1
|
Stueber T, Jaitly V, Moore EM. The clinical significance of increased large cells in marginal zone lymphoma. Hum Pathol 2023; 141:130-138. [PMID: 37633532 DOI: 10.1016/j.humpath.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
Marginal zone lymphoma (MZL) is a primary, indolent small B-cell lymphoma. Subtypes include nodal, splenic, and those of extranodal mucosa-associated lymphoid tissue (MALT). These are slow growing and generally exhibit low rates of transformation to diffuse large B-cell lymphoma (DLBCL). At initial diagnosis, there can be an increase in large cells (LCs) that does not meet criteria for DLBCL. Prior studies have noted this finding, but the clinical significance of these LCs has not been well established. A total of 161 cases of MZL from 1994 to 2021 were evaluated, including all subtypes. There were 33 cases with increased LCs (>10 LCs per high-power field [hpf]), with the majority containing >15 LCs/hpf (28/33) and 128 cases without increased LCs. Cases with increased LCs were significantly more likely to have a Ki-67 proliferation index of ≥30% (P < .0001). Overall survival was not significantly different between the groups but progression-free survival was significantly worse in the LC group (P < .0001). MZL with increased LCs was also associated with a higher stage at diagnosis (P = .0035), was more likely to transform to DLBCL (P = .0016), and had a greater frequency of relapse (P < .0001). Subgroup analysis showed that both nodal and MALT LC groups had a worse progression-free survival and a higher rate of relapse than their standard nodal and MALT lymphoma counterparts, but only within the MALT subgroup did the LC cases present at a higher stage and have a higher rate of transformation to DLBCL than the standard cases. Although larger studies are needed for validation, these results suggest that the presence of LCs in MZL may serve as a useful prognostic indicator and potentially help guide clinical decision-making.
Collapse
Affiliation(s)
- Travis Stueber
- University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Vanya Jaitly
- University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Erika M Moore
- University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.
| |
Collapse
|
2
|
Chen C, Zhang W, Zhou D, Zhang Y. Sintilimab and Chidamide for Refractory Transformed Diffuse Large B Cell Lymphoma: A Case Report and A Literature Review. Front Oncol 2021; 11:757403. [PMID: 34820328 PMCID: PMC8606549 DOI: 10.3389/fonc.2021.757403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/18/2021] [Indexed: 01/22/2023] Open
Abstract
Patients with relapsed/refractory (R/R) transformed diffused large B cell lymphoma (tDLBCL) have a poor prognosis and a low survival rate. In addition, no standard therapy has yet been established for R/R tDLBCL. Herein we presented a single case of a patient with R/R tDLBCL who was successfully treated with sintilimab and chidamide. The patient was a 71-year-old man with pulmonary mucosa-associated lymphoid tissue lymphoma. He did not receive any treatment until tDLBCL was confirmed 2 years later. The tDLBCL was primary refractory to R2-CHOP, R2-MTX, and Gemox regimens. However, the patient achieved sustained complete remission after the combination therapy of sintilimab and chidamide. To the best of our knowledge, this is the first report of sintilimab combined with chidamide for the treatment of R/R tDLBCL, which opens up new therapeutic possibilities for this new combination therapy in future prospective clinical trials.
Collapse
Affiliation(s)
- Chao Chen
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences (CAMS), Beijing, China
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences (CAMS), Beijing, China
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences (CAMS), Beijing, China
| | - Yan Zhang
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences (CAMS), Beijing, China
| |
Collapse
|
3
|
Graf SA, Cassaday RD, Morris K, Voutsinas JM, Wu QV, Behnia S, Lynch RC, Krakow E, Rasmussen H, Chauncey TR, Kanan S, Soma L, Smith SD, Gopal AK. Ibrutinib Monotherapy in Relapsed or Refractory, Transformed Diffuse Large B-cell Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:176-181. [PMID: 33358575 DOI: 10.1016/j.clml.2020.11.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/16/2020] [Accepted: 11/27/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Histologic transformation to diffuse large B-cell lymphoma (tDLBCL) occurs in a significant proportion of indolent lymphomas. However, few studies of novel agents inform its management, particularly when relapsed after or refractory (R/R) to prior treatment. PATIENTS AND METHODS We prospectively evaluated ibrutinib monotherapy in pathologically documented patients with R/R tDLBCL in a single-arm study. The primary endpoint was overall response rate. RESULTS Twenty patients who had received a median of 4 (range, 2-9) prior lines of therapy overall (median, 2.5; range, 1-9 for tDLBCL) were treated. The overall response rate was 35%, including complete responses in 15%. The median progression-free survival and overall survival were 4.1 months (95% confidence interval, 2.4-6.2 months) and 22.4 months (95% confidence interval, 7.5 months to not reached), respectively. Disease control > 2 months was seen in 75% and > 1 year in 15%. Response was associated with either low tumor bulk or low metabolic tumor volume (P = .05) but not with antecedent lymphoma histology (P = 1.0). Treatment-related adverse events were consistent with prior studies of ibrutinib. CONCLUSIONS Ibrutinib showed low toxicity and meaningful efficacy in R/R tDLBCL, including short-term disease control in most cases. Results demonstrate the potential utility of ibrutinib in this challenging clinical setting, including as a potential bridge to more definitive treatments.
Collapse
Affiliation(s)
- Solomon A Graf
- Division of Medical Oncology, University of Washington Medicine, Seattle, WA; Clinical Research Division, Fred Hutch Cancer Research Center, Seattle, WA; Department of Hospital and Specialty Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, WA
| | - Ryan D Cassaday
- Clinical Research Division, Fred Hutch Cancer Research Center, Seattle, WA; Division of Hematology
| | - Karolyn Morris
- Division of Medical Oncology, University of Washington Medicine, Seattle, WA
| | - Jenna M Voutsinas
- Clinical Research Division, Fred Hutch Cancer Research Center, Seattle, WA
| | - Qian Vicky Wu
- Clinical Research Division, Fred Hutch Cancer Research Center, Seattle, WA
| | - Sanaz Behnia
- Division of Nuclear Medicine, Department of Radiology
| | - Ryan C Lynch
- Division of Medical Oncology, University of Washington Medicine, Seattle, WA; Clinical Research Division, Fred Hutch Cancer Research Center, Seattle, WA
| | - Elizabeth Krakow
- Division of Medical Oncology, University of Washington Medicine, Seattle, WA; Clinical Research Division, Fred Hutch Cancer Research Center, Seattle, WA
| | - Heather Rasmussen
- Division of Medical Oncology, University of Washington Medicine, Seattle, WA
| | - Thomas R Chauncey
- Division of Medical Oncology, University of Washington Medicine, Seattle, WA; Clinical Research Division, Fred Hutch Cancer Research Center, Seattle, WA; Department of Hospital and Specialty Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, WA
| | - Sandra Kanan
- Division of Medical Oncology, University of Washington Medicine, Seattle, WA
| | - Lorinda Soma
- Department of Pathology, University of Washington Medicine, Seattle, WA
| | - Stephen D Smith
- Division of Medical Oncology, University of Washington Medicine, Seattle, WA; Clinical Research Division, Fred Hutch Cancer Research Center, Seattle, WA
| | - Ajay K Gopal
- Division of Medical Oncology, University of Washington Medicine, Seattle, WA; Clinical Research Division, Fred Hutch Cancer Research Center, Seattle, WA.
| |
Collapse
|
4
|
Tedjaseputra A, Gilbertson M, Low M, Fedele PL, Kumar B, Simpson I, Grigoriadis G, Shortt J, Opat S, Gregory GP. Excellent outcomes of transformed lymphomas in the rituximab era without autologous stem cell transplantation: an Australian, single-centre experience. Intern Med J 2020; 51:1825-1834. [PMID: 32609419 DOI: 10.1111/imj.14965] [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: 01/17/2020] [Revised: 04/21/2020] [Accepted: 06/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Histologic transformation (HT) is an important event with adverse prognosis in the natural history of indolent lymphomas. There is minimal data on HT in the Australian setting. AIM To characterise patients with biopsy-proven HT and their outcomes identified at a tertiary Australian Hospital. METHODS All patients with biopsy-proven HT during a 15-year period (2002-2017) were included. Clinico-pathological data were systematically collected from review of patient records. Survival estimates were assessed by the Kaplan-Meier method and compared using the log-rank test. Associations between variables and clinical outcomes were evaluated using Cox's proportional hazards model. RESULTS A cohort of 45 patients was identified with a median age of 66 years and the majority (59%) having high-risk disease (Revised-International Prognostic Index score ≥ 3). R-CHOP induction was used in 69% with an overall response rate of 82% (complete response (CR), 75%). 61% of these induction-responders received consolidation, with autologous stem cell transplant (ASCT) performed in only 17% and rituximab maintenance given to 31%. With a median follow-up of 47 months (range: 4-136), the 5-year overall survival (OS) was 69% (95% CI: 52%, 81%). Chemotherapy-naivety at HT was associated with a superior rate of CR (84% vs. 54%, p = 0.057) and 5-year OS (82% vs. 46%, p = 0.012). Rituximab maintenance was associated with a durable progression-free survival in induction-responders. CONCLUSIONS Excellent OS was observed in this modern cohort of patients treated with rituximab-containing induction and low rate of consolidation by ASCT, particularly in those who were chemotherapy-naïve at HT. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
| | - Michael Gilbertson
- Department of Clinical Haematology, Monash Health, Melbourne, Australia.,School of Clinical Sciences at Monash Health, Monash University
| | - Michael Low
- Department of Clinical Haematology, Monash Health, Melbourne, Australia.,School of Clinical Sciences at Monash Health, Monash University
| | - Pasquale L Fedele
- Department of Clinical Haematology, Monash Health, Melbourne, Australia.,School of Clinical Sciences at Monash Health, Monash University
| | - Beena Kumar
- School of Clinical Sciences at Monash Health, Monash University.,Department of Anatomical Pathology, Monash Health, Melbourne, Australia
| | - Ian Simpson
- School of Clinical Sciences at Monash Health, Monash University.,Department of Anatomical Pathology, Monash Health, Melbourne, Australia
| | - George Grigoriadis
- Department of Clinical Haematology, Monash Health, Melbourne, Australia.,School of Clinical Sciences at Monash Health, Monash University
| | - Jake Shortt
- Department of Clinical Haematology, Monash Health, Melbourne, Australia.,School of Clinical Sciences at Monash Health, Monash University
| | - Stephen Opat
- Department of Clinical Haematology, Monash Health, Melbourne, Australia.,School of Clinical Sciences at Monash Health, Monash University
| | - Gareth P Gregory
- Department of Clinical Haematology, Monash Health, Melbourne, Australia.,School of Clinical Sciences at Monash Health, Monash University
| |
Collapse
|
5
|
Progression of disease within 2 years (POD24) is a clinically relevant endpoint to identify high-risk follicular lymphoma patients in real life. Ann Hematol 2020; 99:1595-1604. [PMID: 32417940 DOI: 10.1007/s00277-020-04025-2] [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: 11/26/2019] [Accepted: 04/04/2020] [Indexed: 02/08/2023]
Abstract
Follicular lymphoma (FL) is an indolent non-Hodgkin's lymphoma with heterogeneous outcomes. Progression or relapse of FL within 2 years (so-called POD24) after diagnosis is associated with a poor outcome for patients treated with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, prednisone) in clinical trials. POD24 needs further validation before it can be used as a relevant endpoint to assess treatment efficacy. In the present retrospective monocentric study, we investigated the predictive value of POD24 in a cohort of grade 1, 2, or 3a FL patients treated in our institution (Nantes Medical University, France) and registered in our local database. We investigated the nature of treatment lines, patients' outcomes, and the prognostic value of POD24. Between 2007 and 2016, 317 patients were included. After first-line therapy, 60 patients relapsed within 2 years (POD24-pos cohort), and 254 patients did not relapse within 2 years (PO24-neg cohort). Thirty-three patients died, and 34 patients had an aggressive transformation. The median follow-up is 59.9 months (1.6-395.5). The median PFS is 59.9 months. Overall survival (OS) at 1 year, 3 years, and 5 years is 98.4% [97.0-99.8], 95.1% [92.6-97.6], and 92.5% [89.3-95.9], respectively. The 5-year OS was statistically lower for POD24-pos patients (82% [71.9-93.5]) than for POD24-neg patients (93.3% [88.98-97.8]) (p = 10-5). In multivariate analyses, transformation was predictive of OS, and PS (≥ 1) was predictive of POD24. POD24 is predictive of a worse OS and may be recommended as a relevant endpoint in clinical trials and in real life in particular for patients with advanced disease.
Collapse
|
6
|
Ohmoto A, Fuji S. Histological transformation in malignant lymphoma: a possible role of PET/CT and circulating tumor DNA as noninvasive diagnostic tools. Expert Rev Hematol 2019; 13:23-30. [PMID: 31701788 DOI: 10.1080/17474086.2020.1690987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Transformation is a multi-step event wherein indolent lymphomas, such as follicular lymphomas, are converted into an aggressive subtype, such as diffuse large B-cell lymphoma. This process progresses not only through mutations in several of the causative genes, such as TP53, CDKN2A/B, or MYC, but also through epigenetic or micro-environmental changes. Excisional biopsy is recommended when transformation is clinically suspected.Areas covered: The authors summarized the current knowledge regarding the clinicopathological and molecular features of transformed lymphomas and discussed the relevance of re-biopsy in the diagnosis of transformation, comparing it with noninvasive diagnostic tools [fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) and circulating tumor DNA (ctDNA) analysis].Expert opinion: Pathological confirmation by biopsy is considered the golden standard for diagnosis and is indispensable for determining subsequent treatment strategies. The potential weakness of this approach is its invasiveness and the unavailability of pathological findings outside the biopsied areas. In the context of relapse, PET/CT is used mainly for the selection of the best suitable biopsy site, while ctDNA has the potential for detecting systemic genomic changes associated with relapse before clinical presentation. Future investigations should be focused on combining biopsies with new technologies for an early and accurate diagnosis of transformation.
Collapse
Affiliation(s)
- Akihiro Ohmoto
- Division of Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shigeo Fuji
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| |
Collapse
|
7
|
Rusconi C, Anastasia A, Chiarenza A, Marcheselli L, Cavallo F, Rattotti S, Botto B, Ferrari A, Nassi L, Pagani C, Meli E, Arcaini L, Federico M, Rossi G. Outcome of transformed follicular lymphoma worsens according to the timing of transformation and to the number of previous therapies. A retrospective multicenter study on behalf of Fondazione Italiana Linfomi (
FIL
). Br J Haematol 2019; 185:713-717. [DOI: 10.1111/bjh.15816] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 01/02/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Chiara Rusconi
- Division of Haematology Department of Haematology and Oncology Niguarda Cancer Center ASST Grande Ospedale Metropolitano Niguarda MilanItaly
| | | | - Annalisa Chiarenza
- Division of Haematology A.U.O. Policlinico‐Vittorio Emanuele‐Ferrarotto CataniaItaly
| | - Luigi Marcheselli
- Department of Diagnostic, Clinical and Public Health Medicine University of Modena and Reggio Emilia ModenaItaly
| | - Federica Cavallo
- Haematology, S.C.D.U. Ematologia Universitaria, Azienda Ospedaliera Città della Salute e della Scienza TurinItaly
| | - Sara Rattotti
- Department of Haematology Oncology Fondazione IRCCS Policlinico San Matteo and Department of Molecular Medicine University of Pavia Pavia Italy
| | - Barbara Botto
- SC Ematologia Azienda Ospedaliera Città della Salute e della Scienza TorinoItaly
| | | | - Luca Nassi
- Ematologia Azienda Ospedaliero Universitaria Maggiore della Carità Novara Italy
| | - Chiara Pagani
- Haematology ASST Spedali Civili di Brescia Brescia Italy
| | - Erika Meli
- Division of Haematology Department of Haematology and Oncology Niguarda Cancer Center ASST Grande Ospedale Metropolitano Niguarda MilanItaly
| | - Luca Arcaini
- Department of Haematology Oncology Fondazione IRCCS Policlinico San Matteo and Department of Molecular Medicine University of Pavia Pavia Italy
| | - Massimo Federico
- Department of Diagnostic, Clinical and Public Health Medicine University of Modena and Reggio Emilia ModenaItaly
| | - Giuseppe Rossi
- Haematology ASST Spedali Civili di Brescia Brescia Italy
| | | |
Collapse
|
8
|
Godfrey J, Leukam MJ, Smith SM. An update in treating transformed lymphoma. Best Pract Res Clin Haematol 2018; 31:251-261. [PMID: 30213394 DOI: 10.1016/j.beha.2018.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
Indolent lymphomas typically have a prolonged course and favorable prognosis. Recent data support survival times that can reach several decades, even if periodic treatment is needed to manage symptoms or stabilize disease. However, all indolent lymphomas have the potential to undergo transformation to an aggressive phenotype, clinically characterized by a rapid progression of adenopathy, new-onset constitutional symptoms, or laboratory abnormalities, and the immediate need for therapeutic intervention. The most common scenario is transformation of follicular lymphoma to either diffuse large B-cell lymphoma or high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 translocations; however, other indolent subtypes such as marginal zone lymphoma, lymphoplasmacytic lymphoma, small lymphocytic lymphoma/chronic lymphocytic leukemia, or even nodular lymphocyte predominant Hodgkin lymphoma, can undergo similar histologic transformation. The prognosis of transformed lymphomas has historically been quite poor, but there is ample evidence this is changing in the rituximab era. This article will provide a review of transformed lymphomas with an emphasis on treatment and the nuances of diagnosis and clinical management. Unless otherwise specified, all discussion in this review pertains to transformed follicular lymphoma which is the more common scenario and the subtype with the most robust data. In many cases, this information can be extrapolated and applied to other indolent histologies (i.e. transformed marginal zone lymphoma); however, several other clinical scenarios, such as Richter's transformation and "double hit" transformations, warrant a distinct discussion and will be reviewed separately.
Collapse
Affiliation(s)
- James Godfrey
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, USA
| | - Michael J Leukam
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, USA
| | - Sonali M Smith
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, USA.
| |
Collapse
|
9
|
Arboe B, Halgren Olsen M, Duun-Henriksen AK, Gørløv JS, Nielsen KF, Thomsen RH, Madsen C, Nielsen SR, Dalton SO, Brown PDN. Prolonged hospitalization, primary refractory disease, performance status and age are prognostic factors for survival in patients with diffuse large B-cell lymphoma and transformed indolent lymphoma undergoing autologous stem cell transplantation. Leuk Lymphoma 2017; 59:1153-1162. [DOI: 10.1080/10428194.2017.1369061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Bente Arboe
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhage, Denmark
- The Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | | | - Jette Sønderskov Gørløv
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhage, Denmark
| | | | - Rasmus Heje Thomsen
- Department of Hematology, Copenhagen University Hospital, Herlev, Copenhagen, Denmark
| | - Charlotte Madsen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Peter de Nully Brown
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhage, Denmark
| |
Collapse
|
10
|
Alonso-Álvarez S, Magnano L, Alcoceba M, Andrade-Campos M, Espinosa-Lara N, Rodríguez G, Mercadal S, Carro I, Sancho JM, Moreno M, Salar A, García-Pallarols F, Arranz R, Cannata J, Terol MJ, Teruel AI, Rodríguez A, Jiménez-Ubieto A, González de Villambrosia S, Bello JL, López L, Monsalvo S, Novelli S, de Cabo E, Infante MS, Pardal E, García-Álvarez M, Delgado J, González M, Martín A, López-Guillermo A, Caballero MD. Risk of, and survival following, histological transformation in follicular lymphoma in the rituximab era. A retrospective multicentre study by the Spanish GELTAMO group. Br J Haematol 2017; 178:699-708. [PMID: 28782811 DOI: 10.1111/bjh.14831] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/05/2017] [Indexed: 11/28/2022]
Abstract
The diagnostic criteria for follicular lymphoma (FL) transformation vary among the largest series, which commonly exclude histologically-documented transformation (HT) mandatorily. The aims of this retrospective observational multicentre study by the Spanish Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea, which recruited 1734 patients (800 males/934 females; median age 59 years), diagnosed with FL grades 1-3A, were, (i) the cumulative incidence of HT (CI-HT); (ii) risk factors associated with HT; and (iii) the role of treatment and response on survival following transformation (SFT). With a median follow-up of 6·2 years, 106 patients developed HT. Ten-year CI-HT was 8%. Considering these 106 patients who developed HT, median time to transformation was 2·5 years. High-risk FL International Prognostic Index [Hazard ratio (HR) 2·6, 95% confidence interval (CI): 1·5-4·5] and non-response to first-line therapy (HR 2·9, 95% CI: 1·3-6·8) were associated with HT. Seventy out of the 106 patients died (5-year SFT, 26%). Response to HT first-line therapy (HR 5·3, 95% CI: 2·4-12·0), autologous stem cell transplantation (HR 3·9, 95% CI: 1·5-10·1), and revised International Prognostic Index (HR 2·2, 95% CI: 1·1-4·2) were significantly associated with SFT. Response to treatment and HT were the variables most significantly associated with survival in the rituximab era. Better therapies are needed to improve response. Inclusion of HT in clinical trials with new agents is mandatory.
Collapse
Affiliation(s)
- Sara Alonso-Álvarez
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Laura Magnano
- Hospital Clinic of Barcelona, Barcelona, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Miguel Alcoceba
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO).,CIBERONC, Spain
| | - Marcio Andrade-Campos
- Hospital Universitario Miguel Servet de Zaragoza - CIBERER, IIS-Aragón (ISCIII), Zaragoza, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Natalia Espinosa-Lara
- Hospital Universitario Miguel Servet de Zaragoza - CIBERER, IIS-Aragón (ISCIII), Zaragoza, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Guillermo Rodríguez
- Hospital Virgen del Rocío Sevilla, Sevilla, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Santiago Mercadal
- Instituto Catalán de Oncología (ICO) Duran i Reynals, Barcelona, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Itziar Carro
- Instituto Catalán de Oncología (ICO) Duran i Reynals, Barcelona, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Juan M Sancho
- Instituto Catalán de Oncología (ICO-IJC) German Trias i Pujol, Barcelona, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Miriam Moreno
- Instituto Catalán de Oncología (ICO-IJC) German Trias i Pujol, Barcelona, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Antonio Salar
- Hospital del Mar, Barcelona, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Francesc García-Pallarols
- Hospital del Mar, Barcelona, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Reyes Arranz
- Hospital La Princesa, Madrid, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Jimena Cannata
- Hospital La Princesa, Madrid, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - María José Terol
- Hospital Clínico, Valencia, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Ana I Teruel
- Hospital Clínico, Valencia, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Antonia Rodríguez
- Hospital 12 de Octubre, Madrid, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Ana Jiménez-Ubieto
- Hospital 12 de Octubre, Madrid, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Sonia González de Villambrosia
- Hospital Marqués de Valdecilla, Santander, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - José L Bello
- Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Lourdes López
- Hospital MD Anderson, Madrid, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Silvia Monsalvo
- Hospital Fundación Jiménez Díaz, Madrid, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Silvana Novelli
- Hospital Sant Pau, Barcelona, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Erik de Cabo
- Hospital del Bierzo, Ponferrada, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - María S Infante
- Hospital Infanta Leonor, Madrid, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Emilia Pardal
- Hospital Virgen del Puerto, Plasencia, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - María García-Álvarez
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Julio Delgado
- Hospital Clinic of Barcelona, Barcelona, Spain.,CIBERONC, Spain
| | - Marcos González
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO).,CIBERONC, Spain
| | - Alejandro Martín
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO).,CIBERONC, Spain
| | - Armando López-Guillermo
- Hospital Clinic of Barcelona, Barcelona, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO).,CIBERONC, Spain
| | - María D Caballero
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO).,CIBERONC, Spain
| |
Collapse
|
11
|
Shimoni A. The role of stem-cell transplantation in the treatment of marginal zone lymphoma. Best Pract Res Clin Haematol 2017; 30:166-171. [PMID: 28288712 DOI: 10.1016/j.beha.2016.08.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/08/2016] [Accepted: 08/08/2016] [Indexed: 12/28/2022]
Abstract
High-dose chemotherapy and autologous stem-cell transplantation (ASCT) is standard therapy in relapsed/refractory aggressive lymphoma. The optimal therapy of relapsed/refractory disseminated marginal-zone lymphoma (MZL) has not been defined. Limited data on ASCT in this setting suggests outcomes are similar to what is expected in follicular lymphoma. International guidelines suggest that ASCT should be considered in follicular lymphoma in second or subsequent remission, in particular in high-risk disease, or following disease transformation. These guidelines can be extrapolated to MZL. ASCT is not considered curative but a subset of patients achieve very long remissions. The major concern is the occurrence of secondary malignancies possibly related to total-body irradiation. Allogeneic SCT is usually considered after failure of ASCT, but can also be considered upfront in younger patients seeking curative approach. The introduction of novel/targeted therapies may change the role and timing SCT may have in the treatment algorithm of indolent lymphomas.
Collapse
Affiliation(s)
- Avichai Shimoni
- The Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Israel.
| |
Collapse
|
12
|
Reagan PM, Baran A, Kelly JL, Barr PM, Casulo C, Chengazi VU, Friedberg JW. Consolidative Radioimmunotherapy After Chemoimmunotherapy in Patients With Histologic Transformation of Indolent Non-Hodgkin Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:322-328.e2. [PMID: 27130328 DOI: 10.1016/j.clml.2016.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 03/27/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Histologic transformation (HT) of indolent non-Hodgkin lymphomas is an event that results in considerable morbidity and mortality. The introduction of chemoimmunotherapy regimens has resulted in an improvement in the management of this disease, and consolidation of responses with autologous stem cell transplantation appears efficacious. Many patients are not eligible for high-dose therapy, however. Radioimmunotherapy (RIT) has demonstrated single-agent efficacy in HT and can be used safely as consolidation after chemoimmunotherapy. For these reasons, RIT consolidation after chemoimmunotherapy induction has been our standard treatment approach at the University of Rochester for patients with HT who were ineligible for autologous stem cell transplantation. PATIENTS AND METHODS A retrospective cohort study was performed to describe the clinical outcomes of these patients. Twenty-one patients were identified who received RIT consolidation. The Kaplan-Meier method was used to estimate the distributions of overall survival and progression-free survival. Comparisons were made between patients with pathologic HT and the combination of clinical HT and composite lymphoma using the log-rank test to compare survival curves. RESULTS The median overall survival of the cohort was 84 months, and progression-free survival was 38 months. The major toxicity was myelosuppression, and 2 deaths were attributed to therapy. One case of therapy-related acute myeloid leukemia was noted. CONCLUSION In a population of patients ineligible for high-dose therapy with autologous stem cell support, consolidation of response to chemoimmunotherapy with RIT was well tolerated and should be considered in patients with disease responsive to induction therapy.
Collapse
Affiliation(s)
- Patrick M Reagan
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY.
| | - Andrea Baran
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Jennifer L Kelly
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Carla Casulo
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Vaseem U Chengazi
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY
| | | |
Collapse
|