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de Vos S, Goy A, Dakhil SR, Saleh MN, McLaughlin P, Belt R, Flowers CR, Knapp M, Hart L, Patel-Donnelly D, Glenn M, Gregory SA, Holladay C, Zhang T, Boral AL. Multicenter Randomized Phase II Study of Weekly or Twice-Weekly Bortezomib Plus Rituximab in Patients With Relapsed or Refractory Follicular or Marginal-Zone B-Cell Lymphoma. J Clin Oncol 2009; 27:5023-30. [DOI: 10.1200/jco.2008.17.7980] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To determine overall response rate (ORR), time to progression (TTP), and duration of response (DOR) with twice-weekly/weekly bortezomib plus rituximab, and evaluate safety/tolerability, in patients with relapsed or refractory CD20+ follicular lymphoma (FL) or marginal-zone lymphoma. Patients and Methods Patients were randomly assigned (minimization method) to bortezomib 1.3 mg/m2 twice weekly (days 1, 4, 8, and 11; 21-day cycle, five cycles; arm A) or bortezomib 1.6 mg/m2 weekly (days 1, 8, 15, and 22; 35-day cycle, three cycles; arm B) plus rituximab 375 mg/m2 weekly for 4 weeks (both arms). Response/progression was determined by International Workshop Response Criteria using oncologist/radiologist-adjudicated data from independent radiology review and investigator assessment. Results Eighty-one patients (arm A, n = 41; arm B, n = 40) were enrolled. Dose-intensity was higher in arm A; mean total bortezomib received was similar between arms (18.5 and 17.1 mg/m2). In arm A, ORR was 49% (14% complete response [CR]/CR unconfirmed [CRu]), median TTP was 7.0 months, and median DOR was not reached. In arm B, ORR was 43% (10% CR/CRu), and median TTP/DOR were 10.0/9.3 months. The weekly combination regimen seemed better tolerated. Grade 3 or worse adverse events seemed more common in arm A (54%) versus arm B (35%), including thrombocytopenia (10% v 0%) and peripheral neuropathy (10% v 5%), but diarrhea seemed less frequent (7% v 15%). No grade 4 toxicities were reported in arm B. Conclusion Both bortezomib plus rituximab regimens seem feasible in relapsed or refractory indolent lymphomas. The more convenient weekly combination regimen is being compared with single-agent rituximab in an ongoing phase III study in relapsed FL.
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Affiliation(s)
- Sven de Vos
- From the Division of Hematology/Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Hackensack University Medical Center, Hackensack, NJ; Cancer Center of Kansas, Wichita, KS; Georgia Cancer Specialists, Atlanta, GA; The University of Texas M. D. Anderson Cancer Center, Houston, TX; Kansas City Cancer Care, Kansas City, MO; Winship Cancer Institute, Atlanta, GA; Mid Ohio Oncology/Hematology Inc, Columbus, OH; Florida Cancer Specialists, Fort Myers, FL
| | - André Goy
- From the Division of Hematology/Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Hackensack University Medical Center, Hackensack, NJ; Cancer Center of Kansas, Wichita, KS; Georgia Cancer Specialists, Atlanta, GA; The University of Texas M. D. Anderson Cancer Center, Houston, TX; Kansas City Cancer Care, Kansas City, MO; Winship Cancer Institute, Atlanta, GA; Mid Ohio Oncology/Hematology Inc, Columbus, OH; Florida Cancer Specialists, Fort Myers, FL
| | - Shaker R. Dakhil
- From the Division of Hematology/Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Hackensack University Medical Center, Hackensack, NJ; Cancer Center of Kansas, Wichita, KS; Georgia Cancer Specialists, Atlanta, GA; The University of Texas M. D. Anderson Cancer Center, Houston, TX; Kansas City Cancer Care, Kansas City, MO; Winship Cancer Institute, Atlanta, GA; Mid Ohio Oncology/Hematology Inc, Columbus, OH; Florida Cancer Specialists, Fort Myers, FL
| | - Mansoor N. Saleh
- From the Division of Hematology/Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Hackensack University Medical Center, Hackensack, NJ; Cancer Center of Kansas, Wichita, KS; Georgia Cancer Specialists, Atlanta, GA; The University of Texas M. D. Anderson Cancer Center, Houston, TX; Kansas City Cancer Care, Kansas City, MO; Winship Cancer Institute, Atlanta, GA; Mid Ohio Oncology/Hematology Inc, Columbus, OH; Florida Cancer Specialists, Fort Myers, FL
| | - Peter McLaughlin
- From the Division of Hematology/Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Hackensack University Medical Center, Hackensack, NJ; Cancer Center of Kansas, Wichita, KS; Georgia Cancer Specialists, Atlanta, GA; The University of Texas M. D. Anderson Cancer Center, Houston, TX; Kansas City Cancer Care, Kansas City, MO; Winship Cancer Institute, Atlanta, GA; Mid Ohio Oncology/Hematology Inc, Columbus, OH; Florida Cancer Specialists, Fort Myers, FL
| | - Robert Belt
- From the Division of Hematology/Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Hackensack University Medical Center, Hackensack, NJ; Cancer Center of Kansas, Wichita, KS; Georgia Cancer Specialists, Atlanta, GA; The University of Texas M. D. Anderson Cancer Center, Houston, TX; Kansas City Cancer Care, Kansas City, MO; Winship Cancer Institute, Atlanta, GA; Mid Ohio Oncology/Hematology Inc, Columbus, OH; Florida Cancer Specialists, Fort Myers, FL
| | - Christopher R. Flowers
- From the Division of Hematology/Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Hackensack University Medical Center, Hackensack, NJ; Cancer Center of Kansas, Wichita, KS; Georgia Cancer Specialists, Atlanta, GA; The University of Texas M. D. Anderson Cancer Center, Houston, TX; Kansas City Cancer Care, Kansas City, MO; Winship Cancer Institute, Atlanta, GA; Mid Ohio Oncology/Hematology Inc, Columbus, OH; Florida Cancer Specialists, Fort Myers, FL
| | - Mark Knapp
- From the Division of Hematology/Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Hackensack University Medical Center, Hackensack, NJ; Cancer Center of Kansas, Wichita, KS; Georgia Cancer Specialists, Atlanta, GA; The University of Texas M. D. Anderson Cancer Center, Houston, TX; Kansas City Cancer Care, Kansas City, MO; Winship Cancer Institute, Atlanta, GA; Mid Ohio Oncology/Hematology Inc, Columbus, OH; Florida Cancer Specialists, Fort Myers, FL
| | - Lowell Hart
- From the Division of Hematology/Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Hackensack University Medical Center, Hackensack, NJ; Cancer Center of Kansas, Wichita, KS; Georgia Cancer Specialists, Atlanta, GA; The University of Texas M. D. Anderson Cancer Center, Houston, TX; Kansas City Cancer Care, Kansas City, MO; Winship Cancer Institute, Atlanta, GA; Mid Ohio Oncology/Hematology Inc, Columbus, OH; Florida Cancer Specialists, Fort Myers, FL
| | - Dipti Patel-Donnelly
- From the Division of Hematology/Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Hackensack University Medical Center, Hackensack, NJ; Cancer Center of Kansas, Wichita, KS; Georgia Cancer Specialists, Atlanta, GA; The University of Texas M. D. Anderson Cancer Center, Houston, TX; Kansas City Cancer Care, Kansas City, MO; Winship Cancer Institute, Atlanta, GA; Mid Ohio Oncology/Hematology Inc, Columbus, OH; Florida Cancer Specialists, Fort Myers, FL
| | - Martha Glenn
- From the Division of Hematology/Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Hackensack University Medical Center, Hackensack, NJ; Cancer Center of Kansas, Wichita, KS; Georgia Cancer Specialists, Atlanta, GA; The University of Texas M. D. Anderson Cancer Center, Houston, TX; Kansas City Cancer Care, Kansas City, MO; Winship Cancer Institute, Atlanta, GA; Mid Ohio Oncology/Hematology Inc, Columbus, OH; Florida Cancer Specialists, Fort Myers, FL
| | - Stephanie A. Gregory
- From the Division of Hematology/Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Hackensack University Medical Center, Hackensack, NJ; Cancer Center of Kansas, Wichita, KS; Georgia Cancer Specialists, Atlanta, GA; The University of Texas M. D. Anderson Cancer Center, Houston, TX; Kansas City Cancer Care, Kansas City, MO; Winship Cancer Institute, Atlanta, GA; Mid Ohio Oncology/Hematology Inc, Columbus, OH; Florida Cancer Specialists, Fort Myers, FL
| | - Charles Holladay
- From the Division of Hematology/Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Hackensack University Medical Center, Hackensack, NJ; Cancer Center of Kansas, Wichita, KS; Georgia Cancer Specialists, Atlanta, GA; The University of Texas M. D. Anderson Cancer Center, Houston, TX; Kansas City Cancer Care, Kansas City, MO; Winship Cancer Institute, Atlanta, GA; Mid Ohio Oncology/Hematology Inc, Columbus, OH; Florida Cancer Specialists, Fort Myers, FL
| | - Tracy Zhang
- From the Division of Hematology/Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Hackensack University Medical Center, Hackensack, NJ; Cancer Center of Kansas, Wichita, KS; Georgia Cancer Specialists, Atlanta, GA; The University of Texas M. D. Anderson Cancer Center, Houston, TX; Kansas City Cancer Care, Kansas City, MO; Winship Cancer Institute, Atlanta, GA; Mid Ohio Oncology/Hematology Inc, Columbus, OH; Florida Cancer Specialists, Fort Myers, FL
| | - Anthony L. Boral
- From the Division of Hematology/Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Hackensack University Medical Center, Hackensack, NJ; Cancer Center of Kansas, Wichita, KS; Georgia Cancer Specialists, Atlanta, GA; The University of Texas M. D. Anderson Cancer Center, Houston, TX; Kansas City Cancer Care, Kansas City, MO; Winship Cancer Institute, Atlanta, GA; Mid Ohio Oncology/Hematology Inc, Columbus, OH; Florida Cancer Specialists, Fort Myers, FL
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Chowdhury M, Endo M, Chiba T, Kudara N, Oana S, Sato K, Akasaka R, Tomita K, Fujiwara S, Mizutani T, Sugai T, Takikawa Y, Suzuki K. Characterization of follicular lymphoma in the small intestine using double-balloon endoscopy. Gastroenterol Res Pract 2009; 2009:835258. [PMID: 19901998 PMCID: PMC2773429 DOI: 10.1155/2009/835258] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 07/30/2009] [Indexed: 02/08/2023] Open
Abstract
Follicular lymphomas occur rarely in the gastrointestinal tract, representing only 1-3% of all gastrointestinal tract B-cell non-Hodgkin lymphomas. We describe endoscopic analysis of 3 cases of follicular lymphoma in the small intestine using double-balloon endoscopy. Double-balloon endoscopy revealed multiple nodular lesions and elevated white patches, multiple polypoid lesions, and scattered white polypoid and nodular lesions in the duodenum and small intestine. Fuji Intelligent Chromo Endoscopy demonstrated small, whitish nodules, and narrow-band imaging showed a coiled, elongated vascular pattern within the elevated lesions. These cases are the first follicular lymphomas in the small intestine evaluated using narrow-band imaging or Fuji Intelligent Chromo Endoscopy to be reported.
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Affiliation(s)
- Manzurul Chowdhury
- 1Department of Gastroenterology and Hepatology, Iwate Medical University, Morioka, Iwate 020-8505, Japan
- 2Ministry of Health and Family Welfare, Government of Bangladesh, Polash, Narshingdi, Bangladesh
| | - Masaki Endo
- 1Department of Gastroenterology and Hepatology, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Toshimi Chiba
- 1Department of Gastroenterology and Hepatology, Iwate Medical University, Morioka, Iwate 020-8505, Japan
- *Toshimi Chiba:
| | - Norihiko Kudara
- 1Department of Gastroenterology and Hepatology, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Shuhei Oana
- 1Department of Gastroenterology and Hepatology, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Kunihiko Sato
- 1Department of Gastroenterology and Hepatology, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Risaburo Akasaka
- 1Department of Gastroenterology and Hepatology, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Kazumitsu Tomita
- 1Department of Gastroenterology and Hepatology, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Saori Fujiwara
- 1Department of Gastroenterology and Hepatology, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Tomomi Mizutani
- 1Department of Gastroenterology and Hepatology, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Tamotsu Sugai
- 3Division of Molecular Diagnostic Pathology, Department of Pathology, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Yasuhiro Takikawa
- 1Department of Gastroenterology and Hepatology, Iwate Medical University, Morioka, Iwate 020-8505, Japan
| | - Kazuyuki Suzuki
- 1Department of Gastroenterology and Hepatology, Iwate Medical University, Morioka, Iwate 020-8505, Japan
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