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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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2
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Gupta S, Alexander S, Pole JD, Sutradhar R, Crump M, Nagamuthu C, Baxter NN, Nathan PC. Superior outcomes with paediatric protocols in adolescents and young adults with aggressive B-cell non-Hodgkin lymphoma. Br J Haematol 2021; 196:743-752. [PMID: 34599525 DOI: 10.1111/bjh.17862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/14/2021] [Indexed: 11/28/2022]
Abstract
Survival disparities by locus of care (LOC; paediatric versus adult) among adolescents and young adults (AYA) with acute lymphoblastic leukaemia (ALL) are well documented. Whether similar disparities exist among AYA with aggressive mature B-cell non-Hodgkin lymphoma (B-NHL) is unknown. We identified all Ontario, Canada AYA aged 15-21 years at diagnosis of B-NHL between 1992 and 2012. Demographic, disease, treatment and outcome data were chart abstracted. The impact of LOC on event-free (EFS) and overall survival (OS) were determined, adjusted for patient and disease covariates. Among 176 AYA with B-NHL, 62 (35·2%) received therapy at paediatric centres. The 5-year EFS and OS [± standard error (SE)] for the overall cohort were 72·2 [3·4]% and 76·1 [3·2]% respectively. Both EFS and OS were superior among paediatric centre AYA [EFS (± SE) 82·2 (4·9)% vs. 66·7 (4·4)%, P = 0·02; OS 85·5 (4·5)% vs. 71·1 (4·3)%, P = 0·03]. Adjusted for histology, stage and time period, adult centre AYA had inferior EFS [hazard ratio (HR) 2·4, 95% confidence interval (CI) 1·1-4·9, P = 0·02] and OS (HR 2·5, 95% CI 1·1-5·7, P = 0·03). Sensitivity analyses restricted to the latest time period, when most adult centre AYA received rituximab, demonstrated similar disparities. Similar to AYA with ALL, AYA with B-NHL may benefit from being treated with paediatric protocols. Studies prospectively validating these results are warranted.
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Affiliation(s)
- Sumit Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Cancer Research Program, ICES, Toronto, ON, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Alexander
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jason D Pole
- Cancer Research Program, ICES, Toronto, ON, Canada.,Center for Health Services Research, University of Queensland, Brisbane, Australia.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rinku Sutradhar
- Cancer Research Program, ICES, Toronto, ON, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Michael Crump
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | | | - Nancy N Baxter
- Cancer Research Program, ICES, Toronto, ON, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Paul C Nathan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Cancer Research Program, ICES, Toronto, ON, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Anuar NA, Tey KWF, Ng SC, Teh AKH, Abdul Rahman MHF, Chong BP, Gan GG. Outcomes of high dose therapy and autologous haematopoietic stem cell transplantation for non-hodgkin lymphoma: A retrospective analysis in a resource-limited country. Int J Clin Pract 2021; 75:e13823. [PMID: 33202073 DOI: 10.1111/ijcp.13823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/02/2020] [Indexed: 12/24/2022] Open
Abstract
AIM To retrospectively report the clinical outcomes of non-Hodgkin's Lymphoma (NHL) patients post high dose therapy (HDT) with autologous haematopoietic stem cell transplant (AHSCT) and determine whether upfront transplant, which is a first-line consolidative treatment with induction chemotherapy, would be a feasible modality in a resource-limited country. METHODS The medical records for NHL patients who had undergone HDT followed by AHSCT from October 1997 to November 2016 from two hospitals in Klang Valley, Malaysia were obtained from the medical record database and analysed retrospectively through statistical analysis. RESULTS A total of 148 patients were retrospectively identified post-AHSCT, where the majority of whom had B cell lymphoma (53.4%). Majority of patients (88.5%) were in complete remission before AHSCT. The overall survival (OS) and event-free survival (EFS) at 3 years were 68.9% and 60.8%, respectively. The major cause of death was disease progression at 73.9%, while transplant-related mortality was 15.2%, with a median follow-up period of 179.5 weeks. CONCLUSION Our study illustrates the promising outcomes of HDT with AHSCT in NHL patients in a resource-limited country. We recommend larger studies to be conducted in the future with a longer duration of follow-up to validate our findings.
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Affiliation(s)
- Nur Adila Anuar
- Department of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Kevin Wen Fei Tey
- Department of Pharmacology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Soo Chin Ng
- Department of Haematology, Subang Jaya Medical Centre, Subang Jaya, Malaysia
| | - Alan Kee Hean Teh
- Department of Haematology, Subang Jaya Medical Centre, Subang Jaya, Malaysia
| | | | - Bee Ping Chong
- Department of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Gin Gin Gan
- Department of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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4
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Hoang NM, Rui L. DNA methyltransferases in hematological malignancies. J Genet Genomics 2020; 47:361-372. [PMID: 32994141 PMCID: PMC7704698 DOI: 10.1016/j.jgg.2020.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/05/2020] [Accepted: 04/17/2020] [Indexed: 12/14/2022]
Abstract
DNA methyltransferases (DNMTs) are an evolutionarily conserved family of DNA methylases, transferring a methyl group onto the fifth carbon of a cytosine residue. The mammalian DNMT family includes three major members that have functional methylation activities, termed DNMT1, DNMT3A, and DNMT3B. DNMT3A and DNMT3B are responsible for methylation establishment, whereas DNMT1 maintains methylation during DNA replication. Accumulating evidence demonstrates that regulation of DNA methylation by DNMTs is critical for normal hematopoiesis. Aberrant DNA methylation due to DNMT dysregulation and mutations is known as an important molecular event of hematological malignancies, such as DNMT3A mutations in acute myeloid leukemia. In this review, we first describe the basic methylation mechanisms of DNMTs and their functions in lymphocyte maturation and differentiation. We then discuss the current understanding of DNA methylation heterogeneity in leukemia and lymphoma to highlight the importance of studying DNA methylation targets. We also discuss DNMT mutations and pathogenic roles in human leukemia and lymphoma. We summarize the recent understanding of how DNMTs interact with transcription factors or cofactors to repress the expression of tumor suppressor genes. Finally, we highlight current clinical studies using DNMT inhibitors for the treatment of these hematological malignancies.
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Affiliation(s)
- Nguyet-Minh Hoang
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, USA; Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, USA
| | - Lixin Rui
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, USA; Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, USA.
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5
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Painschab MS, Kohler RE, Kasonkanji E, Zuze T, Kaimila B, Nyasosela R, Nyirenda R, Krysiak R, Gopal S. Microcosting Analysis of Diffuse Large B-Cell Lymphoma Treatment in Malawi. J Glob Oncol 2020; 5:1-10. [PMID: 31322992 PMCID: PMC6690619 DOI: 10.1200/jgo.19.00059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To describe the cost of treating diffuse large B-cell lymphoma (DLBCL) in Malawi under the following circumstances: (1) palliation only, (2) first-line cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), (3) salvage etoposide, ifosfamide, and cisplatin (EPIC), and (4) salvage gemcitabine and oxaliplatin (GEMOX). METHODS We conducted a microcosting analysis from the health system perspective in the context of a prospective cohort study at a national teaching hospital in Lilongwe, Malawi. Clinical outcomes data were derived from previously published literature from the cohort. Cost data were collected for treatment and 2-year follow-up, reflecting costs incurred by the research institution or referral hospital for goods and services. Costs were collected in Malawian kwacha, inflated and converted to 2017 US dollars. RESULTS On a per-patient basis, palliative care alone cost $728 per person. Total costs for first-line treatment with CHOP chemotherapy was $1,844, of which chemotherapy drugs made up 15%. Separate salvage EPIC and GEMOX cost $2,597 and $3,176, respectively. Chemotherapy drugs accounted for 30% of EPIC and 47% of GEMOX. CONCLUSION To our knowledge, this is among the first published efforts to characterize detailed costs of cancer treatment in sub-Saharan Africa. The per-patient cost of first-line treatment of DLBCL in Malawi is low relative to high-income countries, suggesting that investments in fixed-duration, curative-intent DLBCL treatment may be attractive in sub-Saharan Africa. Salvage treatment of relapsed/refractory DLBCL costs much more than first-line therapy. Formal cost-effectiveness modeling for CHOP and salvage treatment in the Malawian and other low-resource settings is needed to inform decision makers about optimal use of resources for cancer treatment.
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Affiliation(s)
- Matthew S Painschab
- The University of North Carolina Project-Malawi, Lilongwe, Malawi.,University of North Carolina, Chapel Hill, NC
| | | | | | - Takondwa Zuze
- The University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Bongani Kaimila
- The University of North Carolina Project-Malawi, Lilongwe, Malawi
| | | | | | - Robert Krysiak
- The University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Satish Gopal
- The University of North Carolina Project-Malawi, Lilongwe, Malawi.,University of North Carolina, Chapel Hill, NC.,University of Malawi College of Medicine, Blantyre, Malawi
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6
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Bioavailable 25(OH)D level is associated with clinical outcomes of patients with diffuse large B-cell lymphoma: An exploratory study. Clin Nutr 2020; 40:157-165. [PMID: 32446789 DOI: 10.1016/j.clnu.2020.04.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/02/2020] [Accepted: 04/25/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUNDS & AIMS Vitamin D insufficiency is associated with worse clinical outcomes in multiple cancer types; however, its roles in diffuse large B-cell lymphoma (DLBCL) patients are still unclear. Here, we aimed to determine the prognostic values of circulating total 25(OH)D and bioavailable 25(OH)D levels in DLBCL patients. METHODS A total of 332 newly diagnosed DLBCL patients were recruited. The plasma total 25(OH)D and bioavailable 25(OH)D levels at diagnosis were determined, and their associations with the clinical characteristics and the prognosis of patients were evaluated. The predictive values of clinical characteristics and 25(OH)D levels in the responses to R-CHOP treatments in DLBCL patients were also assessed. RESULTS Of the patients, 92.8% had insufficient vitamin D status (<30 ng/mL). Patients with higher plasma bioavailable 25(OH)D were associated with better progression-free survival (PFS, multivariate adjusted-HR = 0.72, 95% CI = 0.38-1.35, P = 0.301, Tertile 2 vs. 1; multivariate adjusted-HR = 0.39, 95% CI = 0.20-0.79, P = 0.009, Tertile 3 vs. 1) and overall survival (OS, multivariate adjusted-HR = 0.89, 95% CI = 0.39-2.02, P = 0.777, Tertile 2 vs. 1; multivariate adjusted-HR = 0.21, 95% CI = 0.07-0.65, P = 0.007, Tertile 3 vs. 1). Meanwhile, higher plasma total 25(OH)D level was significantly associated with better PFS but not OS in DLBCL patients. Besides, DLBCL patients with higher total or bioavailable 25(OH)D levels were more sensitive to the R-CHOP regimen treatments. CONCLUSION The bioavailable 25(OH)D level may serve as a novel prognostic biomarker in DLBCL patients.
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7
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Linschoten M, Kamphuis JAM, van Rhenen A, Bosman LP, Cramer MJ, Doevendans PA, Teske AJ, Asselbergs FW. Cardiovascular adverse events in patients with non-Hodgkin lymphoma treated with first-line cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP with rituximab (R-CHOP): a systematic review and meta-analysis. LANCET HAEMATOLOGY 2020; 7:e295-e308. [PMID: 32135128 DOI: 10.1016/s2352-3026(20)30031-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/23/2020] [Accepted: 01/23/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients treated for non-Hodgkin lymphoma are at risk of cardiovascular adverse events, with the risk of heart failure being particularly high. A regimen of cyclophosphamide, doxorubicin, vincristine, and prednisone, with (R-CHOP) or without (CHOP) rituximab is the standard first-line treatment for aggressive non-Hodgkin lymphoma, and doxorubicin and cyclophosphamide are both associated with left ventricular dysfunction. The aim of this systematic review and meta-analysis was to evaluate the cardiovascular toxicity of this regimen. METHODS We systematically searched PubMed, EMBASE, and the Cochrane Library from database inception to June 3, 2019, for clinical trials and observational studies in adult patients with non-Hodgkin lymphoma (diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, peripheral T-cell lymphoma, and non-Hodgkin lymphoma not otherwise specified) that received first-line treatment with R-CHOP or CHOP. Studies reporting on cardiovascular adverse events and treatment-related cardiovascular mortality were included. Abstracts and articles not written in English were excluded. The main outcomes were the proportion of patients with grade 3-4 cardiovascular adverse events and heart failure. Meta-analyses of one-sample proportions were done in all patients receiving CHOP or R-CHOP. Subgroup analyses on summary estimates were done to determine the effect of number of CHOP or R-CHOP cycles, cycle interval, age, and sex. FINDINGS Of 2314 identified entries, 137 studies (21 211 patients) published between April, 1984, and June, 2019 were eligible (9541 patients treated with CHOP, 11 293 patients treated with R-CHOP, 377 both regimens used in the study; median follow-up 39·0 months [IQR 25·5-52·8]). From the included studies, 85 subgroups were treated with CHOP, 76 with R-CHOP, and in four studies both CHOP and R-CHOP were used without a subdivision in separate groups. The pooled proportion for grade 3-4 cardiovascular adverse events, based on 77 studies (n=14 351 patients), was 2·35% (95% CI 1·81-2·93; heterogeneity test Q=326·21; τ2=0·0042; I2=71·40%; p<0·0001). For heart failure, the pooled proportion, based on 38 studies (n=5936 patients), was 4·62% (2·25-7·65; heterogeneity test Q=527·33; τ2=0·0384; I2=95·05%; p<0·0001), with a significant increase in reported heart failure from 1·64% (95% CI 0·82-2·65) to 11·72% (3·00-24·53) when cardiac function was evaluated post-chemotherapy (p=0·017). 53 (39%) of 137 studies were rated as having high risk of bias for incomplete outcome data and 54 (39%) for selective reporting. INTERPRETATION The considerable increase of reported heart failures with cardiac monitoring, indicates that this complication often remains undiagnosed in patients with non-Hodgkin lymphoma who received first-line R-CHOP or CHOP. Our findings are of importance to raise awareness of this complication among clinicians treating patients with non-Hodgkin lymphoma and stresses the need for cardiac monitoring during and after chemotherapy. Prompt initiation of treatment for heart failure in the presymptomatic phase can mitigate the progression to more advanced heart failure stages. FUNDING None.
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Affiliation(s)
- Marijke Linschoten
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands.
| | - Janine A M Kamphuis
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Anna van Rhenen
- Department of Haematology, Cancer Centre, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Laurens P Bosman
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Maarten J Cramer
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands; Netherlands Heart Institute, Utrecht, Netherlands; Central Military Hospital, Utrecht, Netherlands
| | - Arco J Teske
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands; Netherlands Heart Institute, Utrecht, Netherlands; Health Data Research UK, Institute of Health Informatics and Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
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8
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Management of aggressive B-cell NHLs in the AYA population: an adult vs pediatric perspective. Blood 2018; 132:369-375. [PMID: 29895666 DOI: 10.1182/blood-2018-02-778480] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/14/2018] [Indexed: 12/15/2022] Open
Abstract
The adolescents and young adult (AYA) population represent a group wherein mature B-cell lymphomas constitute a significant proportion of the overall malignancies that occur. Among these are aggressive B-cell non-Hodgkin lymphomas (NHLs), which are predominantly diffuse large B-cell lymphoma, primary mediastinal B-cell lymphoma, and Burkitt lymphoma. For the most part, there is remarkable divide in how pediatric/adolescent patients (under the age of 18 years) with lymphoma are treated vs their young adult counterparts, and molecular data are lacking, especially in pediatric and AYA series. The outcome for AYA patients with cancers has historically been inferior to that of children or older adults, highlighting the necessity to focus on this population. This review discusses the pediatric vs adult perspective in terms of how these diseases are understood and approached and emphasizes the importance of collaborative efforts in both developing consensus for treatment of this population and planning future research endeavors.
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Bascuas T, Moreno M, Grille S, Chabalgoity JA. Salmonella Immunotherapy Improves the Outcome of CHOP Chemotherapy in Non-Hodgkin Lymphoma-Bearing Mice. Front Immunol 2018; 9:7. [PMID: 29410666 PMCID: PMC5787062 DOI: 10.3389/fimmu.2018.00007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/03/2018] [Indexed: 12/12/2022] Open
Abstract
We have previously shown that Salmonella immunotherapy is effective to treat B-cell non-Hodgkin lymphoma (B-NHL) in mice. However, this model involves animals with high tumor burden, whereas in the clinics B-NHL patients are usually treated with chemotherapy (CHOP: cyclophosphamide, doxorubicin, vincristine, and prednisone) as first-line therapy prior to immunotherapy. Recently, we have described a NHL-B preclinical model using CHOP chemotherapy to achieve MRD in immunocompetent animals that closely resemble patients' conditions. In this work, we assessed the efficacy of Salmonella immunotherapy in B-NHL-bearing mice undergoing chemotherapy. Salmonella administration significantly delayed tumor growth and prolonged survival of chemotherapy-treated NHL-bearing animals. Mice receiving the CHOP-Salmonella combined therapy showed increased numbers of tumor-infiltrating leukocytes and a different profile of cytokines and chemokines expressed in the tumor microenvironment. Further, Salmonella immunotherapy in CHOP-treated animals also enhanced NK cells cytotoxic activity as well as induced systemic lymphoma-specific humoral and cellular responses. Chemotherapy treatment profoundly impacted on the general health status of recipient animals, but those receiving Salmonella showed significantly better overall body condition. Altogether, the results clearly demonstrated that Salmonella immunotherapy could be safely used in individuals under CHOP treatment, resulting in a better prognosis. These results give strong support to consider Salmonella as a neoadjuvant therapy in a clinical setting.
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Affiliation(s)
- Thais Bascuas
- Laboratory for Vaccine Research, Departamento de Desarrollo Biotecnológico, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - María Moreno
- Laboratory for Vaccine Research, Departamento de Desarrollo Biotecnológico, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Sofía Grille
- Cátedra de Hematología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- Departamento Básico de Medicina, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - José A. Chabalgoity
- Laboratory for Vaccine Research, Departamento de Desarrollo Biotecnológico, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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10
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Cai P, Hao J, Wang D, Xu J. Comparative efficacy of different chemotherapies for non-Hodgkin lymphoma: a network-meta analysis. Oncotarget 2017; 8:91238-91247. [PMID: 29207639 PMCID: PMC5710919 DOI: 10.18632/oncotarget.20437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 07/12/2017] [Indexed: 02/07/2023] Open
Abstract
This network meta-analysis (NMA) was conducted to integrate different chemotherapeutic regimens for non-Hodgkin lymphoma (NHL) patients. Overall survival (OS) and complete remission (CR) were considered as main outcome indicators to evaluate the efficacy of NHL chemotherapies. OS and CR data were extracted from included studies and represented by hazard ratio and odds ratio separately. Network structure and forest plots were further included to visually present the relative efficacy among different regimens. A total of 14 qualified publications with 4,167 patients were included. In OS results, no significant difference was observed from the 1-year OS. For 2-year, 3-year and 5-year OS, patients treated by CNOP exhibited the least favorable results. Moreover, significant advantages of R-CHOP treatment over CHOP and VMP were recognized in view of 3-year OS. In respect of CR, R-HDS presented significantly better outcomes than CNOP and VMP, and no significant difference was identified when compared to CHOP in forest plot. ProMACE-CytaBOM and R-HDS possessed the compelling cumulative ranking probability in OS or CR, indicating their competitive performance in NHL treatment while R-CHOP and I-CHOP yielded desirable in terms of long-term survival and short-term survival, respectively. To conclude, ProMACE-CytaBOM, I-CHOP, R-HDS and R-CHOP were recommended to go through further evaluation to confirm their superiority in NHL treatment. CNOP and VMP were discouraged after comprehensively analyzing OS and CR from NMA results.
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Affiliation(s)
- Pengcheng Cai
- Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jinjin Hao
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Dan Wang
- Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jiawei Xu
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
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11
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Brillant C, Skoetz N, Kluge S, Schwarzer G, Trelle S, Greb A, Schulz H, Engert A, Bohlius J. High-dose chemotherapy with autologous stem cell support for first-line treatment of aggressive non-Hodgkin lymphoma: a systematic review and meta-analysis based on individual patient data. Hippokratia 2016. [DOI: 10.1002/14651858.cd007580.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Corinne Brillant
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Kerpener Str. 62 Cologne Germany 50924
| | - Nicole Skoetz
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Kerpener Str. 62 Cologne Germany 50924
| | | | - Guido Schwarzer
- Medical Center - University of Freiburg; Center for Medical Biometry and Medical Informatics; Stefan-Meier-Str. 26 Freiburg Germany D-79104
| | - Sven Trelle
- University of Bern; Institute of Social and Preventive Medicine; Finkenhubelweg 11 Bern Switzerland CH-3012
| | - Alexander Greb
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Kerpener Str. 62 Cologne Germany 50924
| | - Holger Schulz
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Kerpener Str. 62 Cologne Germany 50924
| | - Andreas Engert
- University Hospital of Cologne; Department I of Internal Medicine; Kerpener Str. 62 Cologne Germany 50924
| | - Julia Bohlius
- University of Bern; Institute of Social and Preventive Medicine; Finkenhubelweg 11 Bern Switzerland CH-3012
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12
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Bascuas T, Moreno M, Mónaco A, Reyes L, Paolino A, Oliver P, Kramer MG, Engler H, Pacheco JP, Grille S, Chabalgoity JA. A novel non-Hodgkin lymphoma murine model closer to the standard clinical scenario. J Transl Med 2016; 14:323. [PMID: 27876058 PMCID: PMC5118904 DOI: 10.1186/s12967-016-1073-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/04/2016] [Indexed: 11/15/2022] Open
Abstract
Background Non-Hodgkin lymphomas (NHL) are the most frequent hemato-oncological malignancies. Despite recent major advances in treatment, a substantial proportion of patients relapses highlighting the need for new therapeutic modalities. Promissory results obtained in pre-clinical studies are usually not translated when moving into clinical trials. Pre-clinical studies are mainly conducted in animals with high tumor burden; instead patients undergo chemotherapy as first line of treatment and most likely are under remission when immunotherapies are applied. Thus, an animal model that more closely resembles patients’ conditions would be a valuable tool. Methods BALB/c mice were injected subcutaneously with A20 lymphoma cells and after tumor development different doses of chemotherapy were assessed to find optimal conditions for minimal residual disease (MRD) establishment. Tumor growth and survival, as well as drugs side effects, were all evaluated. Complete lymphoma remission was monitored in vivo using positron emission tomography (PET), and the results were correlated with histology. Immunological status was assessed by splenocytes proliferation assays in NHL-complete remission mice and by analyzing tumor cell infiltrates and chemokines/cytokines gene expression in the tumor microenvironment of animals with residual lymphoma. Results Two cycles of CHOP chemotherapy at days 25 and 35 post-tumor implantation induced complete remission for around 20 days. PET showed to be a suitable follow-up technique for MRD condition with 85.7 and 75% of sensibility and specificity respectively. Proliferative responses upon mitogen stimulation were similar in animals that received chemotherapy and wild type mice. Tumors from animals with residual lymphoma showed higher numbers of CD4+ and CD8+ and similar numbers of NK, neutrophils and Tregs infiltrating cells as compared with non-treated animals. Gene expression of several cytokines as well as an array of chemokines associated with migration of activated T cells to tumor sites was upregulated in the tumor microenvironment of animals that received chemotherapy treatment. Conclusions We established a NHL-B pre-clinical model using standard chemotherapy to achieve MRD in immunocompetent animals. The MRD condition is maintained for approximately 20 days providing a therapeutic window of time where new immunotherapies can be tested in conditions closer to the clinics.
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Affiliation(s)
- Thais Bascuas
- Departamento de Desarrollo Biotecnológico, Instituto de Higiene, Facultad de Medicina, UdelaR, Montevideo, Uruguay
| | - María Moreno
- Departamento de Desarrollo Biotecnológico, Instituto de Higiene, Facultad de Medicina, UdelaR, Montevideo, Uruguay
| | - Amy Mónaco
- Departamento de Desarrollo Biotecnológico, Instituto de Higiene, Facultad de Medicina, UdelaR, Montevideo, Uruguay
| | - Laura Reyes
- Área de Investigación y Desarrollo, Departamento Biomédico, Centro Uruguayo de Imagenología Molecular (CUDIM), Montevideo, Uruguay
| | - Andrea Paolino
- Área de Investigación y Desarrollo, Departamento Biomédico, Centro Uruguayo de Imagenología Molecular (CUDIM), Montevideo, Uruguay
| | - Patricia Oliver
- Área de Investigación y Desarrollo, Departamento Biomédico, Centro Uruguayo de Imagenología Molecular (CUDIM), Montevideo, Uruguay
| | - María G Kramer
- Departamento de Desarrollo Biotecnológico, Instituto de Higiene, Facultad de Medicina, UdelaR, Montevideo, Uruguay
| | - Henry Engler
- Área de Investigación y Desarrollo, Departamento Biomédico, Centro Uruguayo de Imagenología Molecular (CUDIM), Montevideo, Uruguay
| | - José P Pacheco
- Área de Patología Funcional y Morfológica, Departamento de Patología, Facultad de Veterinaria, UdelaR, Montevideo, Uruguay
| | - Sofía Grille
- Cátedra de Hematología, Hospital de Clínicas, Facultad de Medicina, UdelaR, Montevideo, Uruguay
| | - José A Chabalgoity
- Departamento de Desarrollo Biotecnológico, Instituto de Higiene, Facultad de Medicina, UdelaR, Montevideo, Uruguay.
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13
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Nowakowski GS, LaPlant B, Macon WR, Reeder CB, Foran JM, Nelson GD, Thompson CA, Rivera CE, Inwards DJ, Micallef IN, Johnston PB, Porrata LF, Ansell SM, Gascoyne RD, Habermann TM, Witzig TE. Lenalidomide Combined With R-CHOP Overcomes Negative Prognostic Impact of Non–Germinal Center B-Cell Phenotype in Newly Diagnosed Diffuse Large B-Cell Lymphoma: A Phase II Study. J Clin Oncol 2015; 33:251-7. [DOI: 10.1200/jco.2014.55.5714] [Citation(s) in RCA: 282] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose Lenalidomide has significant single-agent activity in relapsed diffuse large B-cell lymphoma (DLBCL). We demonstrated that lenalidomide can be safely combined with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone); this new combination is known as R2CHOP. The goal of this phase II study was to evaluate the efficacy of this combination in newly diagnosed DLBCL. Patients and Methods Eligible patients were adults with newly diagnosed untreated stages II to IV CD20+ DLBCL. Patients received lenalidomide 25 mg orally per day on days 1 through 10 with standard-dose R-CHOP every 21 days for six cycles. All patients received pegfilgrastim on day 2 of each cycle and aspirin prophylaxis throughout. DLBCL molecular subtype was determined by tumor immunohistochemistry and classified as germinal center B-cell (GCB) versus non-GCB in the R2CHOP patients and 87 control patients with DLBCL from the Lymphoma Database who were treated with conventional R-CHOP. Results In all, 64 patients with DLBCL were enrolled, and 60 were evaluable for response. The overall response rate was 98% (59 of 60) with 80% (48 of 60) achieving complete response. Event-free survival and overall survival (OS) rates at 24 months were 59% (95% CI, 48% to 74%) and 78% (95% CI, 68% to 90%), respectively. In R-CHOP patients, 24-month progression-free survival (PFS) and OS were 28% versus 64% (P < .001) and 46% versus 78% (P < .001) in non-GCB DLBCL versus GCB DLBCL, respectively. In contrast, there was no difference in 24-month PFS or OS for R2CHOP patients on the basis of non-GCB and GCB subtype (60% v 59% [P = .83] and 83% v 75% [P = .61] at 2 years, respectively). Conclusion R2CHOP shows promising efficacy in DLBCL. The addition of lenalidomide appears to mitigate a negative impact of non-GCB phenotype on patient outcome.
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Affiliation(s)
- Grzegorz S. Nowakowski
- Grzegorz S. Nowakowski, Betsy LaPlant, William R. Macon, Garth D. Nelson, Carrie A. Thompson, David J. Inwards, Ivana N. Micallef, Patrick B. Johnston, Luis F. Porrata, Stephen M. Ansell, Thomas M. Habermann, and Thomas E. Witzig, Mayo Clinic, Rochester, MN; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada; Craig B. Reeder, Mayo Clinic, Scottsdale, AZ; and James M. Foran and Candido E. Rivera, Mayo Clinic, Jacksonville, FL
| | - Betsy LaPlant
- Grzegorz S. Nowakowski, Betsy LaPlant, William R. Macon, Garth D. Nelson, Carrie A. Thompson, David J. Inwards, Ivana N. Micallef, Patrick B. Johnston, Luis F. Porrata, Stephen M. Ansell, Thomas M. Habermann, and Thomas E. Witzig, Mayo Clinic, Rochester, MN; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada; Craig B. Reeder, Mayo Clinic, Scottsdale, AZ; and James M. Foran and Candido E. Rivera, Mayo Clinic, Jacksonville, FL
| | - William R. Macon
- Grzegorz S. Nowakowski, Betsy LaPlant, William R. Macon, Garth D. Nelson, Carrie A. Thompson, David J. Inwards, Ivana N. Micallef, Patrick B. Johnston, Luis F. Porrata, Stephen M. Ansell, Thomas M. Habermann, and Thomas E. Witzig, Mayo Clinic, Rochester, MN; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada; Craig B. Reeder, Mayo Clinic, Scottsdale, AZ; and James M. Foran and Candido E. Rivera, Mayo Clinic, Jacksonville, FL
| | - Craig B. Reeder
- Grzegorz S. Nowakowski, Betsy LaPlant, William R. Macon, Garth D. Nelson, Carrie A. Thompson, David J. Inwards, Ivana N. Micallef, Patrick B. Johnston, Luis F. Porrata, Stephen M. Ansell, Thomas M. Habermann, and Thomas E. Witzig, Mayo Clinic, Rochester, MN; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada; Craig B. Reeder, Mayo Clinic, Scottsdale, AZ; and James M. Foran and Candido E. Rivera, Mayo Clinic, Jacksonville, FL
| | - James M. Foran
- Grzegorz S. Nowakowski, Betsy LaPlant, William R. Macon, Garth D. Nelson, Carrie A. Thompson, David J. Inwards, Ivana N. Micallef, Patrick B. Johnston, Luis F. Porrata, Stephen M. Ansell, Thomas M. Habermann, and Thomas E. Witzig, Mayo Clinic, Rochester, MN; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada; Craig B. Reeder, Mayo Clinic, Scottsdale, AZ; and James M. Foran and Candido E. Rivera, Mayo Clinic, Jacksonville, FL
| | - Garth D. Nelson
- Grzegorz S. Nowakowski, Betsy LaPlant, William R. Macon, Garth D. Nelson, Carrie A. Thompson, David J. Inwards, Ivana N. Micallef, Patrick B. Johnston, Luis F. Porrata, Stephen M. Ansell, Thomas M. Habermann, and Thomas E. Witzig, Mayo Clinic, Rochester, MN; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada; Craig B. Reeder, Mayo Clinic, Scottsdale, AZ; and James M. Foran and Candido E. Rivera, Mayo Clinic, Jacksonville, FL
| | - Carrie A. Thompson
- Grzegorz S. Nowakowski, Betsy LaPlant, William R. Macon, Garth D. Nelson, Carrie A. Thompson, David J. Inwards, Ivana N. Micallef, Patrick B. Johnston, Luis F. Porrata, Stephen M. Ansell, Thomas M. Habermann, and Thomas E. Witzig, Mayo Clinic, Rochester, MN; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada; Craig B. Reeder, Mayo Clinic, Scottsdale, AZ; and James M. Foran and Candido E. Rivera, Mayo Clinic, Jacksonville, FL
| | - Candido E. Rivera
- Grzegorz S. Nowakowski, Betsy LaPlant, William R. Macon, Garth D. Nelson, Carrie A. Thompson, David J. Inwards, Ivana N. Micallef, Patrick B. Johnston, Luis F. Porrata, Stephen M. Ansell, Thomas M. Habermann, and Thomas E. Witzig, Mayo Clinic, Rochester, MN; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada; Craig B. Reeder, Mayo Clinic, Scottsdale, AZ; and James M. Foran and Candido E. Rivera, Mayo Clinic, Jacksonville, FL
| | - David J. Inwards
- Grzegorz S. Nowakowski, Betsy LaPlant, William R. Macon, Garth D. Nelson, Carrie A. Thompson, David J. Inwards, Ivana N. Micallef, Patrick B. Johnston, Luis F. Porrata, Stephen M. Ansell, Thomas M. Habermann, and Thomas E. Witzig, Mayo Clinic, Rochester, MN; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada; Craig B. Reeder, Mayo Clinic, Scottsdale, AZ; and James M. Foran and Candido E. Rivera, Mayo Clinic, Jacksonville, FL
| | - Ivana N. Micallef
- Grzegorz S. Nowakowski, Betsy LaPlant, William R. Macon, Garth D. Nelson, Carrie A. Thompson, David J. Inwards, Ivana N. Micallef, Patrick B. Johnston, Luis F. Porrata, Stephen M. Ansell, Thomas M. Habermann, and Thomas E. Witzig, Mayo Clinic, Rochester, MN; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada; Craig B. Reeder, Mayo Clinic, Scottsdale, AZ; and James M. Foran and Candido E. Rivera, Mayo Clinic, Jacksonville, FL
| | - Patrick B. Johnston
- Grzegorz S. Nowakowski, Betsy LaPlant, William R. Macon, Garth D. Nelson, Carrie A. Thompson, David J. Inwards, Ivana N. Micallef, Patrick B. Johnston, Luis F. Porrata, Stephen M. Ansell, Thomas M. Habermann, and Thomas E. Witzig, Mayo Clinic, Rochester, MN; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada; Craig B. Reeder, Mayo Clinic, Scottsdale, AZ; and James M. Foran and Candido E. Rivera, Mayo Clinic, Jacksonville, FL
| | - Luis F. Porrata
- Grzegorz S. Nowakowski, Betsy LaPlant, William R. Macon, Garth D. Nelson, Carrie A. Thompson, David J. Inwards, Ivana N. Micallef, Patrick B. Johnston, Luis F. Porrata, Stephen M. Ansell, Thomas M. Habermann, and Thomas E. Witzig, Mayo Clinic, Rochester, MN; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada; Craig B. Reeder, Mayo Clinic, Scottsdale, AZ; and James M. Foran and Candido E. Rivera, Mayo Clinic, Jacksonville, FL
| | - Stephen M. Ansell
- Grzegorz S. Nowakowski, Betsy LaPlant, William R. Macon, Garth D. Nelson, Carrie A. Thompson, David J. Inwards, Ivana N. Micallef, Patrick B. Johnston, Luis F. Porrata, Stephen M. Ansell, Thomas M. Habermann, and Thomas E. Witzig, Mayo Clinic, Rochester, MN; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada; Craig B. Reeder, Mayo Clinic, Scottsdale, AZ; and James M. Foran and Candido E. Rivera, Mayo Clinic, Jacksonville, FL
| | - Randy D. Gascoyne
- Grzegorz S. Nowakowski, Betsy LaPlant, William R. Macon, Garth D. Nelson, Carrie A. Thompson, David J. Inwards, Ivana N. Micallef, Patrick B. Johnston, Luis F. Porrata, Stephen M. Ansell, Thomas M. Habermann, and Thomas E. Witzig, Mayo Clinic, Rochester, MN; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada; Craig B. Reeder, Mayo Clinic, Scottsdale, AZ; and James M. Foran and Candido E. Rivera, Mayo Clinic, Jacksonville, FL
| | - Thomas M. Habermann
- Grzegorz S. Nowakowski, Betsy LaPlant, William R. Macon, Garth D. Nelson, Carrie A. Thompson, David J. Inwards, Ivana N. Micallef, Patrick B. Johnston, Luis F. Porrata, Stephen M. Ansell, Thomas M. Habermann, and Thomas E. Witzig, Mayo Clinic, Rochester, MN; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada; Craig B. Reeder, Mayo Clinic, Scottsdale, AZ; and James M. Foran and Candido E. Rivera, Mayo Clinic, Jacksonville, FL
| | - Thomas E. Witzig
- Grzegorz S. Nowakowski, Betsy LaPlant, William R. Macon, Garth D. Nelson, Carrie A. Thompson, David J. Inwards, Ivana N. Micallef, Patrick B. Johnston, Luis F. Porrata, Stephen M. Ansell, Thomas M. Habermann, and Thomas E. Witzig, Mayo Clinic, Rochester, MN; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC, Canada; Craig B. Reeder, Mayo Clinic, Scottsdale, AZ; and James M. Foran and Candido E. Rivera, Mayo Clinic, Jacksonville, FL
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14
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Visani G, Isidori A. Nonpegylated liposomal doxorubicin in the treatment of B-cell non-Hodgkin’s lymphoma: where we stand. Expert Rev Anticancer Ther 2014; 9:357-63. [DOI: 10.1586/14737140.9.3.357] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Clozel T, Yang S, Elstrom RL, Tam W, Martin P, Kormaksson M, Banerjee S, Vasanthakumar A, Culjkovic B, Scott DW, Wyman S, Leser M, Shaknovich R, Chadburn A, Tabbo F, Godley LA, Gascoyne RD, Borden KL, Inghirami G, Leonard JP, Melnick A, Cerchietti L. Mechanism-based epigenetic chemosensitization therapy of diffuse large B-cell lymphoma. Cancer Discov 2013; 3:1002-19. [PMID: 23955273 PMCID: PMC3770813 DOI: 10.1158/2159-8290.cd-13-0117] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Although aberrant DNA methylation patterning is a hallmark of cancer, the relevance of targeting DNA methyltransferases (DNMT) remains unclear for most tumors. In diffuse large B-cell lymphoma (DLBCL) we observed that chemoresistance is associated with aberrant DNA methylation programming. Prolonged exposure to low-dose DNMT inhibitors (DNMTI) reprogrammed chemoresistant cells to become doxorubicin sensitive without major toxicity in vivo. Nine genes were recurrently hypermethylated in chemoresistant DLBCL. Of these, SMAD1 was a critical contributor, and reactivation was required for chemosensitization. A phase I clinical study was conducted evaluating azacitidine priming followed by standard chemoimmunotherapy in high-risk patients newly diagnosed with DLBCL. The combination was well tolerated and yielded a high rate of complete remission. Pre- and post-azacitidine treatment biopsies confirmed SMAD1 demethylation and chemosensitization, delineating a personalized strategy for the clinical use of DNMTIs. SIGNIFICANCE The problem of chemoresistant DLBCL remains the most urgent challenge in the clinical management of patients with this disease. We describe a mechanism-based approach toward the rational translation of DNMTIs for the treatment of high-risk DLBCL.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antimetabolites, Antineoplastic/therapeutic use
- Azacitidine/adverse effects
- Azacitidine/therapeutic use
- Cell Line, Tumor
- DNA Damage/drug effects
- DNA Methylation/genetics
- DNA Modification Methylases/antagonists & inhibitors
- DNA Modification Methylases/metabolism
- Doxorubicin/pharmacology
- Drug Resistance, Neoplasm/genetics
- Epigenesis, Genetic
- Humans
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Middle Aged
- RNA Interference
- RNA, Small Interfering
- Smad1 Protein/genetics
- Young Adult
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Affiliation(s)
- Thomas Clozel
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medical College, Cornell University, United States
| | - ShaoNing Yang
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medical College, Cornell University, United States
| | - Rebecca L. Elstrom
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medical College, Cornell University, United States
- Weill Cornell Cancer Center, Weill Cornell Medical College, Cornell University, United States
| | - Wayne Tam
- Pathology Department, Weill Cornell Medical College, Cornell University, United States
| | - Peter Martin
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medical College, Cornell University, United States
| | | | - Samprit Banerjee
- Division of Biostatistics and Epidemiology, Public Health Department, Weill Cornell Medical College, Cornell University, United States
| | - Aparna Vasanthakumar
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, United States
| | - Biljana Culjkovic
- Institute for Research in Immunology and Cancer & Department of Pathology and Cell Biology, University of Montreal, Canada
| | - David W. Scott
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Sarah Wyman
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medical College, Cornell University, United States
| | - Michael Leser
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medical College, Cornell University, United States
| | - Rita Shaknovich
- Pathology Department, Weill Cornell Medical College, Cornell University, United States
| | - Amy Chadburn
- Department of Pathology, Northwestern University, Chicago, United States
| | - Fabrizio Tabbo
- Department of Oncological Sciences, University of Turin, Turin, Italy
| | - Lucy A. Godley
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, United States
| | - Randy D. Gascoyne
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Katherine L. Borden
- Institute for Research in Immunology and Cancer & Department of Pathology and Cell Biology, University of Montreal, Canada
| | - Giorgio Inghirami
- Department of Oncological Sciences, University of Turin, Turin, Italy
| | - John P. Leonard
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medical College, Cornell University, United States
- Weill Cornell Cancer Center, Weill Cornell Medical College, Cornell University, United States
| | - Ari Melnick
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medical College, Cornell University, United States
- Weill Cornell Cancer Center, Weill Cornell Medical College, Cornell University, United States
- Department of Pharmacology, Weill Cornell Medical College, Cornell University, United States
| | - Leandro Cerchietti
- Division of Hematology and Oncology, Medicine Department, Weill Cornell Medical College, Cornell University, United States
- Weill Cornell Cancer Center, Weill Cornell Medical College, Cornell University, United States
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16
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Affiliation(s)
- Bruce D Cheson
- Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC 20007, USA.
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17
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Huang HH, Xiao F, Chen FY, Wang T, Li JM, Wang JM, Cao JN, Wang C, Zou SH. Reassessment of the prognostic value of the International Prognostic Index and the revised International Prognostic Index in patients with diffuse large B-cell lymphoma: A multicentre study. Exp Ther Med 2012. [PMID: 23181121 PMCID: PMC3503699 DOI: 10.3892/etm.2012.607] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The International Prognostic Index (IPI) is a widely accepted model that is used to predict the prognosis of patients with diffuse large B-cell lymphoma (DLBCL) who are treated using chemotherapy. However, the prognostic value of the IPI has been a focal point of debate in the immunochemotherapy era. The aim of this study was to reassess the value of the IPI and revised IPI (R-IPI) in a Chinese population. A multicentre retrospective analysis of DLBCL patients who were treated with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP)-like chemotherapy alone or chemotherapy plus rituximab (R-CHOP-like) was performed. The prognostic values of IPI and R-IPI at the time of diagnosis with respect to overall survival (OS) and progression-free survival (PFS) were evaluated. Among the 438 patients in the study, 241 received a CHOP-like regimen and 197 patients received an R-CHOP-like regimen. Although the IPI remained predictive for the CHOP-like group, it failed to distinguish between the various prognostic categories in the R-CHOP-like group. Notably, redistribution of the IPI factors into R-IPI factors identified three discrete prognostic groups with significantly different outcomes in both the CHOP-like and R-CHOP-like groups. In the R-CHOP-like group, these three risk groups, very good, good and poor, had distinctly different 3-year PFS rates of 96, 84.3 and 67.5% (P=0.001), and 3-year OS rates of 96, 87.6 and 71.1% (P=0.003), respectively. Our study demonstrates the power of the R-IPI as a simplified and more clinically relevant predictor of disease outcome than the standard IPI in DLBCL populations in the rituximab era. Therefore, the R-IPI merits further study in a larger population-based prospective study.
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18
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Huntington SF, Talbott MS, Greer JP, Morgan DS, Reddy N. Toxicities and outcomes among septuagenarians and octogenarians with diffuse large B-cell lymphoma treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone therapy. Leuk Lymphoma 2012; 53:1461-8. [PMID: 22260160 DOI: 10.3109/10428194.2012.658793] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The diagnosis of non-Hodgkin lymphoma (NHL) is increasingly common among the elderly and it is well recognized that this patient population may benefit from therapy. No guidelines exist for chemotherapy dosing in the elderly population, and a clear assessment of treatment toxicity and benefits has not been previously reported. In this single-institution study, we report the toxicities and treatment outcomes of septuagenarians and octogenarians with large cell lymphoma treated with chemo-immunotherapy with or without radiation, as primary therapy with curative intent. We identified 37 patients over the age of 70 years diagnosed with large cell lymphoma treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) and compared their experience with 65 patients aged less than 70 years. Our retrospective analysis suggests that elderly patients are more susceptible to treatment-related toxicity despite more frequent chemotherapy dose reductions and greater utilization of supportive care. While our aged patients experienced greater frequency of hospitalization during R-CHOP treatment, the vast majority were able to receive relative chemotherapy dose-intensity greater than 70% and experienced similar rates of complete remission.
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Affiliation(s)
- Scott F Huntington
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37135, USA
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19
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Li S, Zhang D, Sun J, Li Z, Deng L, Zou B, Zhan J, Jiang W. Pharmacokinetics and tolerability of human mouse chimeric anti-CD22 monoclonal antibody in Chinese patients with CD22-positive non-Hodgkin lymphoma. MAbs 2012; 4:256-66. [PMID: 22453099 PMCID: PMC3361661 DOI: 10.4161/mabs.4.2.19136] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 12/19/2011] [Accepted: 12/20/2011] [Indexed: 12/14/2022] Open
Abstract
The safety and pharmacokinetics assessment of antibodies targeting CD22 (e.g., epratuzumab) have been established in western Caucasian populations, but there are no reports of the effects in Chinese populations. This dose-escalation study examines the safety, pharmacokinetics and biologic effects of multiple doses of anti-CD22 human-murine chimeric monoclonal antibody SM03 in 21 Chinese patients with CD22-positive non-Hodgkin lymphoma. Most of drug-related adverse events (AEs) were mild and reversible. Two patients experienced serious AEs (hemorrhage); one patient had grade 4 neutropenia; one patient had asymptomatic grade III prolongation of activated partial thromboplastin time (APTT). Major AEs included fever (71%), prolongation of APTT (42.8%), leukocytopenia (44.4%), alanine transaminase elevation (28.6%), elevated serum creatinine (23.8%) and injection site skin redness (14.3%). Circulating B cells transiently decreased without significant effects on T cells or immunoglobulin levels. Pharmacokinetic data revealed that mean maximum observed SM03 concentration and mean AUC from time zero to infinity increased in a dose-dependent manner up to 360 mg/m (2) SM03. Mean clearance was similar at doses ≤ 360 mg/m (2) and decreased significantly at dose 480 mg/m (2), supporting saturation of B-cell binding at 360 mg/m (2). Across all dose levels and histologies, one patient achieved partial response at 480 mg/m (2) dose; 14 patients had stable disease as best response and four patients progressed. Overall, SM03 was tolerated at doses ranging from 60-480 mg/m (2) and had potential efficacy in Chinese patients with follicular lymphoma.
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MESH Headings
- Adult
- Aged
- Animals
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/pharmacokinetics
- Antibodies, Neoplasm/administration & dosage
- Antibodies, Neoplasm/adverse effects
- Antibodies, Neoplasm/immunology
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/immunology
- Antineoplastic Agents/pharmacokinetics
- China
- Dose-Response Relationship, Drug
- Female
- Humans
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/immunology
- Lymphoma, Follicular/pathology
- Male
- Mice
- Middle Aged
- Sialic Acid Binding Ig-like Lectin 2
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Affiliation(s)
- Su Li
- State Key Laboratory of Oncology in Southern China; Sun Yat-Sen University; Guangzhou, Guangdong China
- Department of Clinical Trial Center; Cancer Center; Sun Yat-sen University; Guangzhou, Guangdong China
| | - Dongsheng Zhang
- State Key Laboratory of Oncology in Southern China; Sun Yat-Sen University; Guangzhou, Guangdong China
- Department of Medical Oncology; Cancer Center; Sun Yat-Sen University; Guangzhou, Guangdong China
| | - Jian Sun
- State Key Laboratory of Oncology in Southern China; Sun Yat-Sen University; Guangzhou, Guangdong China
- Department of Clinical Trial Center; Cancer Center; Sun Yat-sen University; Guangzhou, Guangdong China
| | - Zhinming Li
- State Key Laboratory of Oncology in Southern China; Sun Yat-Sen University; Guangzhou, Guangdong China
- Department of Medical Oncology; Cancer Center; Sun Yat-Sen University; Guangzhou, Guangdong China
| | - Liting Deng
- State Key Laboratory of Oncology in Southern China; Sun Yat-Sen University; Guangzhou, Guangdong China
- Department of Clinical Trial Center; Cancer Center; Sun Yat-sen University; Guangzhou, Guangdong China
| | - Benyan Zou
- State Key Laboratory of Oncology in Southern China; Sun Yat-Sen University; Guangzhou, Guangdong China
- Department of Medical Oncology; Cancer Center; Sun Yat-Sen University; Guangzhou, Guangdong China
| | - Jing Zhan
- State Key Laboratory of Oncology in Southern China; Sun Yat-Sen University; Guangzhou, Guangdong China
- Department of Clinical Trial Center; Cancer Center; Sun Yat-sen University; Guangzhou, Guangdong China
| | - Wenqi Jiang
- State Key Laboratory of Oncology in Southern China; Sun Yat-Sen University; Guangzhou, Guangdong China
- Department of Medical Oncology; Cancer Center; Sun Yat-Sen University; Guangzhou, Guangdong China
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20
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Abstract
OPINION STATEMENT: The standard front-line treatment of Diffuse Large B-Cell Lymphoma (DLBCL) remains Rituximab combined with multi-agent cytotoxic chemotherapy. In spite of high response rates to this therapy, relapsed/refractory disease is observed in up to 40% of patients. It is our opinion that additional chemoimmunotherapy, followed by high-dose therapy with autologous stem cell transplant (HDT-ASCT) for responsive disease, is the optimal therapy for these patients. However, many patients cannot tolerate HDT-ASCT, or have relapsed/refractory disease in spite of it. These patients have a poor overall prognosis, and there is no clear consensus as to how these patients should be treated. Over the past decade, significant advances have been made in the understanding of the molecular genesis and subtyping of DLBCL, leading to the identification of multiple pathways and molecules that can be targeted for clinical benefit. Examples include Bcl-2, Bcl-6, cell surface markers, and myriad molecules in both the B-Cell receptor and PI3K/Akt/mTOR pathways. As agents targeting these molecules and pathways progress from preclinical models to early clinical trials, more is learned about what might predict for response to these agents, such as cell of origin classification, and/or expression of relevant molecular markers, as measured by immunohistochemistry or gene expression profiling. Both the successes and failures of these novel targeted agents promise to dramatically refine, improve, and individualize the classification and treatment of DLBCL. Therefore, it is our opinion that patients with relapsed/refractory DLBCL are an ideal population for clinical trials due to both the lack of standardized treatment, and the recent advancements in pathobiology and early-phase treatment options.
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21
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Yamaguchi H, Hirakawa T, Inokuchi K. Importance of relative dose intensity in chemotherapy for diffuse large B-cell lymphoma. ACTA ACUST UNITED AC 2011; 51:1-5. [PMID: 21628854 DOI: 10.3960/jslrt.51.1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
CHOP therapy combined with rituximab (R-CHOP) is currently a standard chemotherapy for diffuse large B-cell lymphoma (DLBCL). However, relapse is detected despite R-CHOP in approximately 30% of patients. Treatment results should be further improved. Previously, second- and third-generation therapies such as MACOP-B, m-BACOD, and ProMACE-CytaBOM were performed to improve the results of DLBCL treatment. However, dose intensity (DI) enhancement increased treatment-associated toxicity, and the treatment results did not improve. Recently, the entity of the relative dose intensity (RDI) was proposed as an index of the intensity of chemotherapy. In this method, the ratio of actual DI to the DI designed per specific period is numerically evaluated. The purpose of calculating the RDI is to achieve chemotherapy as scheduled while maintaining the DI, and not to improve the DI. Previous studies reported that the maintenance of the RDI during CHOP therapy improved the treatment results. In this paper, we review DI and RDI in studies of DLBCL, and revisit the significance of these indicators.
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Affiliation(s)
- Hiroki Yamaguchi
- Division of Hematology, Department of Internal Medicine, Nippon Medical School, Bunkyo-Ku, Tokyo Japan.
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22
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Reagan JL, Rosmarin A, Butera JN, Nadeem A, Schiffman FJ, Sikov WM, Winer E, Mega AE. Phase I trial examining addition of gemcitabine to CHOP in intermediate grade NHL. Cancer Chemother Pharmacol 2011; 68:1075-80. [DOI: 10.1007/s00280-011-1702-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 06/29/2011] [Indexed: 10/18/2022]
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23
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Nowakowski GS, LaPlant B, Habermann TM, Rivera CE, Macon WR, Inwards DJ, Micallef IN, Johnston PB, Porrata LF, Ansell SM, Klebig RR, Reeder CB, Witzig TE. Lenalidomide can be safely combined with R-CHOP (R2CHOP) in the initial chemotherapy for aggressive B-cell lymphomas: phase I study. Leukemia 2011; 25:1877-81. [PMID: 21720383 DOI: 10.1038/leu.2011.165] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Lenalidomide was shown to have significant single-agent activity in relapsed aggressive non-Hodgkin's lymphoma (NHL). We conducted a phase I trial to establish the maximum tolerated dose of lenalidomide that could be combined with R-CHOP (rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone). Eligible patients were adults with newly diagnosed, untreated CD20 positive diffuse large cell or follicular grade III NHL. Patients received oral lenalidomide on days 1-10 with standard dose R-CHOP every 21 days. All patients received pegfilgrastim on day 2 of the cycle and aspirin prophylaxis. The lenalidomide dose levels tested were 15, 20 and 25 mg. A total of 24 patients were enrolled. The median age was 65 (35-82) years and 54% were over 60 years. Three patients received 15 mg, 3 received 20 mg and 18 received 25 mg of lenalidomide. No dose limiting toxicity was found, and 25 mg on days 1-10 is the recommended dose for phase II. The incidence of grade IV neutropenia and thrombocytopenia was 67% and 21%, respectively. Febrile neutropenia was rare (4%) and there were no toxic deaths. The overall response rate was 100% with a complete response rate of 77%. Lenalidomide at the dose of 25 mg/day administered on days 1 to 10 of 21-day cycle can be safely combined with R-CHOP in the initial chemotherapy of aggressive B-cell lymphoma.
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Affiliation(s)
- G S Nowakowski
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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24
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Jang G, Yoon DH, Kim S, Lee DH, Lee SW, Huh J, Suh C. Addition of rituximab to the CHOP regimen has no benefit in patients with primary extranodal diffuse large B-cell lymphoma. THE KOREAN JOURNAL OF HEMATOLOGY 2011; 46:103-10. [PMID: 21747882 PMCID: PMC3128890 DOI: 10.5045/kjh.2011.46.2.103] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 06/07/2011] [Accepted: 06/08/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND The addition of rituximab to cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy (R-CHOP) has significantly improved clinical outcomes for patients with diffuse large B-cell lymphoma (DLBCL). However, new predictors of patient response to R-CHOP have not been established. We aimed to evaluate the impact of R-CHOP compared with CHOP in patients with DLBCL and to establish clinical predictors of better outcomes in these patients. METHODS We retrospectively identified 177 patients diagnosed with CD20-positive DLBCL and treated with CHOP (N=82) or R-CHOP (N=95). The response rate, event-free survival (EFS), and overall survival (OS) rates were compared between the 2 treatment groups. All patients were classified into primary extranodal lymphoma (PENL) or nodal lymphoma (NL) subgroups, and the clinical parameters of each subgroup were analyzed. RESULTS The overall response rate was higher in R-CHOP group (95% vs. 84%, P=0.07). The 3-year EFS rate was significantly higher in R-CHOP group (71% vs. 52%, P=0.013), but the OS rate was comparable between the 2 groups (79% vs. 69%, P=0.23). A significant survival benefit was seen with R-CHOP compared to CHOP therapy in NL patients (P=0.002 for EFS and 0.04 for OS). Multivariate analyses confirmed that R-CHOP therapy is an independent prognostic factor for EFS (hazard ratio of 0.32 [0.17-0.62], P=0.001) and OS (hazard ratio of 0.4 [0.18-0.87], P=0.02) in NL patients. CONCLUSION Patients in the PENL group did not benefit from R-CHOP chemotherapy.
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Affiliation(s)
- Geundoo Jang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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25
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Ohmachi K, Tobinai K, Kobayashi Y, Itoh K, Nakata M, Shibata T, Morishima Y, Ogura M, Suzuki T, Ueda R, Aikawa K, Nakamura S, Fukuda H, Shimoyama M, Hotta T. Phase III trial of CHOP-21 versus CHOP-14 for aggressive non-Hodgkin’s lymphoma: final results of the Japan Clinical Oncology Group Study, JCOG 9809. Ann Oncol 2011; 22:1382-1391. [DOI: 10.1093/annonc/mdq619] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Dell'olio M, Potito scalzulli R, Sanpaolo G, Nobile M, Saverio mantuano F, La sala A, D'arena G, Miraglia E, Lucania A, Mastrullo L, Nicola C. Non-pegylated liposomal doxorubicin (Myocet®) in patients with poor-risk aggressive B-cell non-Hodgkin lymphoma. Leuk Lymphoma 2011; 52:1222-9. [DOI: 10.3109/10428194.2011.572321] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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27
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Lee L, Wang L, Crump M. Identification of potential surrogate end points in randomized clinical trials of aggressive and indolent non-Hodgkin's lymphoma: correlation of complete response, time-to-event and overall survival end points. Ann Oncol 2011; 22:1392-1403. [PMID: 21266519 PMCID: PMC3101365 DOI: 10.1093/annonc/mdq615] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The correlation between efficacy end points in randomized controlled trials (RCTs) of systemic therapy for non-Hodgkin's lymphoma (NHL) was investigated to identify an appropriate surrogate end point for overall survival (OS). METHODS RCTs of previously untreated NHL published from 1990 to 2009 were identified. Associations between absolute differences in efficacy end points were determined using nonparametric Spearman's rank correlation coefficients (r(s)). RESULTS Thirty-eight RCTs representing 85 treatment arms for aggressive NHL and 20 RCTs representing 42 arms for indolent NHL were included. For aggressive NHL, differences in 3-year progression-free survival (PFS)/event-free survival (EFS) were high correlated with differences in 5-year OS {r(s) of 0.90 [95% confidence interval (CI) 0.73-0.96]} and linear regression determined that a 10% improvement in 3-year EFS or PFS would predict for a 7% ± 1% improvement in 5-year OS. For indolent histology disease, differences in complete response were strongly correlated with differences in 3-year EFS [r(s) 0.86 (95% CI 0.35-0.97)], but there was no correlation between 3-year time-to-event end points and 5-year OS. CONCLUSIONS Improvements in 3-year EFS/PFS are highly correlated with improvements in 5-year OS in aggressive NHL and should be explored as a candidate surrogate end point. Definition of these relationships may inform future clinical trial design and interpretation of interim trial data.
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Affiliation(s)
- L Lee
- Division of Medical Oncology and Hematology
| | - L Wang
- Department of Biostatistics, Princess Margaret Hospital, Toronto, Canada
| | - M Crump
- Division of Medical Oncology and Hematology.
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28
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Zinzani PL, Broccoli A, Stefoni V, Musuraca G, Abruzzese E, De Renzo A, Cantonetti M, Bacci F, Baccarani M, Pileri SA. Immunophenotype and intermediate-high international prognostic index score are prognostic factors for therapy in diffuse large B-cell lymphoma patients. Cancer 2010; 116:5667-75. [DOI: 10.1002/cncr.25307] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 12/23/2009] [Accepted: 01/26/2010] [Indexed: 11/10/2022]
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29
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Abstract
Lymphoma involving the colon and rectum is rare and can occur either as primary colorectal lymphoma or as a manifestation of systemic disease. Most patients with primary colorectal lymphoma present with abdominal pain, and obstruction is unusual. Although lesions may be evident on radiographic studies, the findings are generally nonspecific. Historically, aggressive B-cell lymphomas have been the most common gastrointestinal lymphomas reported in the literature. However, recent reports suggest increased rates of mucosa-associated lymphoid tissue (MALT) lymphoma and mantle cell lymphoma (MCL) with increased surveillance.1 Most patients with colorectal lymphoma undergo surgery, but multiagent chemotherapy remains the mainstay of treatment. B-cell lymphomas tend to be most aggressive, with a median survival of about 2 years.
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Affiliation(s)
- Frank J Quayle
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
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30
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Rituximab in combination with CHOP chemotherapy for the treatment of diffuse large B cell lymphoma in Japan: a retrospective analysis of 1,057 cases from Kyushu Lymphoma Study Group. Int J Hematol 2010; 91:258-66. [DOI: 10.1007/s12185-009-0475-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Revised: 11/02/2009] [Accepted: 12/15/2009] [Indexed: 11/24/2022]
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31
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Evens AM, Sehn LH, Farinha P, Nelson BP, Raji A, Lu Y, Brakman A, Parimi V, Winter JN, Schumacker PT, Gascoyne RD, Gordon LI. Hypoxia-inducible factor-1 {alpha} expression predicts superior survival in patients with diffuse large B-cell lymphoma treated with R-CHOP. J Clin Oncol 2010; 28:1017-24. [PMID: 20048181 DOI: 10.1200/jco.2009.24.1893] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Hypoxia-inducible factor (HIF) controls the expression of genes in response to hypoxia, as well as a wide range of other cellular processes. We previously showed constitutive stabilization of HIF-1alpha in the majority of patients with diffuse large B-cell lymphoma (DLBCL). To our knowledge, the prognostic significance of HIF in lymphoma has never been investigated. PATIENTS AND METHODS We studied the immunohistochemical protein expression of HIF-1alpha on tissue microarrays from 153 patients with DLBCL treated in sequential cohorts with cyclophosphamide, doxorubicin, oncovin, and prednisone (CHOP) or rituximab-CHOP (R-CHOP) from 1999 to 2002. Results were correlated with patient outcome. Results Median follow-up for all patients was 80 months. Among all patients, HIF-1alpha was expressed in 62% of germinal center and 59% of non-germinal center patients. With HIF-1alpha analyzed as a dependent variable, there were no survival differences in CHOP-treated patients. In the R-CHOP group, however, HIF-1alpha protein expression correlated with significantly improved progression-free survival (PFS) and overall survival (OS). Five-year PFS for HIF-1alpha-positive patients was 71% v 43% for HIF-1alpha-negative patients (P = .0187), whereas 5-year OS was 75% and 54%, respectively (P = .025). In multivariate analysis with International Prognostic Index criteria, HIF-1alpha remained a significant predictor for PFS (P = .026) and OS (P = .043). Compared with other biomarkers, HIF-1alpha correlated only with BCL6 (P = .004). In terms of gene expression, we found several common gene associations of HIF-1alpha and the stromal-1 signature with genes predominantly involved in regulation of the extracellular matrix (eg, BGN, COL1A2, COL5A1, and PLOD2). CONCLUSION The expression of HIF-1alpha protein is an important independent favorable prognostic factor for survival in patients with DLBCL treated with R-CHOP.
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Affiliation(s)
- Andrew M Evens
- DO, Division of Hematology/Oncology, 676 N St Clair St, Suite 850, Chicago, IL 60611, USA.
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Aguiar Bujanda D, Aguiar Morales J, Bohn Sarmiento U, Saura Grau S, Rodríguez Franco C. Clinical experience with biweekly CHOP plus rituximab chemoimmunotherapy for the treatment of aggressive B-cell non-Hodgkin lymphoma. Clin Transl Oncol 2009; 11:604-8. [PMID: 19776000 DOI: 10.1007/s12094-009-0411-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The results of CHOP-21 (cyclophosphamide, doxorubicin, vincristine and prednisone given every 21 days) for the treatment of aggressive B-cell lymphoma have recently been improved by the addition of rituximab and by increasing the dose density. R-CHOP-14 combines these two approaches. PATIENTS AND METHODS We present our experience with R-CHOP-14 in a retrospective single-centre review of 50 patients consecutively treated for aggressive B-cell lymphoma. RESULTS The median age was 59 years and 48% of patients were >60 years. Stage III-IV was present in 62% of the patients and international prognostic index was high-to-intermediate risk or high risk in 32% of the patients. Toxicity was mainly haematological, with grade 3-4 neutropenia observed in 32% and febrile neutropenia in 18%. Other relevant toxicities were peripheral neuropathy in 45% (grade 3 in 4%) and cardiac dysfunction grade 3 in 7.5%. After therapy, 82% of the patients achieved complete response or unproved complete response. With a median follow-up of 30 months, 3-year event-free survival and overall survival were 67% and 82% respectively. CONCLUSIONS In our experience the combination of RCHOP- 14 is highly effective in patients with aggressive B-cell lymphoma. However special attention must be paid to the control of early and late toxicities.
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Affiliation(s)
- David Aguiar Bujanda
- Servicio de Oncología Médica, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain.
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Danzon A, Belot A, Maynadié M, Remontet L, Dupont ACG, Carbonnel F. Incidence and survival of gastric non-Hodgkin's lymphoma: a population-based study from the Association of the French Cancer Registries (FRANCIM). Acta Oncol 2009; 48:977-83. [PMID: 19551530 DOI: 10.1080/02841860903032825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Most epidemiological studies on gastric lymphomas (GL) were carried out before changes in therapy were introduced. The aim of the study was to measure the incidence of GL and to estimate survival. MATERIAL AND METHODS Data were provided by the Association of the French Cancer Registries database. Age-standardized incidence rates were calculated for 786 incident cases diagnosed between 1978 and 2002. Crude and relative survival were calculated for 361 cases diagnosed between 1989 and 1997. Effects specific to sex, age at diagnosis, year of diagnosis, and grade of malignancy were estimated in multivariate analysis. RESULTS Incidence was stable during the study period. However, high-grade GL frequency increased whereas low-grade and not otherwise specified (NOS) GL frequencies were respectively stable and decreased. At 5 years, relative survival was 63% in men and 60% in women. Patients aged 75 or older had a five-year relative survival of 33%. Age at diagnosis was the only significant prognostic factor in multivariate analysis. Time trend improvement in prognosis was observed. DISCUSSION Results in elderly patients show that therapeutic regimens should be specifically designed and assessed for them. The prognosis improvement trend is probably related to the implementation of changes in management of patients and has to be confirmed by more recent data.
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Halaas JL, Moskowitz CH, Horwitz S, Portlock C, Noy A, Straus D, O'Connor OA, Yahalom J, Zelenetz AD. R-CHOP-14 in patients with diffuse large B-cell lymphoma: Feasibility and preliminary efficacy. Leuk Lymphoma 2009; 46:541-7. [PMID: 16019482 DOI: 10.1080/10428190400029932] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Treatment of diffuse large B-cell lymphoma (DLBCL) with CHOP-21 (cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, vincristine 1.4 mg/m2, prednisone 100 mg for 5 days every 21 days) results in long-term remission in approximately 45% of patients. Recent phase III trials have demonstrated improved survival by modifying CHOP either through adding rituximab or shortening the time between cycles to 14 days. These studies prompted our institution to treat newly diagnosed patients with DLBCL refusing or not eligible for protocol-based therapy with R-CHOP-14. In this single-institution retrospective analysis, we report our results with this regimen. Forty-nine patients with newly diagnosed DLBCL and ineligible or refusing protocol-based therapy were retrospectively identified. Patients were treated with 6-8 cycles of R-CHOP-14 given with filgrastim and prophylactic antibiotics. The main toxicities with R-CHOP-14 were hematological and neurological and were not unexpected. There were no treatment-related deaths. Patients received 90% of planned cytotoxic drug density. The complete remission/complete remission uncertain (CR/CRu) rate was 82.2%. At a median follow-up of 24 months, the event-free survival was 80% and overall survival 90%. These results demonstrate R-CHOP-14 can be given to patients safely and short-term results regarding survival are promising. Whether adding rituximab and increasing dose intensity improves survival over either alone will require randomized studies.
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MESH Headings
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/adverse effects
- Cyclophosphamide/therapeutic use
- Dose-Response Relationship, Drug
- Doxorubicin/administration & dosage
- Doxorubicin/adverse effects
- Doxorubicin/therapeutic use
- Feasibility Studies
- Female
- Follow-Up Studies
- Humans
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/drug therapy
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Male
- Middle Aged
- Prednisone/administration & dosage
- Prednisone/adverse effects
- Prednisone/therapeutic use
- Prospective Studies
- Retrospective Studies
- Rituximab
- Survival Analysis
- Treatment Outcome
- Vincristine/administration & dosage
- Vincristine/adverse effects
- Vincristine/therapeutic use
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Affiliation(s)
- Jeffrey L Halaas
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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35
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Morschhauser F, Zinzani PL, Burgess M, Sloots L, Bouafia F, Dumontet C. Phase I/II trial of a P-glycoprotein inhibitor, Zosuquidar.3HCl trihydrochloride (LY335979), given orally in combination with the CHOP regimen in patients with non-Hodgkin's lymphoma. Leuk Lymphoma 2009; 48:708-15. [PMID: 17454628 DOI: 10.1080/10428190701190169] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A phase I/II trial was performed to investigate the safety and tolerance of zosuquidar.3HCL, a potent inhibitor of P-glycoprotein (P-gp), when administered orally alone and in combination with the CHOP regimen in patients with untreated non-Hodgkin's lymphoma and to determine whether zosuquidar.3HCL affects pharmacokinetics of doxorubicin and vincristine. Doses of CHOP remained constant and the doses of zosuquidar.3HCL were increased from 200 to 500 mg per dose. A total of 15 patients were treated at three dose levels. A target dose providing peak and trough levels compatible with prolonged modulation of P-gp function was obtained in patients receiving three doses of 500 mg of zosuquidar.3HCL p.o. At this dose level, toxicity was minimal and no enhancement of CHOP-related toxicity was observed. Zosuquidar.3HCL did not significantly affect the pharmacokinetics of doxorubicin and had moderate effects on the pharmacokinetics of vincristine. Zosuquidar.3HCL can be safely administered with CHOP therapy using a 24-h schedule.
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36
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Biagi JJ, Herbert KE, Smith C, Abdi E, Leahy M, Falkson C, Wolf M, Januszewicz H, Seymour JF, Richards K, Matthews JP, Dale B, Prince HM. A phase II study of dexamethasone, ifosfamide, cisplatin and etoposide (DICE) as salvage chemotherapy for patients with relapsed and refractory lymphoma. Leuk Lymphoma 2009; 46:197-206. [PMID: 15621802 DOI: 10.1080/10428190400014884] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The 4-day combination of dexamethasone, ifosfamide, cisplatin, and etoposide (DICE) is a salvage regimen for lymphoma. We report a prospective phase II multi-center trial of a modified DICE regimen in relapsed or refractory Hodgkin (HL) or non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia (CLL), constituting a single day of intravenous administration followed by 3 days of oral administration, aimed at reducing inpatient days without losing efficacy. Forty patients (median age 56, range 25 - 79) were included: 28 (70%) NHL, 9 (23%) HL and 3 (8%) CLL. Fifty-three per cent had received 2 prior treatment regimens. International Prognostic Index (IPI) was 2 in 75% of NHL patients. Patients aged 55 and those with previous autologous stem cell transplantation (ASCT) started on a lower-dose regimen, with dose escalation possible in 2 patients. Overall response rate was 41%. Thirty-eight per cent of patients had stable disease. With a median of 3.1 years of follow-up, estimated progression-free survival (PFS) and overall survival (OS) rates at 3 years were 15% and 43% respectively. OS was longer in the < 55 compared to the 55 age cohort (P = 0.0091), longer for HL than NHL (P = 0.59 and 0.039 respectively) and longer for Low/Low-Int IPI than High/High-Int IPI (P = 0.0074 and 0.0009 respectively). Median duration of inpatient stay was 3 days. There were no treatment-related deaths. In conclusion, this modification of DICE is an effective and well tolerated salvage regimen, even in this poor prognosis group of patients. Further clinical studies of DICE in first relapse and in older patients, possibly with the addition of rituximab, are warranted.
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Affiliation(s)
- J J Biagi
- Department of Hematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Peterson BA, Johnson J, Shipp MA, Barcos M, Gockerman JP, Canellos GP. High dose CHOP: A phase II study of initial treatment in aggressive non-Hodgkin lymphoma. Cancer and Leukemia Group B 9351. Leuk Lymphoma 2009; 48:870-80. [PMID: 17487729 DOI: 10.1080/10428190701259758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cyclophosphamide and doxorubicin, two important drugs in the treatment of lymphoma, exhibit a relationship between dose and fractional cell kill, and because of their toxicity profiles, they are candidates for significant dose escalation. We performed a phase II trial to determine the response rate, toxicity, and feasibility of escalated doses of both drugs as part of high dose CHOP in diffuse aggressive lymphoma. Patients who had advanced, previously untreated diffuse aggressive lymphomas (IWF E-H) and an International Prognostic Index of intermediate to high risk were eligible. Treatment was cyclophosphamide 2 gm/m(2)/day intravenously on Days 1 and 2 (total cycle dose 4 gm/m(2)), doxorubicin 35 mg/m(2)/day as a continuous infusion on Days 1 and 2 (total 70 mg/m(2)), vincristine 1.4 mg/m(2) (maximum 2 mg) on Day 1 and prednisone 100 mg/day orally on Days 1 - 5 repeated every 3 weeks for a total of four cycles. G-CSF, prophylactic antibiotics, and mesna were provided. A total of 99 patients were enrolled; 98 received therapy. Major toxicities were Grade 4 neutropenia and thrombocytopenia occurring in 97% and 92%, respectively. Serious infections occurred in 53%. Treatment-related mortality was 2%. The overall response rate is 85%, and two-year failure free and overall survival are 39% and 64%, respectively. Persistent or relapsed lymphoma was the overwhelming cause of death. Six patients have developed AML or MDS. In view of the substantial toxicity accompanying high dose CHOP, the observed outcome suggests that its efficacy is not sufficient to make further study feasible.
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38
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Lin Y, Guo XM, Shen KW, Wang JL, Jiang GL. Primary breast lymphoma: Long-term treatment outcomeand prognosis. Leuk Lymphoma 2009; 47:2102-9. [PMID: 17071483 DOI: 10.1080/10428190600679064] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Between 1980 and 2002, 32 cases diagnosed as primary breast lymphoma were reviewed. Among them, 18 patients were stage I and 14 were stage II. Four patients underwent mastectomy and the remainder underwent lumpectomy. Twenty-eight patients received postoperative chemotherapy and 20 patients received postoperative radiotherapy. After a median follow-up of 76 (range 25 - 245) months, the 5-year overall survival and relapse-free survival was 69.3% and 47.7%, respectively. Ann Arbor stage, International Prognostic Index (IPI) excluding stage, lactic dehydrogenase (LDH) and radiotherapy were significant factors for relapse-free survival. We conclude that younger age and elevated LDH were apparent characters of the patients in our study. IPI excluding stage was a valuable prognostic factor. Combined radiotherapy and chemotherapy appeared to be important for treatment.
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Affiliation(s)
- Yuan Lin
- Department of Radiation Oncology. Fudan University, Shanghai, PR China.
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39
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Visani G, Ferrara F, Alesiani F, Ronconi S, Catarini M, D'adamo F, Guiducci B, Bernardi D, Barulli S, Piccaluga P, Rocchi M, Isidori A. R-COMP 21 for frail elderly patients with aggressive B-cell non-Hodgkin lymphoma: A pilot study. Leuk Lymphoma 2009; 49:1081-6. [PMID: 18569635 DOI: 10.1080/10428190802043853] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We evaluated the toxicity and efficacy of nonpegylated liposomal doxorubicin (Myocet) when substituted for conventional doxorubicin in the CHOP-21 regimen in the treatment of frail elderly patients with aggressive non-Hodgkin lymphoma. Twenty frail patients (median age, 73 years), as defined by Balducci et al., with diffuse large B cell or grade IIIb follicular lymphoma, either at diagnosis (15 patients) or relapsed (five patients), were prospectively enrolled. Nine out of 20 (45%) had a World Health Organisation (WHO) performance status > or =2. Fifteen out of 20 patients (75%) had an International Prognostic Index (IPI) score > or =3. Thirteen out of 20 (65%) evaluable patients obtained a complete response. Five additional patients (25%) achieved a partial response. With a median follow-up of 24 months (range 18-27), 15/18 responding patients (83%) are alive and disease free, as well as 3/18 are alive with active disease. Toxicity was mainly hematological with grade 3/4 neutropenia in 26% of cycles and febrile neutropenia in 5%. However, 3/20 patients presented a grade III-IV WHO toxicity (one fatal pulmonary embolism, one congestive, and one ischemic heart failure) while receiving R-COMP chemotherapy. In conclusion, R-COMP-21 is an effective regimen with promising response rates for frail and elderly patients with aggressive non-Hodgkin lymphoma.
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40
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The effect of adding rituximab to CHOP-based therapy on clinical outcomes for Japanese patients with diffuse large B-cell lymphoma: a propensity score matching analysis. Int J Hematol 2009; 89:326-331. [DOI: 10.1007/s12185-009-0259-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2008] [Revised: 01/06/2009] [Accepted: 01/27/2009] [Indexed: 10/21/2022]
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41
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Schulz H, Brillant C, Schwarzer G, Trelle S, Greb A, Bohlius J, Engert A. High-dose chemotherapy with autologous stem cell support for first-line treatment of aggressive non-Hodgkin lymphoma: a systematic review and meta-analysis based on individual patient data. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2009. [DOI: 10.1002/14651858.cd007580] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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42
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Jabbour E, Peslin N, Arnaud P, Ferme C, Carde P, Vantelon JM, Bocaccio C, Bourhis JH, Koscielny S, Ribrag V. Prognostic value of the age-adjusted International Prognostic Index in chemosensitive recurrent or refractory non-Hodgkin's lymphomas treated with high-dose BEAM therapy and autologous stem cell transplantation. Leuk Lymphoma 2008; 46:861-7. [PMID: 16019530 DOI: 10.1080/10428190500054350] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
High-dose therapy (HDT) is now recommended for patients under 60 years of age with chemosensitive relapsed aggressive non-Hodgkin's lymphoma. However, approximately half of these patients will be cured by HDT. Prognostic factors are needed to predict which patients with chemosensitive lymphoma to second-line therapy could benefit from HDT. We retrospectively investigated the prognostic value of the widely used age-adjusted International Prognostic Index (AA-IPI) calculated at the time of relapse (35 patients) or just before second-line salvage therapy for primary refractory disease (5 patients). The median age was 51 years (range 18-64 years). Thirty-six patients had diffuse large B-cell lymphoma. Salvage cytoreductive therapy before HDT was DHAP/ESHAP (cytarabine, cysplatin, etoposide, steroids) in 17 patients, VIM3-Ara-c/MAMI (high-dose cytarabine, ifosfamide, methyl-gag, amsacrine) in 17 patients, CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) or reinforced CHOP in 4 patients, high-dose cyclophosphamide and etoposide in 2 patients. The HDT regimen consisted of BEAM (carmusine, cytarabine, etoposide, melphalan) in all cases. Eleven patients were in partial remission and 29 in complete remission at the time of HDT. Ten patients had an IPI >1, 16 had relapsed early (<6 months after first-line therapy) or disease was refractory to first-line therapy (5 of the 16 patients). The median follow-up was 6.07 years (range 1.24-9.74 years). Overall survival was not statistically different in patients with refractory disease or in those who relapsed early compared with late failures (>6 months after first-line chemotherapy) (P=1), but the AA-IPI >1 was associated with a poor outcome (P=0.03). In conclusion, the AA-IPI could have a prognostic value in patients with chemosensitive recurrent lymphoma treated with BEAM HDT.
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Affiliation(s)
- E Jabbour
- Département de Médecine, Institut Gustave Roussy, Villejuif, France
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43
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The use of erythropoiesis-stimulating agents in patients with non-myeloid hematological malignancies: a systematic review. Ann Hematol 2008; 87:961-73. [DOI: 10.1007/s00277-008-0525-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Accepted: 05/30/2008] [Indexed: 10/21/2022]
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44
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Blaes AH, Santa-Cruz KS, Lee CKK, Hui SK, Peterson BA. Necrotizing leukoencephalopathy following CHOP chemotherapy. Leuk Res 2008; 32:1611-4. [PMID: 18378307 DOI: 10.1016/j.leukres.2008.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 02/15/2008] [Accepted: 02/17/2008] [Indexed: 11/28/2022]
Abstract
Toxic leukoencephalopathy syndromes are rare disorders of cerebral injury characterized by changes in the white matter and accompanying neurologic dysfunction. They have been reported in association with a variety of clinical etiologies, most commonly including severe hypertension, cranial irradiation, and environmental toxins. However, they have also been described in conjunction with immunosuppressive and chemotherapeutic agents. There has been one case of fatal leukoencephalopathy reported following CHOP chemotherapy for non-Hodgkin lymphoma. We report a second case of fatal necrotizing leukoencephalopathy following the administration of CHOP chemotherapy.
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Affiliation(s)
- Anne H Blaes
- University of Minnesota, Department of Medicine, Division of Hematology/Oncology/Transplantation, United States.
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45
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Affiliation(s)
- Jonathan W Friedberg
- University of Rochester Medical Center, James P. Wilmot Cancer Center, Lymphoma Program 601 Elmwood Avenue, Box 704 Rochester, NY 14642, USA
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46
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Greb A, Bohlius J, Schiefer D, Schwarzer G, Schulz H, Engert A. High-dose chemotherapy with autologous stem cell transplantation in the first line treatment of aggressive non-Hodgkin lymphoma (NHL) in adults. Cochrane Database Syst Rev 2008; 2008:CD004024. [PMID: 18254036 PMCID: PMC9037599 DOI: 10.1002/14651858.cd004024.pub2] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND High-dose chemotherapy with autologous stem cell support (HDT) has been proven effective in relapsed aggressive non-Hodgkin lymphoma (NHL). However, conflicting results of HDT as part of first-line treatment have been reported in randomised controlled trials (RCTs). We undertook a systematic review and meta-analysis to assess the effects of such treatment. OBJECTIVES To determine whether high-dose chemotherapy with autologous stem cell transplantation as part of first-line treatment improves survival in patients with aggressive non-Hodgkin lymphoma. SEARCH STRATEGY MEDLINE, EMBASE, Cancer Lit, the Cochrane Library and smaller databases, Internet-databases of ongoing trials, conference proceedings of the American Society of Clinical Oncology and the American Society of Hematology were searched. We included full-text, abstract publications and unpublished data. SELECTION CRITERIA Randomised controlled trials comparing conventional chemotherapy versus high-dose chemotherapy in the first-line treatment of adults with aggressive non-Hodgkin lymphoma were included in this review. DATA COLLECTION AND ANALYSIS Eligibility and quality assessment, data extraction and analysis were done in duplicate. All authors were contacted to obtain missing data and asked to provide individual patient data. MAIN RESULTS Fifteen RCTs including 3079 patients were eligible for this meta-analysis. Overall treatment-related mortality was 6.0% in the HDT group and not significantly different compared to conventional chemotherapy (OR 1.33 [95% CI 0.91 to 1.93], P=0.14). 13 studies including 2018 patients showed significantly higher CR rates in the group receiving HDT (OR 1.32, [95% CI 1.09 to 1.59], P=0.004). However, HDT did not have an effect on OS, when compared to conventional chemotherapy. The pooled HR was 1.04 ([95% CI 0.91 to 1.18], P=0.58). There was no statistical heterogeneity among the trials. Sensitivity analyses underlined the robustness of these results. Subgroup analysis of prognostic groups according to IPI did not show any survival difference between HDT and controls in 12 trials (low and low-intermediate risk IPI: HR 1.41[95% CI 0.95 to 2.10], P=0.09; high-intermediate and high risk IPI: HR 0.97 [95% CI 0.83 to 1.13], P=0.71. Event-free survival (EFS) also showed no significant difference between HDT and CT (HR 0.93, [95% CI 0.81 to 1.07], P=0.31). Other possible risk factors such as the proportion of patient with diffuse large cell lymphoma, protocol adherence, HDT strategy, response status before HDT, conditioning regimens and methodological issues were analysed in sensitivity analyses. However, there was no evidence for an association between these factors and the results of our analyses. AUTHORS' CONCLUSIONS . Despite higher CR rates, there is no benefit for high-dose chemotherapy with stem cell transplantation as a first line treatment in patients with aggressive NHL.
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Affiliation(s)
| | - Julia Bohlius
- University of BernInstitute of Social and Preventive MedicineBernSwitzerland3012
| | - Daniel Schiefer
- University Hospital UlmDepartment of Internal Medicine IISteinhoevelweg 9UlmGermanyD‐89070
| | - Guido Schwarzer
- Institute of Medical Biometry and Medical Informatics, University Medical Center FreiburgGerman Cochrane CentreStefan‐Meier‐Str. 26FreiburgGermanyD‐79104
| | - Holger Schulz
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50924
| | - Andreas Engert
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50924
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47
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Ganjoo KN, An CS, Robertson MJ, Gordon LI, Sen JA, Weisenbach J, Li S, Weller EA, Orazi A, Horning SJ. Rituximab, bevacizumab and CHOP (RA-CHOP) in untreated diffuse large B-cell lymphoma: safety, biomarker and pharmacokinetic analysis. Leuk Lymphoma 2007; 47:998-1005. [PMID: 16840188 DOI: 10.1080/10428190600563821] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Bevacizumab is a humanized monoclonal antibody directed against vascular endothelial growth factor (VEGF-A). Non-Hodgkin's lymphoma patients with high serum VEGF levels have an inferior survival compared to patients with low VEGF levels. Bevacizumab was administered through a central line at 15 mg kg(-1) IV on day 1 followed by rituximab (R) and CHOP on day 2 for cycle 1 and day 1 for cycles 2 - 8. Serum levels of bevacizumab and R were measured at specified time points to assess pharmacokinetics (PK). Plasma and urine samples were also analysed for VEGF. Tumor samples were stained for VEGF, CD31 and factor VIII by immunohistochemistry. Thirteen patients with newly-diagnosed DLBCL received a total of 88 cycles (range 2 - 8, median 7). Best response included five CR, six PR, one SD and one PD with an overall response rate of 85% and complete response rate of 38%. The 12-month PFS is 77% and a median follow-up of 16.9 months for the surviving patients. All tumor samples stained strongly positive for VEGF and there was a marginal association between baseline plasma VEGF and response (p = 0.04). Patients with higher plasma VEGF levels were generally younger and had bulky disease. Micro-vessel density did not correlate with presenting disease characteristics, VEGF expression or response. The PK of bevacizumab and rituximab were not influenced by combined treatment. In this patient population, treatment with RA-CHOP did not result in any episodes of grade 3 or 4 proteinuria, heart failure or hemorrhage. The RA-CHOP combination was generally well tolerated and safe.
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MESH Headings
- Adult
- Angiogenesis Inhibitors/pharmacology
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Humanized
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/pharmacokinetics
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bevacizumab
- Biomarkers, Tumor/metabolism
- Cohort Studies
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Female
- Humans
- Lymphoma, B-Cell/drug therapy
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Male
- Middle Aged
- Neovascularization, Pathologic
- Prednisone/therapeutic use
- Rituximab
- Vincristine/therapeutic use
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Affiliation(s)
- Kristen N Ganjoo
- Department of Medicine (Oncology), Stanford University, CA, USA.
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48
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Ganjoo KN, Moore AM, Orazi A, Sen JA, Johnson CS, An CS. The importance of angiogenesis markers in the outcome of patients with diffuse large B cell lymphoma: a retrospective study of 97 patients. J Cancer Res Clin Oncol 2007; 134:381-7. [PMID: 17694324 DOI: 10.1007/s00432-007-0294-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Accepted: 07/17/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE The role of angiogenesis has been extensively evaluated in solid tumors and more recently in hematologic malignancies. Several surrogate markers of angiogenesis including tumor VEGF, VEGF receptors, and microvessel density have correlated with outcome in some lymphoma studies. This is a single institution retrospective study evaluating the role of angiogenesis markers in the clinical outcome of patients with diffuse large B cell lymphoma (DLBCL). PATIENTS AND METHODS A total of 97 patients with DLBCL diagnosed and managed at Indiana University between 1993 and 2001 were included. Archived tumor samples were stained for VEGF-A, VEGF-C, VEGF-R1, and CD31 and graded as negative or positive (1+, 2+, 3+). The relationship between the expression of these markers and the international prognostic variables as well as the progression free survival (PFS) and the overall survival (OS) was evaluated. RESULTS VEGF-A, VEGF-C, VEGF-R1 were expressed in 77, 98, and 18% of tumors, respectively. VEGF-A negative patients had an improved OS compared to VEGF-A (1+) (P = 0.0502). VEGF-C correlated with both LDH (r = 0.28, P = 0.0502) and IPI score (r = 0.25, P = 0.013). VEGF-R1 negative patients had a superior survival compared to those with VEGF-R1 (2+) (P = 0.0154). CONCLUSIONS The presence of tumor associated angiogenesis may alter the outcome of patients with DLBCL and could be a prognostic factor. Further clinical studies are needed to correlate the degree of angiogenesis with response to anti-angiogenesis agents.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/metabolism
- Disease-Free Survival
- Female
- Humans
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Neovascularization, Pathologic/metabolism
- Prognosis
- Retrospective Studies
- Vascular Endothelial Growth Factor A/analysis
- Vascular Endothelial Growth Factor A/metabolism
- Vascular Endothelial Growth Factor C/analysis
- Vascular Endothelial Growth Factor C/metabolism
- Vascular Endothelial Growth Factor Receptor-1/analysis
- Vascular Endothelial Growth Factor Receptor-1/metabolism
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49
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Panwalkar AW, Armitage JO. T-cell/NK-cell lymphomas: A review. Cancer Lett 2007; 253:1-13. [PMID: 17196327 DOI: 10.1016/j.canlet.2006.11.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Revised: 11/17/2006] [Accepted: 11/21/2006] [Indexed: 11/26/2022]
Abstract
T-cell neoplasms are a group of heterogeneous neoplasms that present a challenge in management. Accurate diagnosis and classification are necessary for proper treatment. This dilemma is exemplified by continuous upgrading of classification systems in an effort to better understand these diseases. The spectrum of management varies from observation and monitoring to prompt aggressive multimodality treatment to achieve optimal outcomes. Allogeneic transplant has been successful in a minority of cases with the possibility of cure; however this approach is still largely experimental. Molecular studies such as gene expression profiling are expected to offer exciting insight into the biology of these diseases. Novel therapeutic approaches continue to be explored, however will probably require larger clinical trials to establish their utility over the current standard.
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Affiliation(s)
- Amit W Panwalkar
- University of Nebraska Medical Center, Department of Oncology/Hematology, 987680 Nebraska Medical Center, Omaha, NE 68198-7680, United States.
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50
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Mohammad RM, Goustin AS, Aboukameel A, Chen B, Banerjee S, Wang G, Nikolovska-Coleska Z, Wang S, Al-Katib A. Preclinical studies of TW-37, a new nonpeptidic small-molecule inhibitor of Bcl-2, in diffuse large cell lymphoma xenograft model reveal drug action on both Bcl-2 and Mcl-1. Clin Cancer Res 2007; 13:2226-35. [PMID: 17404107 DOI: 10.1158/1078-0432.ccr-06-1574] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Overexpression of Bcl-2 protein has been observed in more than 80% of B-cell lymphomas, including diffuse large cell lymphoma (DLCL), the most common subtype of non-Hodgkin's lymphoma. We have previously employed the natural product (-)-gossypol to test its therapeutic potential as a small-molecule inhibitor of Bcl-2 for the treatment of B-cell lymphomas. EXPERIMENTAL DESIGN Recently, we have used a structure-based strategy to design a new class of potent small-molecule inhibitor acting on Bcl-2. One such lead compound is the benzenesulfonyl derivative TW-37, which was designed to target the BH3-binding groove in Bcl-2 where proapoptotic Bcl-2 proteins, such as Bak, Bax, Bid, and Bim bind. RESULTS In our fluorescence polarization-based binding assays using recombinant Bcl-2, Bcl-X(L), and Mcl-1 proteins, TW-37 binds to Bcl-2, Bcl-X(L), and Mcl-1 with K(i) values of 290, 1,110 and 260 nmol/L, respectively. Hence, TW-37 is a potent inhibitor of Bcl-2 and has >3-fold selectivity over Bcl-X(L). In vitro, TW-37 showed significant antiproliferative effect in a de novo chemoresistant WSU-DLCL(2) lymphoma cell line and primary cells obtained from a lymphoma patient with no effect on normal peripheral blood lymphocytes. Coimmunoprecipitation experiments showed that TW-37 disrupted heterodimer formation between Bax or truncated-Bid and antiapoptotic proteins in the order Mcl-1 > Bcl-2 >> Bcl-X(L). As expected, TW-37 caused apoptotic death. Pre-exposure of lymphoma cells to TW-37 significantly enhanced the killing effect of cyclophosphamide-doxorubicin-vincristine-prednisone (CHOP) regimen. The maximum tolerated dose of TW-37 in severe combined immunodeficient (SCID) mice was 40 mg/kg for three i.v. injections when given alone and 20 mg/kg, x3 when given in combination with CHOP. Using WSU-DLCL(2)-SCID mouse xenograft model, the addition of TW-37 to CHOP resulted in more complete tumor inhibition compared with either CHOP or TW-37 alone. CONCLUSIONS We conclude that the administration of TW-37, as a potent Bcl-2 and Mcl-1 inhibitor, to standard chemotherapy may prove an effective strategy in the treatment of B-cell lymphoma.
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Affiliation(s)
- Ramzi M Mohammad
- Division of Hematology and Oncology, Department of Internal Medicine, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan, USA.
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