal. Of 380 screened records, 13 studies including 5188 patients were reviewed. DI was often calculated as the ratio of the cumulative delivered dose of prespecified drug(s) to the cumulative planned dose multiplied by a time-correction factor. Lower DI (intended or relative) was associated with inferior survival in 7 of 9 studies reporting crude survival analyses. Multivariable analysis using DI as a covariate was performed in 10 studies. Six showed an association (P < .05) with adjustment for other covariates, and 4 did not. Most studies and those larger studies of higher quality showed poorer outcomes associated with reduced DI. In subgroups aged ≥80 years, survival was not consistently affected by reduced DI. DI-specific randomized trials are warranted, but these data support full-dose R-CHOP in elderly and fit patients aged <80 years with DLBCL, but not in those aged ≥80 years, where dose-reduced R-CHOP does not appear to compromise survival.
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9
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Vinorelbine as substitute for vincristine in patients with diffuse large B cell lymphoma and vincristine-induced neuropathy. Support Care Cancer 2021; 29:5197-5207. [PMID: 33625586 PMCID: PMC8295169 DOI: 10.1007/s00520-021-06059-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/07/2021] [Indexed: 11/23/2022]
Abstract
Background A combination of rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is the standard first-line therapy for diffuse large B cell lymphoma (DLBCL), the most common aggressive lymphoma in adults. One of the major adverse effects of this regimen is vincristine-induced polyneuropathy which leads to discontinuation of vincristine in up to 30% of DLBCL-patients. Dose reduction of vincristine might worsen treatment outcomes of DLBCL but identification of treatment alternatives for patients exhibiting peripheral neuropathy during R-CHOP is an unmet need in hematology. Methods In this retrospective cohort study, comprising 987 patients with de novo DLBCL, we delineated the role of vinorelbine as a substitute for vincristine in R-CHOP by measuring improvements in neuropathy and outcome variables. Results Five-year overall survival (OS) and progression-free survival (PFS) were 72.6% and 63.1% in patients who received regular doses of vincristine, as compared to 60.6% and 51.7% in patients who received reduced doses of vincristine (p = 0.022 and p = 0.003, respectively). Of 199 patients who switched to vinorelbine, the majority experienced an improvement of neuropathy Furthermore, vinorelbine-switched patients showed favorable oncologic outcomes. Conclusion Replacement of vincristine by vinorelbine due to neuropathy is effective and safe, and results in a significant improvement in neuropathy as compared to treatment with R-CHOP. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06059-2.
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Marshall S, Nishimura N, Inoue N, Yamauchi H, Tsuyama N, Takeuchi K, Mishima Y, Yokoyama M, Ogasawara T, Mori N, Ogawa T, Sakura H, Terui Y. Impact of Omission/Reduction of Vincristine From R-CHOP in Treatment of DLBCL. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:162-169. [PMID: 33483276 DOI: 10.1016/j.clml.2020.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/12/2020] [Accepted: 12/19/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND The R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) is the standard therapy for patients with diffuse large B-cell lymphoma (DLBCL). However, vincristine is sometimes omitted or reduced owing to side effects. MATERIALS AND METHODS We retrospectively reviewed newly diagnosed patients with DLBCL with R-CHOP-like chemotherapy in our institute from January 2005 to February 2018 to investigate whether the omission/reduction of vincristine reduced the efficacy of the treatment. We compared the overall survival (OS) with and without the omission/reduction of vincristine from the R-CHOP regimen. RESULTS A total of 576 cases were reviewed, and vincristine was omitted/reduced in 50 (9%) patients. The 4-year OS with and without vincristine omission/reduction for relative dose intensity < 80%, 50%, and 25% was 70% versus 82% (P = .035), 70% versus 82% (P = .085), and 53% versus 82% (P = .0007). In a multivariate analysis, adjusting for international prognostic index risk factors, a statistically significant, poor OS was indicated in the patients with relative dose intensity < 25%. CONCLUSIONS Excessive dose omission/reduction of vincristine might lead to a substantial loss of efficacy of R-CHOP therapy.
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Affiliation(s)
- Shoko Marshall
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan; Department of Hematology Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Toyo, Japan.
| | - Noriko Nishimura
- Department of Hematology Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Toyo, Japan
| | - Norihito Inoue
- Department of Hematology Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Toyo, Japan; Division of Pathology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Toyo, Japan
| | - Hirofumi Yamauchi
- Department of Hematology Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Toyo, Japan
| | - Naoko Tsuyama
- Division of Pathology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Toyo, Japan
| | - Kengo Takeuchi
- Division of Pathology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Toyo, Japan; Pathology Project for Molecular Targets, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Toyo, Japan
| | - Yuko Mishima
- Department of Hematology Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Toyo, Japan
| | - Masahiro Yokoyama
- Department of Hematology Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Toyo, Japan
| | - Toshie Ogasawara
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Naoki Mori
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Tetsuya Ogawa
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Hiroshi Sakura
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Yasuhito Terui
- Department of Hematology Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Toyo, Japan
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11
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Abdulla M, Hollander P, Pandzic T, Mansouri L, Ednersson SB, Andersson P, Hultdin M, Fors M, Erlanson M, Degerman S, Petersen HM, Asmar F, Grønbæk K, Enblad G, Cavelier L, Rosenquist R, Amini R. Cell-of-origin determined by both gene expression profiling and immunohistochemistry is the strongest predictor of survival in patients with diffuse large B-cell lymphoma. Am J Hematol 2020; 95:57-67. [PMID: 31659781 PMCID: PMC6916573 DOI: 10.1002/ajh.25666] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/18/2019] [Accepted: 10/18/2019] [Indexed: 12/16/2022]
Abstract
The tumor cells in diffuse large B‐cell lymphomas (DLBCL) are considered to originate from germinal center derived B‐cells (GCB) or activated B‐cells (ABC). Gene expression profiling (GEP) is preferably used to determine the cell of origin (COO). However, GEP is not widely applied in clinical practice and consequently, several algorithms based on immunohistochemistry (IHC) have been developed. Our aim was to evaluate the concordance of COO assignment between the Lymph2Cx GEP assay and the IHC‐based Hans algorithm, to decide which model is the best survival predictor. Both GEP and IHC were performed in 359 homogenously treated Swedish and Danish DLBCL patients, in a retrospective multicenter cohort. The overall concordance between GEP and IHC algorithm was 72%; GEP classified 85% of cases assigned as GCB by IHC, as GCB, while 58% classified as non‐GCB by IHC, were categorized as ABC by GEP. There were significant survival differences (overall survival and progression‐free survival) if cases were classified by GEP, whereas if cases were categorized by IHC only progression‐free survival differed significantly. Importantly, patients assigned as non‐GCB/ABC both by IHC and GEP had the worst prognosis, which was also significant in multivariate analyses. Double expression of MYC and BCL2 was more common in ABC cases and was associated with a dismal outcome. In conclusion, to determine COO both by IHC and GEP is the strongest outcome predictor to identify DLBCL patients with the worst outcome.
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Affiliation(s)
- Maysaa Abdulla
- Clinical and Experimental Pathology, Department of Immunology, Genetics and PathologyUppsala University Uppsala Sweden
| | - Peter Hollander
- Clinical and Experimental Pathology, Department of Immunology, Genetics and PathologyUppsala University Uppsala Sweden
| | - Tatjana Pandzic
- Medical Genetics and Genomics, Department of Immunology, Genetics and PathologyUppsala University Uppsala Sweden
| | - Larry Mansouri
- Department of Molecular Medicine and SurgeryKarolinska Institute Stockholm Sweden
| | | | - Per‐Ola Andersson
- Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
- Department of MedicineSödra Älvsborg Hospital Borås Borås Sweden
| | - Magnus Hultdin
- Department of Medical BiosciencesPathology, Umeå University Umeå Sweden
| | - Maja Fors
- Department of Medical BiosciencesPathology, Umeå University Umeå Sweden
| | - Martin Erlanson
- Department of Radiation Sciences, OncologyUmeå University Umeå Sweden
| | - Sofie Degerman
- Department of Medical BiosciencesPathology, Umeå University Umeå Sweden
| | - Helga Munch Petersen
- Department of PathologyCopenhagen University Hospital, Rigshospitalet Copenhagen Denmark
| | - Fazila Asmar
- Department of HematologyCopenhagen University Hospital, Rigshospitalet Copenhagen Denmark
| | - Kirsten Grønbæk
- Department of HematologyCopenhagen University Hospital, Rigshospitalet Copenhagen Denmark
| | - Gunilla Enblad
- Experimental and Clinical Oncology, Department of Immunology, Genetics and PathologyUppsala University Uppsala Sweden
| | - Lucia Cavelier
- Medical Genetics and Genomics, Department of Immunology, Genetics and PathologyUppsala University Uppsala Sweden
| | - Richard Rosenquist
- Department of Molecular Medicine and SurgeryKarolinska Institute Stockholm Sweden
| | - Rose‐Marie Amini
- Clinical and Experimental Pathology, Department of Immunology, Genetics and PathologyUppsala University Uppsala Sweden
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12
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Madsen ML, Due H, Ejskjær N, Jensen P, Madsen J, Dybkær K. Aspects of vincristine-induced neuropathy in hematologic malignancies: a systematic review. Cancer Chemother Pharmacol 2019; 84:471-485. [PMID: 31214762 PMCID: PMC6682573 DOI: 10.1007/s00280-019-03884-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/04/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE Vincristine is widely used as anticancer therapy for a variety of hematological malignancies. The treatment is limited by progressive vincristine-induced neuropathy, possibly including both peripheral sensory and motor nerves, autonomic nervous functions, and the central nervous system. This dose-limiting side-effect can diminish quality of life and, furthermore, cause discontinuation of vincristine treatment. The present review elucidates the current knowledge regarding vincristine-induced neuropathy in hematologic malignancies, focusing on neuropathy assessment, clinical and molecular predictive markers, drug-drug interference, prevention, and treatment. METHODS This review is conducted by a systematic search strategy for the identification of relevant literature in the PubMed and Embase databases. RESULTS No clinical parameters displayed convincing potential as predictors of vincristine-induced neuropathy; however, preexisting neuropathy was consistently reported to be associated with an increased risk of neurotoxicity. In contrast, molecular markers, including polymorphisms in genes involved in the pharmacodynamics and pharmacokinetics of vincristine, displayed great potential as predictive markers of neuropathy incidence and severity. Furthermore, antifungal drugs, such as itraconazole and voriconazole, decrease the metabolism of vincristine and consequently lead to severe neuropathy when co-administered with vincristine, underscoring why fluconazole should be the antifungal drug of choice. CONCLUSION Reports from the 71 included studies clearly emphasize the lack of consistency in neuropathy assessment, grading systems, and reporting, making it difficult to interpret results between studies. Thus, truer clinical and molecular markers could emerge if the consistency of neuropathy detection and reporting increases by the use of conventional standardized neuropathy assessment tools and grading scales.
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Affiliation(s)
- Marie Lindhard Madsen
- Department of Hematology, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - Hanne Due
- Department of Hematology, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - Niels Ejskjær
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark.,Steno Diabetes Center North Denmark, Aalborg University Hospital, 9000, Aalborg, Denmark
| | - Paw Jensen
- Department of Hematology, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark.,Clinical Cancer Research Center, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - Jakob Madsen
- Department of Hematology, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - Karen Dybkær
- Department of Hematology, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark. .,Clinical Cancer Research Center, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark.
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13
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Eyre TA, Martinez-Calle N, Hildyard C, Eyre DW, Plaschkes H, Griffith J, Wolf J, Fields P, Gunawan A, Oliver R, Djebbari F, Booth S, McMillan A, Fox CP, Bishton MJ, Collins GP, Hatton CSR. Impact of intended and relative dose intensity of R-CHOP in a large, consecutive cohort of elderly diffuse large B-cell lymphoma patients treated with curative intent: no difference in cumulative incidence of relapse comparing patients by age. J Intern Med 2019; 285:681-692. [PMID: 30811713 DOI: 10.1111/joim.12889] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The increasing incidence of diffuse large B-cell lymphoma (DLBCL) in ageing populations places a significant burden on healthcare systems. Co-morbidity, frailty, and reduced organ and physiological reserve contribute to treatment-related complications. The optimal dose intensity of R-CHOP to optimize outcome across different ages with variable frailty and comorbidity burden is unclear. OBJECTIVES AND METHODS We examined the influence of intended (IDI) and relative (RDI) dose intensity of the combination of cyclophosphamide and doxorubicin, age and comorbidity on outcomes for DLBCL patients ≥70 years in a representative, consecutive cohort across eight UK centres (2009-2018). We determined predictors of survival using multivariable Cox regression, and predictors of recurrence before death using competing risks regression. RESULTS Porgression-free survival (PFS) and overall survival (OS) were significantly inferior in patients ≥80 vs. 70-79 years (P < 0.001). In contrast, 2-year cumulative relapse incidence, when accounting for non-relapse mortality as a competing risk, was no different between 70-79 vs. ≥80 years (P = 0.27) or comorbidity status (CIRS-G: 0-6 vs. >6) (P = 0.27). In 70-79 years, patients with an IDI ≥80% had a significantly improved PFS and OS (P < 0.001) compared to IDI < 80%. Conversely, in patients ≥80 years, there was no difference in PFS (P = 0.88) or OS (P = 0.75) according to IDI <80% vs. ≥80%. On multivariable analysis, when comparing by age, there was a significantly higher cumulative relapse rate for patients aged 70-79 years with an IDI <80% (vs. >80%) (P = 0.04) but not for patients ≥80 years comparing IDI (P = 0.32). CONCLUSION 'R-mini-CHOP' provides adequate lymphoma-specific disease control and represents a reasonable treatment option in elderly patients ≥80 years aiming for cure.
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Affiliation(s)
- T A Eyre
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - N Martinez-Calle
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C Hildyard
- Department of Haematology, Milton Keynes Hospital, Milton Keynes, UK
| | - D W Eyre
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Big Data Institute, University of Oxford, Oxford, UK
| | - H Plaschkes
- Oxford University Medical School, Oxford, UK
| | - J Griffith
- Department of Haematology, Great Western Hospital, Swindon, UK
| | - J Wolf
- Department of Haematology, Great Western Hospital, Swindon, UK
| | - P Fields
- Department of Haematology, Guys and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - A Gunawan
- Department of Haematology, Guys and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - R Oliver
- Department of Haematology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - F Djebbari
- Department of Cancer Pharmacy, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Booth
- Department of Haematology, Royal Berkshire Hospital NHS Foundation Trust, Reading, UK
| | - A McMillan
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C P Fox
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M J Bishton
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - G P Collins
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C S R Hatton
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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