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Rudreshaa AH, Goyal S, Lokanatha D, Jacob LA, Lokesh KN, Saldanha S, Sansar B, Rajeev LK. Follicular Lymphoma in Young Adults: Study from a Regional Cancer Center in South India. South Asian J Cancer 2021; 10:115-119. [PMID: 34595141 PMCID: PMC8478526 DOI: 10.1055/s-0041-1728226] [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] [Indexed: 11/02/2022] Open
Abstract
Objective Follicular lymphoma (FL) is a disease of the elderly. It is postulated that younger patients have distinct tumor biology and treatment outcomes. Various lymphoma groups across the world have studied this to understand if young adults (YAs) need a different treatment approach. Our study fills the void in data from an Asian country on YA population with FL. Patients and Methods We retrospectively analyzed young patients (age ≤40 years) diagnosed with FL at our center from 2012 to 2018. Their disease characteristics, treatment details, and outcomes were studied to examine any association between various parameters and survival. Results There were 28 young FL patients included in our study that constituted 14.6% of FL cases (males: 53.5% and females: 46.5%). The median age at diagnosis was 36.5 years. Most of the patients presented in an advanced stage, 57% had extranodal involvement, and 39.3% had bone marrow involvement at the time of presentation. The most common chemotherapy regimen used was cyclophosphamide, vincristine, and prednisone. Half of them received chemoimmunotherapy and only 18% continued rituximab as maintenance therapy. The overall response rate was 92.9% ( n = 26), and the remaining two patients had progressive disease while on treatment. The median progression free survival (PFS) was 6.1 years and median overall survival (OS) was not reached. On univariate analysis, extranodal disease was associated with a lower PFS ( p = 0.06) and low hemoglobin showed a significant association with OS ( p = 0.005). On multivariate analysis, none of the factors showed a significant association with survival. Conclusion Most YAs present with advanced disease with a good response to treatment and favorable outcomes.
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Affiliation(s)
- A H Rudreshaa
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Shina Goyal
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - D Lokanatha
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Linu Abraham Jacob
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - K N Lokesh
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Smitha Saldanha
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Bipinesh Sansar
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - L K Rajeev
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
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Robak T, Smolewski P, Robak P, Dreyling M. Mantle cell lymphoma: therapeutic options in transplant-ineligible patients. Leuk Lymphoma 2019; 60:2622-2634. [DOI: 10.1080/10428194.2019.1605511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Piotr Smolewski
- Department of Experimental Hematology, Medical University of Lodz, Lodz, Poland
| | - Pawel Robak
- Department of Experimental Hematology, Medical University of Lodz, Lodz, Poland
| | - Martin Dreyling
- Department of Medicine III, University Hospital Ludwig Maximilians University, Munich, Germany
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3
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Altered treatment of chronic lymphocytic leukemia in Germany during the last decade. Ann Hematol 2016; 95:853-61. [DOI: 10.1007/s00277-016-2640-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 03/09/2016] [Indexed: 11/26/2022]
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4
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Müller D, Fischer K, Kaiser P, Eichhorst B, Walshe R, Reiser M, Kellermann L, Borsi L, Civello D, Mensch A, Bahlo J, Hallek M, Stock S, Fingerle-Rowson G. Cost-effectiveness of rituximab in addition to fludarabine and cyclophosphamide (R-FC) for the first-line treatment of chronic lymphocytic leukemia. Leuk Lymphoma 2015; 57:1130-9. [PMID: 26584689 DOI: 10.3109/10428194.2015.1070151] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The cost-effectiveness of rituximab in combination with fludarabine/cyclophosphamide (R-FC) for the first line treatment of chronic lymphocytic leukemia (CLL) was evaluated. Based on long-term clinical data (follow-up of 5.9 years) from the CLL8-trial, a Markov-model with three health states (Free from disease progression, Progressive disease, Death) was used to evaluate the cost per quality-adjusted life-year (QALY) and cost per life years gained (LYG) of R-FC from the perspective of the German statutory health insurance (SHI). The addition of rituximab to FC chemotherapy results in a gain of 1.1 quality-adjusted life-years. The incremental cost-effectiveness ratio (ICER) of R-FC compared with FC was €17,979 per QALY (€15,773 per LYG). Results were robust in deterministic and probabilistic sensitivity analyses. From the German SHI perspective, rituximab in combination with FC chemotherapy represents good value for first-line treatment of patients with CLL and compares favorably with chemotherapy alone.
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Affiliation(s)
- Dirk Müller
- a Institute of Health Economics and Clinical Epidemiology , University of Cologne , Cologne , Germany
| | - Kirsten Fischer
- b Department of Internal Medicine and Centre for Integrated Oncology , University of Cologne , Cologne , Germany
| | - Peter Kaiser
- a Institute of Health Economics and Clinical Epidemiology , University of Cologne , Cologne , Germany
| | - Barbara Eichhorst
- b Department of Internal Medicine and Centre for Integrated Oncology , University of Cologne , Cologne , Germany
| | | | - Marcel Reiser
- d PIOH, Praxis of Oncology and Hematology , Cologne , Germany
| | | | - Lisa Borsi
- a Institute of Health Economics and Clinical Epidemiology , University of Cologne , Cologne , Germany
| | - Daniele Civello
- a Institute of Health Economics and Clinical Epidemiology , University of Cologne , Cologne , Germany
| | - Alexander Mensch
- a Institute of Health Economics and Clinical Epidemiology , University of Cologne , Cologne , Germany
| | - Jasmin Bahlo
- b Department of Internal Medicine and Centre for Integrated Oncology , University of Cologne , Cologne , Germany
| | - Michael Hallek
- b Department of Internal Medicine and Centre for Integrated Oncology , University of Cologne , Cologne , Germany
| | - Stephanie Stock
- a Institute of Health Economics and Clinical Epidemiology , University of Cologne , Cologne , Germany
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5
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Gangatharan SA, Maganti M, Kuruvilla JG, Kukreti V, Tiedemann RE, Gospodarowicz MK, Hodgson DC, Sun A, Tsang RW, Pintilie M, Crump M. Clinical characteristics and early treatment outcomes of follicular lymphoma in young adults. Br J Haematol 2015; 170:384-90. [PMID: 25904266 DOI: 10.1111/bjh.13451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/09/2015] [Indexed: 01/18/2023]
Abstract
Follicular lymphoma (FL) in young adults (YA, <40 years old) is uncommon, and the clinical characteristics and outcomes of this group are not well defined. We conducted a retrospective database review of 427 patients with newly diagnosed FL aged 65 years or less registered at Princess Margaret Cancer Centre between 1995 and 2010. YA (n = 61) and those 40-65 (n = 366) were compared with regards to clinical stage at diagnosis, FL International Prognostic Index (FLIPI) score, and the following clinical outcomes: time to second treatment, cause-specific survival (CSS) and overall survival (OS). At diagnosis, stage and FLIPI score were similar, as were the proportion of patients requiring therapy (YA 75% versus older adults 71%). Median follow-up was 8.1 years. Time to second therapy was similar in both age groups (5-year probability 23% YA versus 27% older adults; Gray's P-value = 0.76). Ten-year OS was significantly higher for YA (87% versus older adults 72%; P = 0.029). On multivariate analysis, age <40 years, low FLIPI score and observation as initial management were favourable prognostic factors for OS and CSS. We conclude that YA with FL have a favourable prognosis compared to older patients; whether this reflects competing mortality risks or age-related differences in lymphoma biology warrants further investigation.
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Affiliation(s)
- Shane A Gangatharan
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Manjula Maganti
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - John G Kuruvilla
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Vishal Kukreti
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Rodger E Tiedemann
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Mary K Gospodarowicz
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - David C Hodgson
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Alex Sun
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Richard W Tsang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Melania Pintilie
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Michael Crump
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Iwata H, Sawada R, Mizutani S, Yamanishi Y. Systematic drug repositioning for a wide range of diseases with integrative analyses of phenotypic and molecular data. J Chem Inf Model 2015; 55:446-59. [PMID: 25602292 DOI: 10.1021/ci500670q] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Drug repositioning, or the application of known drugs to new indications, is a challenging issue in pharmaceutical science. In this study, we developed a new computational method to predict unknown drug indications for systematic drug repositioning in a framework of supervised network inference. We defined a descriptor for each drug-disease pair based on the phenotypic features of drugs (e.g., medicinal effects and side effects) and various molecular features of diseases (e.g., disease-causing genes, diagnostic markers, disease-related pathways, and environmental factors) and constructed a statistical model to predict new drug-disease associations for a wide range of diseases in the International Classification of Diseases. Our results show that the proposed method outperforms previous methods in terms of accuracy and applicability, and its performance does not depend on drug chemical structure similarity. Finally, we performed a comprehensive prediction of a drug-disease association network consisting of 2349 drugs and 858 diseases and described biologically meaningful examples of newly predicted drug indications for several types of cancers and nonhereditary diseases.
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Affiliation(s)
- Hiroaki Iwata
- Division of System Cohort, Multi-Scale Research Center for Medical Science, Medical Institute of Bioregulation, Kyushu University , 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 812-8582, Japan
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Rossi G, Marcheselli L, Dondi A, Bottelli C, Tucci A, Luminari S, Arcaini L, Merli M, Pulsoni A, Boccomini C, Puccini B, Micheletti M, Martinelli G, Rossi A, Zilioli VR, Bozzoli V, Balzarotti M, Bolis S, Cabras MG, Federico M. The use of anthracycline at first-line compared to alkylating agents or nucleoside analogs improves the outcome of salvage treatments after relapse in follicular lymphoma The REFOLL study by the Fondazione Italiana Linfomi. Am J Hematol 2015; 90:56-61. [PMID: 25327841 DOI: 10.1002/ajh.23872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 10/10/2014] [Accepted: 10/13/2014] [Indexed: 11/12/2022]
Abstract
Follicular lymphoma (FL) patients experience multiple remissions and relapses and commonly receive multiple treatment lines. A crucial question is whether anthracyclines should be used at first-line or whether they would be better "reserved" for relapse and whether FL outcome can be optimized by definite sequences of treatments. Randomized trials can be hardly designed to address this question. In this retrospective multi-institutional study, time-to-next-treatment after first relapse was analyzed in 510 patients who had received either alkylating agents- or anthracycline- or nucleoside analogs-based chemotherapy with/without rituximab at first-line and different second-line therapies. After a median of 42 months, median time-to-next-treatment after relapse was 41 months (CI95%:34-47 months). After adjustment for covariates, first-line anthracycline-based chemotherapy with/without rituximab was associated with better time-to-next-treatment after any salvage than alkylating agents-based chemotherapy with/without rituximab or nucleoside analogs-based chemotherapy with/without rituximab (HR:0.74, P = 0.027). The addition of rituximab to first-line chemotherapy had no significant impact (HR:1.22, P = 0.140). Autologs stem cell transplantation performed better than any other salvage treatment (HR:0.53, P < 0.001). First-line anthracycline-based chemotherapy significantly improved time-to-next-treatment even in patients receiving salvage autologs stem cell transplantation (P = 0.041). This study supports the concept that in FL previous treatments significantly impact on the outcome of subsequent therapies. The outcome of second-line treatments, either with salvage chemoimmunotherapy or with autologs stem cell transplantation, was better when an anthracycline-containing regimen was used at first-line.
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Affiliation(s)
| | - Luigi Marcheselli
- Department of Diagnostic; Clinical; and Public Health Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - Alessandra Dondi
- Department of Diagnostic; Clinical; and Public Health Medicine; University of Modena and Reggio Emilia; Modena Italy
| | | | | | - Stefano Luminari
- Department of Diagnostic; Clinical; and Public Health Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - Luca Arcaini
- Department of Hematology Oncology; Fondazione IRCCS Policlinico San Matteo; University of Pavia; Pavia Italy
| | - Michele Merli
- Hematology Division; Department of Internal Medicine; Circolo e Fondazione Macchi; Varese Italy
| | | | - Carola Boccomini
- Department of Hematology; Città della Salute e della Scienza; Torino Italy
| | - Benedetta Puccini
- Department of Hematology; Azienda Ospedaliero Universitaria Careggi; Firenze Italy
| | | | | | - Andrea Rossi
- Department of Hematology; Ospedali Riuniti; Bergamo Italy
| | | | - Valentina Bozzoli
- Department of Hematology; University Cattolica Sacro Cuore; Roma Italy
| | | | - Silvia Bolis
- Hematology Unit; Ospedale San Gerardo; Monza Italy
| | | | - Massimo Federico
- Department of Diagnostic; Clinical; and Public Health Medicine; University of Modena and Reggio Emilia; Modena Italy
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Schmidt C, Fingerle-Rowson G, Boehme A, Brendel K, Fischer R, Gonnermann M, Höhler T, Kegel T, Kellermann L, Nusch A, Pönisch W, Wendtner C, Dreyling M. Changes in the diagnosis and treatment of patients with low grade lymphoma in Germany: years 2006–2009. Leuk Lymphoma 2014; 56:694-702. [DOI: 10.3109/10428194.2014.928935] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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