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Ng DLC, Leong YC, Gan GG. Quality of life amongst lymphoma survivors in a developing country. Support Care Cancer 2016; 24:5015-5023. [PMID: 27460016 DOI: 10.1007/s00520-016-3364-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 07/18/2016] [Indexed: 01/10/2023]
Abstract
PURPOSE The survival for patients with lymphoma has improved over the past decades with the introduction of novel agents. Quality of life of these survivors is now being studied with focus on minimising the late effects of chemotherapy and improving psychosocial support. This study aims to determine the prevalence of anxiety and depression of lymphoma survivors and to investigate the possible association between these disorders and quality of life. METHODS Patients with previous diagnosis of lymphoma who remained in remission were recruited from a major hospital in Malaysia. Quality of life of these patients was measured using European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C30). Anxiety and depression symptoms were assessed using Hospital Anxiety and Depression scale (HADS). RESULTS A total of 156 patients participated in this study. Eighteen percent (18 %) of patients had symptoms of anxiety, and 10 % had symptoms of depression. Patients who had higher depression scores were older, of lower education level and had more than one comorbidity illness. Patients with anxiety were associated with lower overall quality of life (QOL) score, lower emotional and cognitive functioning and complained more of fatigue and insomnia (p < 0.05). Patients who had depression were associated with lower physical functioning and complained more of insomnia (p < 0.05). CONCLUSION It is important for the treating physicians to ensure follow-up of lymphoma survivors for any psychological disorders in order early counseling and support can be provided. This may improve patients' quality of life.
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Affiliation(s)
- Diana L C Ng
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Malaysia
| | - Y C Leong
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Gin Gin Gan
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
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Casulo C, Day B, Dawson KL, Zhou X, Flowers CR, Farber CM, Hainsworth JD, Cerhan JR, Link BK, Zelenetz AD, Friedberg JW. Disease characteristics, treatment patterns, and outcomes of follicular lymphoma in patients 40 years of age and younger: an analysis from the National Lymphocare Study†. Ann Oncol 2015; 26:2311-7. [PMID: 26362568 DOI: 10.1093/annonc/mdv375] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 09/04/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma, with median age at diagnosis in the seventh decade. FL in young adults (YAs), defined as diagnosis at ≤40 years, is uncommon. No standard approaches exist guiding the treatment of YA FL, and little is known about their disease characteristics and outcomes. To gain further insights into YA FL, we analyzed the National LymphoCare Study (NLCS) to describe characteristics, initial treatments, and outcomes in this population versus patients aged >40 years. PATIENTS AND METHODS Using the NLCS database, we stratified FL patients by age: 18-40 (YA), 41-60, 61-70, 71-80, and >80 years. Survival probability was estimated using Kaplan-Meier methodology. We examined associations between age and survival using hazard ratios and 95% confidence intervals (CIs) from multivariable Cox models. RESULTS Of 2652 eligible FL patients in the NLCS, 164 (6%) were YAs. Of YA patients, 69% had advanced disease, 80% had low-grade histology, and 50% had good-risk disease according to the Follicular Lymphoma International Prognostic Index (FLIPI). Nineteen percent underwent observation, 12% received rituximab monotherapy, and 46% received chemoimmunotherapy [in 59% of these: R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone)]. With a median follow-up of 8 years, overall survival (OS) at 2, 5, and 8 years was 98% (95% CI 93-99), 94% (95% CI 89-97), and 90% (95% CI 83-94), respectively. Median progression-free survival (PFS) was 7.3 years (95% CI 5.6-not reached). CONCLUSIONS In one of the largest cohorts of YA FL patients treated in the rituximab era, disease characteristics and outcomes were similar to patients aged 41-60 years, with favorable OS and PFS in YAs. Longer-term outcomes and YA-specific survivorship concerns should be considered when defining management. These data may not support the need for more aggressive therapies in YA FL. CLINICAL TRIAL NUMBER Roche/Genentech ML01377 (U2963n).
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Affiliation(s)
- C Casulo
- James P. Wilmot Cancer Center, University of Rochester, Rochester
| | - B Day
- Genentech, Inc., South San Francisco
| | | | - X Zhou
- RTI Health Solutions, Research Triangle Park, Durham
| | - C R Flowers
- Department of Medicine, Emory University, Atlanta
| | - C M Farber
- Carol G. Simon Cancer Center, Morristown
| | | | - J R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester
| | | | - A D Zelenetz
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - J W Friedberg
- James P. Wilmot Cancer Center, University of Rochester, Rochester
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Hagemeister F, Rodriguez MA, Deitcher SR, Younes A, Fayad L, Goy A, Dang NH, Forman A, McLaughlin P, Medeiros LJ, Pro B, Romaguera J, Samaniego F, Silverman JA, Sarris A, Cabanillas F. Long term results of a phase 2 study of vincristine sulfate liposome injection (Marqibo®) substituted for non-liposomal vincristine in cyclophosphamide, doxorubicin, vincristine, prednisone with or without rituximab for patients with untreated aggressive. Br J Haematol 2013; 162:631-8. [DOI: 10.1111/bjh.12446] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 05/22/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Anas Younes
- Memorial Sloan-Kettering Cancer Center; New York City; NY; USA
| | - Luis Fayad
- University of Texas M. D. Anderson Cancer Center (UTMDACC); Houston; TX; USA
| | - Andre Goy
- John Theurer Cancer Center at HUMC; Hackensack; NJ; USA
| | - Nam H. Dang
- University of Florida Shands Cancer Center; Gainesville; FL; USA
| | - Arthur Forman
- University of Texas M. D. Anderson Cancer Center (UTMDACC); Houston; TX; USA
| | - Peter McLaughlin
- University of Texas M. D. Anderson Cancer Center (UTMDACC); Houston; TX; USA
| | | | - Barbara Pro
- Thomas Jefferson University Hospital; Philadelphia; PA; USA
| | - Jorge Romaguera
- University of Texas M. D. Anderson Cancer Center (UTMDACC); Houston; TX; USA
| | - Felipe Samaniego
- University of Texas M. D. Anderson Cancer Center (UTMDACC); Houston; TX; USA
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O'Brien S, Schiller G, Lister J, Damon L, Goldberg S, Aulitzky W, Ben-Yehuda D, Stock W, Coutre S, Douer D, Heffner LT, Larson M, Seiter K, Smith S, Assouline S, Kuriakose P, Maness L, Nagler A, Rowe J, Schaich M, Shpilberg O, Yee K, Schmieder G, Silverman JA, Thomas D, Deitcher SR, Kantarjian H. High-dose vincristine sulfate liposome injection for advanced, relapsed, and refractory adult Philadelphia chromosome-negative acute lymphoblastic leukemia. J Clin Oncol 2012; 31:676-83. [PMID: 23169518 DOI: 10.1200/jco.2012.46.2309] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Relapsed adult acute lymphoblastic leukemia (ALL) is associated with high reinduction mortality, chemotherapy resistance, and rapid progression leading to death. Vincristine sulfate liposome injection (VSLI), sphingomyelin and cholesterol nanoparticle vincristine (VCR), facilitates VCR dose-intensification and densification plus enhances target tissue delivery. We evaluated high-dose VSLI monotherapy in adults with Philadelphia chromosome (Ph) -negative ALL that was multiply relapsed, relapsed and refractory to reinduction, and/or relapsed after hematopoietic cell transplantation (HCT). PATIENTS AND METHODS Sixty-five adults with Ph-negative ALL in second or greater relapse or whose disease had progressed following two or more leukemia therapies were treated in this pivotal phase II, multinational trial. Intravenous VSLI 2.25 mg/m(2), without dose capping, was administered once per week until response, progression, toxicity, or pursuit of HCT. The primary end point was achievement of complete response (CR) or CR with incomplete hematologic recovery (CRi). RESULTS The CR/CRi rate was 20% and overall response rate was 35%. VSLI monotherapy was effective as third-, fourth-, and fifth-line therapy and in patients refractory to other single- and multiagent reinduction therapies. Median CR/CRi duration was 23 weeks (range, 5 to 66 weeks); 12 patients bridged to a post-VSLI HCT, and five patients were long-term survivors. VSLI was generally well tolerated and associated with a low 30-day mortality rate (12%). CONCLUSION High-dose VSLI monotherapy resulted in meaningful clinical outcomes including durable responses and bridging to HCT in advanced ALL settings. The toxicity profile of VSLI was predictable, manageable, and comparable to standard VCR despite the delivery of large, normally unachievable, individual and cumulative doses of VCR.
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Affiliation(s)
- Susan O'Brien
- University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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Pirani M, Marcheselli R, Marcheselli L, Bari A, Federico M, Sacchi S. Risk for second malignancies in non-Hodgkin's lymphoma survivors: a meta-analysis. Ann Oncol 2011; 22:1845-58. [PMID: 21310758 DOI: 10.1093/annonc/mdq697] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Late side-effects are becoming an important issue in non-Hodgkin's lymphoma (NHL) survivors. We intended to estimate pooled relative risk (RR) of secondary malignant neoplasms (SMNs), to evaluate site-associated RR and the impact of different treatments. DESIGN We carried out an electronic search of Medline and EMBASE seeking articles investigating the risk of SMNs and reporting RR measures. The studies were evaluated for heterogeneity before meta-analysis and for publication bias. Pooled RRs were estimated using fixed- and random-effects models. RESULTS A total of 23 studies met the inclusion criteria. Pooled RRs of SMNs overall and for solid tumors were 1.88 and 1.32, respectively. We found an excess of risk for several specific cancer sites. Radiotherapy alone did not increase the risk for SMNs, while chemotherapy and combined treatments augmented the RR. Regression analyses revealed a positive significant association for all SMNs with total body irradiation, and for solid SMNs with younger age. No publication bias was observed. CONCLUSIONS Our results indicate that NHL patients experience a higher risk for SMNs than the general population and that various treatments have different impact on RR. More information will be necessary to evaluate possible interactions with genetic susceptibility and environmental exposure.
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Affiliation(s)
- M Pirani
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena, Italy
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Elis A, Tevet A, Yerushalmi R, Blickstein D, Bairy O, Dann EJ, Blumenfeld Z, Abraham A, Manor Y, Shpilberg O, Lishner M. Fertility status among women treated for aggressive non-Hodgkin's lymphoma. Leuk Lymphoma 2009; 47:623-7. [PMID: 16690520 DOI: 10.1080/10428190500353877] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In young women treated for intermediate-high-grade non-Hodgkin's lymphoma with CHOP (cyclophosphamide, adriamycin, oncovine and prednisone), there is insufficient data concerning gonadotoxicity or the need for fertility-preserving measures. The aim of the present study was to evaluate the fertility status in the first complete remission of women who were treated for aggressive non-Hodgkin's lymphoma. A cohort of 36 women with aggressive non-Hodgkin's lymphoma in first remission, who were treated in five university-affiliated hospitals in Israel, was evaluated. All women were aged younger than 40 years at diagnosis and received frontline protocols, including cyclophosphamide and adriamycin, mostly CHOP. Menstrual cycle characteristics, as well as pregnancies before the diagnosis, during treatment and in first complete remission, were evaluated. The patients' mean age at the diagnosis was 28 +/- 7 years (range 17 - 40 years). All patients were treated with chemotherapy, although 10 patients received additional radiotherapy. Follow-up time at first complete remission was 84 +/- 48 months. Before diagnosis, all patients had menstrual cycles, which were regular in 31 (86%). Three patients received gonadtropin-releasing hormone analogs, whereas nine received contraceptive pills together with cytotoxic treatment. During treatment, 18 patients (50%) had amenorrhea, six (17%) had irregular menstrual cycles, and 12 (33%) continued their regular cycles. All but two women resumed menses in the first complete remission, and these were regular in 22 (61%) patients. In 63% of patients, the menstrual cycle recovered within 3 months of the discontinuation of chemotherapy. Eighteen patients (50%) became pregnant during the first complete remission. There was no significant difference between those patients who received fertility-preserving measures versus the remainder concerning regular menstrual cycles recovery or pregnancies. The two patients who developed amenorrhea were 40 years old at the time of diagnosis. In conclusion, the rate of gonadal dysfunction is very low among young, CHOP treated, non-Hodgkin's lymphoma female patients. Fertility-preserving techniques are not needed for women aged younger than 40 years and should probably be reserved for those who are at high risk for gonadal toxicity.
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Affiliation(s)
- Avishay Elis
- Department of Medicine, Sapir Medical Center, Meir Hospital, Kfar Saba, Israel
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Ruiz-Soto R, Sergent G, Gisselbrecht C, Larghero J, Ertault M, Hennequin C, Manson J, de Kerviler E, Briere J, Mounier N. Estimating late adverse events using competing risks after autologous stem-cell transplantation in aggressive non-Hodgkin lymphoma patients. Cancer 2006; 104:2735-42. [PMID: 16284986 DOI: 10.1002/cncr.21492] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Consolidative autologous stem-cell transplantation (ASCT) is a valuable option in high-risk or disease recurrence large-cell non-Hodgkin lymphoma patients (NHL); however, its long-term toxicity must still be assessed. METHODS Among the 439 lymphoma patients transplanted at our institution from January 1, 1993, to January 1, 2002, 158 exhibited aggressive NHL. The median age of the patients was 46 years (range, 18-69), 98 males and 60 females. Ninety (57%) patients received first-line ASCT. The median number of prior chemotherapy regimens was 2 (range, 1-10). Thirty-eight (24%) patients received total body irradiation conditioning. Here we report the adverse events which occurred at least 30 days after ASCT and before disease recurrence. RESULTS After a median follow-up of 3 years, the overall and disease-free survival rates were 61% and 55%, respectively. Sixty-eight late adverse events affected 43 (27%) patients, leading to a cumulative incidence of 34% at 3 years. Infections were the most frequent adverse events (n = 13), followed by neurologic (n = 12), pulmonary (n = 6), or cardiovascular (n = 4). Eight malignancies were diagnosed (six solid, two hematologic), leading to a cumulative incidence of 3.7% at 3 years. Taking into account the competing risks, multivariate analysis revealed that the number of progressions (relative risk [RR] = 2.68) and a mitoxantrone-containing conditioning regimen (RR = 2.98) significantly increased the incidence of late toxicity. CONCLUSION ASCT is effective in patients with aggressive NHL with a poor prognosis. However, careful long-term follow-up of survivors is recommended because of the increase in malignant and nonmalignant toxicities.
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