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Castro-Uriol D, Rios L, Enriquez-Vera D, Montoya J, Runciman T, Alarcón S, Zapata A, Hernández E, León E, Malpica L, Valcarcel B. Real-World Outcomes of Adolescents and Young Adults with Diffuse Large B-Cell Lymphoma: A Multicenter Retrospective Cohort Study. J Adolesc Young Adult Oncol 2024; 13:323-330. [PMID: 37843922 PMCID: PMC10998009 DOI: 10.1089/jayao.2023.0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
Purpose: Patients with diffuse large B-cell lymphoma (DLBCL) are typically treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). However, a standard of care for managing adolescents and young adults (AYAs) with DLBCL is lacking. We examine treatment approaches and outcomes of this population. Methods: We included 90 AYAs (15-39 years) diagnosed with DLBCL between 2008 and 2018 in three tertiary centers in Peru. Overall response rates (ORR) were available for all patients. Overall survival (OS) and progression-free survival (PFS) rates were estimated using the Kaplan-Meier method. Results: The median age at diagnosis was 33 years, 57% were males, 57% had good performance status (Lansky/Karnofsky ≥90), and 61% were diagnosed with early-stage disease (Ann Arbor stages I-II). R-CHOP (n = 69, 77%) was the most frequently used first-line regimen, with an ORR of 91%. With a median follow-up of 83 months, the 5-year OS and PFS among all patients were 79% and 67%, respectively. Among the patients who received R-CHOP, the 5-year OS and PFS were 77% and 66%, respectively. Of the 29 (32%) patients with relapsed/refractory (R/R) disease, 83% received second-line treatment and only 14% underwent consolidation therapy with autologous transplantation. The 3-year OS for R/R DLBCL was 36%. Conclusion: Our data show that AYAs with DLBCL who received conventional therapy had comparable outcomes to those observed in studies conducted among the adult population. However, the prognosis for AYAs with R/R disease was dismal, indicating the unmet need for developing and increasing access to novel treatment modalities in AYAs.
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Affiliation(s)
- Denisse Castro-Uriol
- Departamento de Oncología y Radioterapia, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
- Centro de Medicina de Precisión, Instituto de Investigación, Universidad de San Martín de Porres, Lima, Perú
| | - Ligia Rios
- Unidad de Oncología Pediátrica y del Adolescente, Departamento de Oncología y Radioterapia, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - Daniel Enriquez-Vera
- Division of HTLV-1/ATL Carcinogenesis and Therapeutics, Joint Research Center for Human Retrovirus Infection, Kagoshima University, Kagoshima, Japan
| | - Jacqueline Montoya
- Departamento de Oncología Pediátrica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Thanya Runciman
- Departamento de Oncología y Radioterapia, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
| | - Sandra Alarcón
- Departamento de Oncología Pediátrica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Arturo Zapata
- Departamento de Oncología Pediátrica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Eddy Hernández
- Departamento de Oncología Pediátrica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Esmeralda León
- Unidad de Oncología Pediátrica y del Adolescente, Departamento de Oncología y Radioterapia, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
| | - Luis Malpica
- Division of Cancer Medicine, Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bryan Valcarcel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
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Banchi M, Lanzolla T, Di Napoli A, Bandini A, Bocci G, Cox MC. Complete Remission of a Diffuse Large B-Cell Lymphoma in a Young Patient, with Severe Tuberous Sclerosis, Treated with Metronomic Chemotherapy and Ibrutinib: A Case Report. Chemotherapy 2023; 69:40-44. [PMID: 37549660 DOI: 10.1159/000533236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/21/2023] [Indexed: 08/09/2023]
Abstract
Tuberous sclerosis (TS) is a rare autosomal dominant genetic multisystem disease caused by mutations in either the TSC1 or TSC2 gene and results in the growth of non-cancerous masses in several organs. Diffuse large B-cell lymphoma (DLBCL) is the predominant non-Hodgkin lymphoma in adolescents and young adults. Metronomic chemotherapy (mCHEMO) can be defined as the frequent, regular administration of drug doses able to maintain a low, but active, range of concentrations of chemotherapeutic drugs during prolonged periods of time. We present the case of a young woman with severe TS who developed DLBCL. She was treated consecutively with the mCHEMO schedule R-DEVEC (prednisone, vinorelbine, etoposide, cyclophosphamide, plus rituximab) and then ibrutinib, achieving an impressive long-lasting complete remission. In conclusion, alternative treatments could be necessary when comorbidities are present in patients, and mCHEMO can be a potential successful therapeutic approach in frail subjects.
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Affiliation(s)
- Marta Banchi
- Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, Pisa, Italy
| | - Tiziana Lanzolla
- UOC Medicina Nucleare, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy
| | - Arianna Di Napoli
- UOC Anatomia Patologica, Azienda Ospedaliera Universitaria Sant'Andrea and Department of Clinical and Molecular Medicine Sapienza University, Rome, Italy
| | - Arianna Bandini
- Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, Pisa, Italy
| | - Guido Bocci
- Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, Pisa, Italy
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Başcı S, Bakırtaş M, Yiğenoğlu TN, Uncu Ulu B, Batgi H, Yıldız J, Dal MS, Kızıl Çakar M, Altuntaş F. The Outcome of Diffuse Large B Cell Lymphoma Patients in Adolescent and Young Adult Age Group. J Adolesc Young Adult Oncol 2020; 10:483-487. [PMID: 33237829 DOI: 10.1089/jayao.2020.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: In the literature, substantial differences have been reported regarding incidence and outcomes for the pediatric and adult groups with non-Hodgkin's lymphoma (NHL). Diffuse large B cell lymphoma (DLBCL) is the most common NHL subtype, and its outcome in adolescents and young adults (AYA) has not been widely investigated. This study aims at reporting our experience on the outcome of DLBCL in the AYA group. Methods: One hundred twenty DLBCL patients, 40 AYA patients, and 1:2 matched 80 control non-AYA patients were diagnosed and followed up at our center included. Results: In both groups, the median progression-free survival (PFS) and overall survival (OS) were not reached, without any difference between groups (p = 0.7, p = 0.7, respectively). The median follow-up time was 28 (range 1-133) months in all patients. In both groups, international prognostic index scores and early relapse were associated with worse PFS and OS, but in the non-AYA group, the immunohistologic type was, in fact, related to worse outcomes. Conclusion: DLBCL in AYA is a predominantly overlooked subject, due to the rarity of the disease. The outcome of DLBCL in this age group is not encouraging, which not only needs to be further investigated, but novel approaches must also be developed.
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Affiliation(s)
- Semih Başcı
- Department of Hematology and Bone Marrow Transplantation Center, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehmet Bakırtaş
- Department of Hematology and Bone Marrow Transplantation Center, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Tuğçe Nur Yiğenoğlu
- Department of Hematology and Bone Marrow Transplantation Center, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Bahar Uncu Ulu
- Department of Hematology and Bone Marrow Transplantation Center, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Hikmetullah Batgi
- Department of Hematology and Bone Marrow Transplantation Center, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Jale Yıldız
- Department of Hematology and Bone Marrow Transplantation Center, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehmet Sinan Dal
- Department of Hematology and Bone Marrow Transplantation Center, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Merih Kızıl Çakar
- Department of Hematology and Bone Marrow Transplantation Center, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Fevzi Altuntaş
- Department of Hematology and Bone Marrow Transplantation Center, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Garciaz S, Coso D, Brice P, Bouabdallah R. [Hodgkin and non-Hodgkin lymphoma of adolescents and young adults]. Bull Cancer 2016; 103:1035-1049. [PMID: 27866679 DOI: 10.1016/j.bulcan.2016.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/07/2016] [Accepted: 10/07/2016] [Indexed: 12/18/2022]
Abstract
Lymphoma is one of the most frequent cancers in adolescent and young adults. Hodgkin Lymphoma is curable in more than 90% of cases. Recent pediatric and adults protocols aimed to decrease long term toxicities (mostly gonadic and cardiovascular) and secondary malignancies, reducing the use of alkylating agents and limiting radiation fields. Risk-adapted strategies, using positron emission tomography staging, are about to become a standard, both in adult and pediatric protocols. These approaches allow obtaining excellent results in adolescents with Hodgkin lymphoma. On the other hand, treatment of adolescents with diffuse large B-cell lymphoma raises some questions. Even through children have good outcomes when treated with risk-adapted strategies, adolescents who are between 15 and 18 years old seem to experience poorer survivals, whereas patients older than 18 years old have globally the same outcome than older adults. This category of patient needs a particular care, based on a tight coordination between adults and pediatric oncologists. Primary mediastinal lymphomas, a subtype of BLDCL frequent in young adult population, exhibits poorer outcomes in children or young adolescent population than in older ones. Taking together, B-cell lymphoma benefited from recent advances in immunotherapy (in particular with the extended utilization of rituximab) and metabolic response-adapted strategies. In conclusion, adolescent and young adult's lymphomas are very curable diseases but require a personalized management in onco-hematological units.
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Affiliation(s)
- Sylvain Garciaz
- Institut Paoli-Calmettes, département d'hématologie, 232, boulevard Sainte-Marguerite, 13009 Marseille, France.
| | - Diane Coso
- Institut Paoli-Calmettes, département d'hématologie, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - Pauline Brice
- Hôpital Saint-Louis, service d'hémato-oncologie, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - Réda Bouabdallah
- Institut Paoli-Calmettes, département d'hématologie, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
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