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Li J, Zhu Y. Survival analysis of multiple myeloma patients after autologous stem cell transplantation. Stem Cell Investig 2020; 6:42. [PMID: 32039264 DOI: 10.21037/sci.2019.10.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 10/08/2019] [Indexed: 11/06/2022]
Abstract
Background Hematopoietic stem cell transplantation has been applied to treat the hematologic malignancies since the 1980s. However, allogenic transplantation has inherent complications such as graft-versus-host disease and graft failure. Autologous transplantation has become more and more popular because of its lower transplant-related mortality. This study was performed to analyze the possible prognostic factors for myeloma patients post stem cell transplantation. Methods Patients' information was collected by history review and follow-up through the phone call. Kaplan-Meier was used to exhibit overall survival (OS) and progression-free survival (PFS). Univariate and multivariate analyses were performed using Cox proportional hazards model. A P<0.05 is considered statistically significant. Results Thirty patients with multiple myeloma were included in this study, 7 of them died because of myeloma relapse and myeloma-associated complications. The average survival time was 29.8 months and the median follow-up was 25.1 months. The 1-year OS and PFS were 93.3% and 90.0%, respectively. Both the 3-year OS and PFS were 76.7%. In a variety of factors, improved renal function showed a good effect on the outcome of transplantation. Conclusions To prevent cancer relapse after autologous transplantation, it is of great significance to achieve a complete remission prior to the transplantation.
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Affiliation(s)
- Ju Li
- Department of Hematology, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Yan Zhu
- Department of Hematology, Southwest Hospital, Army Medical University, Chongqing 400038, China
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2
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Prognostic analysis of DLBCL patients and the role of upfront ASCT in high-intermediate and high-risk patients. Oncotarget 2017; 8:73168-73176. [PMID: 29069860 PMCID: PMC5641203 DOI: 10.18632/oncotarget.17324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/30/2017] [Indexed: 11/25/2022] Open
Abstract
The role of autologous stem cell transplantation (ASCT) as a frontline treatment in patients with diffuse large B cell lymphoma (DLBCL) who are in their first remission has not been fully elucidated in the rituximab era. We analyzed 272 DLBCL patients who received 4-6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) or R-CHOP followed by ASCT, from January 2005 to June 2013 in our institution. Multivariate analysis showed the none germinal center B cell (non-GCB) subtype (P=0.014, P=0.012) and International Prognostic Index (IPI) (3-5) (P=0.004, P=0.016) were independent unfavorable predictors of overall survival (OS) and progression-free survival (PFS), respectively. To investigate the treatment effect of upfront ASCT, we selected 94 high-intermediate and high-risk DLBCL patients who achieved complete remission after R-CHOP, with 41 in the ASCT and 53 in the non-ASCT groups. Survival analysis revealed patients who received upfront ASCT compared with those who did not had better OS (3-year OS: 74.5% vs. 50.4%, P=0.029) or PFS (3-year PFS: 59.6% vs. 32.1%, P=0.004), suggesting up-front ASCT following R-CHOP could improve the outcome of high-intermediate and high-risk DLBCL patients.
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Oberoi D, White V, Seymour J, Prince HM, Harrison S, Jefford M, Winship I, Hill D, Bolton D, Kay A, Millar J, Doo NW, Giles G. The course of anxiety, depression and unmet needs in survivors of diffuse large B cell lymphoma and multiple myeloma in the early survivorship period. J Cancer Surviv 2017; 11:329-338. [PMID: 28144891 DOI: 10.1007/s11764-016-0591-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 12/21/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the study is to examine the course of anxiety, depression and unmet needs in diffuse large B cell lymphoma (DLBCL) and multiple myeloma (MM) survivors in the first 2 years post diagnosis. METHODS DLBCL and MM survivors, recruited through the Victorian Cancer Registry, completed two interviews approximately 7 and 15 months post diagnosis. Hospital Anxiety and Depression Scale (HADS) and Supportive Care Needs Survey (SCNS-SF34) were completed at both interviews. Primary outcomes were prevalence of anxiety, depression and unmet needs (any or moderate-high). Generalized estimating equation examined whether course of anxiety, depression and unmet needs differed between the two cancers. RESULTS Overall, 236 DLBCL and 178 MM survivors completed both telephone interviews. Course of anxiety differed (p < 0.01) with rate increasing in DLBCL (14 to 22%) while remaining stable for MM (15 to 12%). Course of depression also differed (p < 0.01), decreasing for MM (22 to 12%) and remaining stable for DLBCL (15 to 16%) survivors. Change in unmet needs was generally similar for the two cancer groups, except for moderate to high psychological needs (p < 0.05). CONCLUSIONS Patterns of change in anxiety and depression in first 2 years post diagnosis differ for DLBCL and MM survivors. IMPLICATIONS FOR CANCER SURVIVORS Studying psychological outcomes in mixed haematological cancer samples may be inappropriate, at least in the early survivorship phase. Separate studies of the experiences of people with the different haematological cancer subtypes are needed to ensure psychosocial and supportive care interventions are appropriate to the needs of individuals with different haematological cancers.
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Affiliation(s)
- Devesh Oberoi
- Cancer Council Victoria, 615 St. Kilda Road, Melbourne, VIC, 3004, Australia
| | - Victoria White
- Cancer Council Victoria, 615 St. Kilda Road, Melbourne, VIC, 3004, Australia.
- The University of Melbourne, Parkville, VIC, 3010, Australia.
| | - John Seymour
- The University of Melbourne, Parkville, VIC, 3010, Australia
- Peter MacCallum Cancer Centre, 305 Grattan St., Melbourne, VIC, 3000, Australia
| | - H Miles Prince
- The University of Melbourne, Parkville, VIC, 3010, Australia
- Peter MacCallum Cancer Centre, 305 Grattan St., Melbourne, VIC, 3000, Australia
| | - Simon Harrison
- The University of Melbourne, Parkville, VIC, 3010, Australia
- Peter MacCallum Cancer Centre, 305 Grattan St., Melbourne, VIC, 3000, Australia
| | - Michael Jefford
- The University of Melbourne, Parkville, VIC, 3010, Australia
- Peter MacCallum Cancer Centre, 305 Grattan St., Melbourne, VIC, 3000, Australia
| | - Ingrid Winship
- Royal Melbourne Hospital Familial Cancer Centre, Level 2, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3052, Australia
| | - David Hill
- Cancer Council Victoria, 615 St. Kilda Road, Melbourne, VIC, 3004, Australia
- The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Damien Bolton
- Austin Health, Suite 5 210 Burgundy Street, Heidelberg, VIC, 3084, Australia
| | - Anne Kay
- North Eastern Melbourne Integrated Cancer Service, 145 Studley Rd, Heidelberg, VIC, 3084, Australia
| | - Jeremy Millar
- AlfredHealth, The Alfred, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Nicole Wong Doo
- Concord Hospital, Hospital Rd., Concord, NSW, 2139, Australia
| | - Graham Giles
- Cancer Council Victoria, 615 St. Kilda Road, Melbourne, VIC, 3004, Australia
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Gohil SH, Ardeshna KM, Lambert JM, Pule MA, Mohamedbhai S, Virchis A, Morris EC, Linch DC, Thomson KJ, Peggs KS. Autologous stem cell transplantation outcomes in elderly patients with B cell Non-Hodgkin Lymphoma. Br J Haematol 2015; 171:197-204. [PMID: 26119524 DOI: 10.1111/bjh.13561] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 05/20/2015] [Indexed: 01/19/2023]
Abstract
The precise role of autologous haematopoietic stem cell transplantation (ASCT) remains unclear in patients over 60 years of age. There is potential for increased procedural morbidity and mortality, and differences in disease biology that could impact outcomes. We performed a retrospective single-centre review of 81 elderly B-cell Non-Hodgkin Lymphoma patients undergoing ASCT. Five-year overall survival (OS) and progression-free survival (PFS) was 54·7% and 49·1% respectively. Non-relapse mortality (NRM) at 100 days and 1 year was 1·3% and 2·5%, suggesting no major excess compared to younger cohorts. OS and PFS were significantly worse in those over 65 years compared to those aged 60-64 (47·6% vs. 57·7%, P = 0·0437, and 27·6% vs. 57·7%, P = 0·0052 at 5 years). This resulted largely from an increased relapse risk (RR) (53·8% vs. 30·1%, P = 0·0511) rather than excess NRM, and age remained independently significant for PFS on multivariate analyses [Hazard ratio 2·56 (1·35-4·84, P = 0·0052) for PFS and 1·89 (0·99-3·61, P = 0·054) for OS]. Our data adds to the growing body of evidence demonstrating that ASCT can be an effective treatment strategy with an acceptable safety profile in selected elderly patients. Further evaluation of its overall benefit is warranted, however, in those over 65 years of age, as RR appears to be considerably higher.
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Affiliation(s)
- Satyen H Gohil
- Research Department of Haematology, University College London, London, UK
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Kirit M Ardeshna
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Jonathan M Lambert
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Martin A Pule
- Research Department of Haematology, University College London, London, UK
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Sajir Mohamedbhai
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Andres Virchis
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Emma C Morris
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - David C Linch
- Research Department of Haematology, University College London, London, UK
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Kirsty J Thomson
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Karl S Peggs
- Research Department of Haematology, University College London, London, UK
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
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Clinical outcomes of a novel combination of lenalidomide and rituximab followed by stem cell transplantation for relapsed/refractory aggressive B-cell non-hodgkin lymphoma. Oncotarget 2015; 5:7368-80. [PMID: 25228589 PMCID: PMC4202129 DOI: 10.18632/oncotarget.2255] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We retrospectively compared outcomes of patients with relapsed/refractory non-Hodgkin lymphoma (NHL) who underwent stem cell transplantation (SCT) with stable disease or better following a novel combination of lenalidomide and rituximab (LR) treatment and did not undergo SCT in a phase I/II clinical trial. We retrospectively compared outcomes of patients who underwent SCT with that of patients who had stable disease or better following LR treatment and did not undergo SCT. Twenty-two patients enrolled in LR clinical trial and undergone SCT were identified, 13 with mantle cell lymphoma (MCL) and nine with large B-cell lymphoma (LBCL). All patients who underwent SCT achieved complete response. In the MCL subset, there were no significant differences between SCT and non-SCT groups except that non-SCT patients were older and had a higher mantle-cell international prognostic index score. There was no difference between SCT-group and non-SCT-group in response duration (P=0.3), progression-free survival (PFS) (P=0.304) and overall survival (OS) (P=0.87). In LBCL subgroup, there were no significant differences between two groups except that non-SCT group had a higher international prognostic index score. Patients with LBCL who underwent SCT had significantly longer response duration (P=0.001), PFS (P=0.000), and OS (P=0.003) than the non-SCT group. The novel therapeutic combination offers a bridge to SCT in patients with relapsed/refractory aggressive B-cell NHL.
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Matched unrelated donor allogeneic transplantation provides comparable long-term outcome to HLA-identical sibling transplantation in relapsed diffuse large B-cell lymphoma. Bone Marrow Transplant 2014; 49:671-8. [PMID: 24510071 DOI: 10.1038/bmt.2014.4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 10/16/2013] [Accepted: 10/17/2013] [Indexed: 01/20/2023]
Abstract
The objective of this retrospective analysis was to compare outcomes of patients with diffuse large B-cell lymphoma (DLBCL) who received either a matched sibling (sib) or an unrelated donor (URD) allogeneic hematopoietic cell transplantation (allo-HCT). Long-term outcome of 172 DLBCL patients receiving URD-HCT between 2000 and 2007 and reported to the European Group for Blood and Marrow Transplantation, was compared with that of 301 subjects, allografted from sib-HCT. With a median follow-up of 45 months, 3-year PFS approached 35% for both groups; overall survival (OS) was 42% for sib-HCT versus 37% for URD (NS). Multivariate analyses confirmed that donor type was not associated with differences in non-relapse mortality (NRM), relapse rate (RR), PFS or OS. Poor performance status (PS) and refractory disease adversely affected PFS and OS. Prior auto-SCT and multiple previous therapies predicted for shorter PFS. NRM was adversely affected by older age (⩾50 years), poor PS and refractory disease, and RR by time from diagnosis to allo-HCT of <36 months, prior auto-SCT, refractory disease, poor PS and in vivo T-cell depletion with alemtuzumab. This large study shows for the first time that URD-HCT is not inferior to sib-HCT, providing a reasonable therapeutic approach for DLBCL patients, having no HLA-identical sibling available.
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Redondo AM, Pomares H, Vidal MJ, Pascual MJ, Quereda B, Sancho JM, Polo M, López J, Conde E, Jarque I, Alonso N, Ramírez MJ, Fernández P, Sayas MJ, Requena MJ, Salar A, González JD, González-Barca E, Arranz R, Caballero D, Martín A. Impact of prior rituximab on outcomes of autologous stem-cell transplantation in patients with relapsed or refractory aggressive B-cell lymphoma: a multicentre retrospective Spanish group of lymphoma/autologous bone marrow transplant study. Br J Haematol 2013; 164:668-74. [PMID: 24274082 DOI: 10.1111/bjh.12676] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 09/18/2013] [Indexed: 12/22/2022]
Abstract
The use of highly effective rituximab-containing therapy for treating diffuse large B-cell lymphoma (DLBCL) makes it more difficult to salvage relapsed or refractory patients. Autologous stem-cell transplantation (ASCT) is the reference treatment for these patients, but the impact of previous exposure to rituximab on the subsequent results of ASCT remains unknown. We analysed 248 patients with relapsed or refractory DLBCL or grade 3B follicular lymphoma pre-treated with rituximab as part of first-line therapy (R+ group) who received ASCT, in comparison with a control group of 127 patients without previous exposure to rituximab (R- group). The complete remission (CR) rates were similar in both groups. Multivariate analysis identified age-adjusted International Prognostic Index at diagnosis, extranodal involvement and disease status at transplant, and the number of previous chemotherapy lines as independent factors with a negative influence on CR rate. Compared with R- patients, those in the R+ group had a significantly better progression-free survival (63% vs. 48% at 5 years) and overall survival (72% vs. 61% at 5 years). This observation was independent of other prognostic factors that affected these outcomes. In conclusion, ASCT is no less effective in patients with relapsed or refractory aggressive B-cell lymphoma pre-treated with first-line rituximab-containing therapy than in rituximab-naive patients.
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Affiliation(s)
- Alba M Redondo
- Hospital Universitario de Salamanca and IBSAL, Salamanca, Spain
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Vijay A, Duan Q, Henning JW, Duggan P, Daly A, Shafey M, Bahlis NJ, Stewart DA. High dose salvage therapy with dose intensive cyclophosphamide, etoposide and cisplatin may increase transplant rates for relapsed/refractory aggressive non-Hodgkin lymphoma. Leuk Lymphoma 2013; 54:2620-6. [DOI: 10.3109/10428194.2013.783211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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9
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Armitage JO. My treatment approach to patients with diffuse large B-cell lymphoma. Mayo Clin Proc 2012; 87:161-71. [PMID: 22305028 PMCID: PMC3497705 DOI: 10.1016/j.mayocp.2011.11.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 11/10/2011] [Indexed: 11/28/2022]
Abstract
My favored treatment approach for patients with diffuse large B-cell lymphoma continues to evolve. Diffuse large B-cell lymphoma can now be cured in more than 50% of patients. This is a result of improved definitions of the disease, improved diagnostic capabilities, better staging and restaging techniques, a useful prognostic index to guide therapeutic decisions, and the development of increasingly effective therapies. Positron emission tomographic scans have improved the accuracy of both staging and restaging. Findings on a positron emission tomographic scan at the end of therapy are the best predictors of a good treatment outcome. Numerous subtypes of diffuse large B-cell lymphoma have been identified that require specific treatment approaches. For example, plasmablastic lymphoma typically lacks CD20 and does not benefit from treatment with rituximab. Diffuse large B-cell lymphoma originating in specific extranodal sites such as the central nervous system, testes, and skin presents special problems and requires specific treatment approaches. A subgroup of diffuse large B-cell lymphoma with a very high proliferative rate seems to have a poor outcome when treated with CHOP-R and does better with regimens used for patients with Burkitt lymphoma. New insights into the biology of these disorders are likely to further change treatment approaches. Recognition that diffuse large B-cell lymphoma is not one disease, but a variety of clinicopathologic syndromes provides the opportunity to further improve our ability to benefit patients.
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MESH Headings
- Adult
- Aged
- Algorithms
- Antibodies, Monoclonal/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Central Nervous System Neoplasms/diagnosis
- Central Nervous System Neoplasms/drug therapy
- Central Nervous System Neoplasms/radiotherapy
- Central Nervous System Neoplasms/therapy
- Combined Modality Therapy
- Cyclophosphamide/therapeutic use
- Disease-Free Survival
- Doxorubicin/therapeutic use
- Humans
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/radiotherapy
- Lymphoma, Large B-Cell, Diffuse/therapy
- Middle Aged
- Neoplasm Staging
- Prednisone/therapeutic use
- Radiotherapy Dosage
- Radiotherapy, Adjuvant
- Secondary Prevention
- Survival Analysis
- Treatment Outcome
- Vincristine/therapeutic use
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Affiliation(s)
- James O Armitage
- Division of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE 68198-7835, USA.
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