1
|
Tormane MA, Laamiri G, Beji H, Gazzeh H, Bouassida M, Touinsi H. Primary mantle-cell lymphoma of small intestine presenting with intussusceptions: A case report and review of the literature. Int J Surg Case Rep 2024; 121:109963. [PMID: 38954973 DOI: 10.1016/j.ijscr.2024.109963] [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: 12/05/2023] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Mantle cell lymphoma is a rare type of non-Hodgkin's lymphoma which accounts for 5 % of all cases. Patients present with an advanced form of the disease. We present here a case of ileocolic intussusception secondary to mantle cell lymphoma which was revealed by abdominal pain and vomiting that was treated by surgical resection followed by chemotherapy. CASE PRESENTATION This report illustrates the case of a 34-year-old male who presented with abdominal pain and vomiting. Imageology demonstrated an ileocolic intussusception which was treated with hemicolectomy followed by chemotherapy. Histopathology confirmed the diagnosis of Mantle cell lymphoma. CLINICAL DISCUSSION Mantel cell lymphoma is a rare type of B-cell cancer. Patients are generally diagnosed with an advanced stage of the disease. Ileocolic intussusception is an uncommon presentation. Surgery is the pillar of the treatment. Resection depends on the extent and location of the lesion. Postoperative chemotherapy is crucial and it increases survival rate. CONCLUSION Mantle cell lymphoma is a rare subgroup of B-cell lymphomas. Ileocolic intussusception is a complicated form of the disease. Surgery combined with chemotherapy is the mainstay of the treatment. Diagnosis is confirmed by histological analysis of the surgical specimen.
Collapse
Affiliation(s)
- Mohamed Amine Tormane
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia.
| | - Ghazi Laamiri
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Hazem Beji
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Houda Gazzeh
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Mahdi Bouassida
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Hassen Touinsi
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| |
Collapse
|
2
|
Bortezomib in combination with fludarabine plus cyclophosphamide for patients with relapsed or refractory mantle-cell lymphoma: results of the LYM-4003 study. Ann Hematol 2021; 100:2961-2968. [PMID: 34331111 DOI: 10.1007/s00277-021-04619-4] [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: 12/02/2020] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
This study aimed to identify the maximum-tolerated dose (MTD) of cyclophosphamide when combined with bortezomib and fludarabine (B-FC) in a phase 1b trial, and to assess the efficacy and safety of this combination in a phase 2 trial in patients with relapsed or refractory MCL (rrMCL). Forty patients were enrolled between April 8, 2011, and October 10, 2015. The MTD of cyclophosphamide was identified to be 250 mg/m2 days 1-2. At a median follow-up of 31.6 months (13.5-47.4), among 32 patients in phase 2, 10 (31%) had a complete response and 13 (41%) had a partial response. The median progression-free survival was 21 months (95% CI 7.3-34.7), and the median overall survival was 32.4 months (95% CI 17.8-47.0). Grade 3-4 hematologic AEs included neutropenia (27%) and thrombocytopenia (39%). The B-FC regimen has satisfactory responses and manageable toxicities in rrMCL patients (ClinicalTrials.gov NCT01322776).
Collapse
|
3
|
Weaver JA, Peng Y, Ji Y, Gilbertson D, Pease DF, Morrison VA. A medicare database analysis of practice patterns in patients with mantle cell lymphoma. J Geriatr Oncol 2021; 12:894-901. [PMID: 33423932 DOI: 10.1016/j.jgo.2020.12.013] [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: 04/22/2020] [Revised: 10/21/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Although treatment approaches to younger fit patients with mantle cell lymphoma (MCL) are well-described, the optimal treatment of older or less fit patients with varying comorbidities is less clear. The objectives of this study were to examine first-line treatment patterns, and the impact of comorbidities and age on treatment choices and overall survival (OS) in a large, predominantly older, Medicare population. PATIENTS AND METHODS In Medicare data from 1/1/2007-8/31/2015, 3,008 patients with MCL were identified. Data on age, gender, race, Charlson comorbidities, Charlson comorbidity index (CCI), timing of injectable MCL therapies, and OS were collected and analyzed. RESULTS Median age of the study population was 75.5 (range, 33-107; 25th, 75th: 69.9, 81.5) years. Over half of the individuals had ≥two comorbidities. The CCI was 1-2 in 45%, and 3-4 in 26.6% of patients. Rituximab was the most commonly used agent, regardless of age or comorbidity, in the first 60 days following diagnosis, being administered to 40.2% of patients. In contrast, administration of cyclophosphamide, doxorubicin, vincristine, or bendamustine in the first 60 days after diagnosis was less common (17.9%, 13.1%, 17.2%, and 12%, respectively). Overall survival was 3.23 (range, 0.003-7.668) years, and decreased with increasing number of comorbidities. DISCUSSION Our analysis of a real-world patient population with MCL found that older patients have a high rate of comorbidities which impact administered treatment and subsequent OS. Our findings can be used to prospectively guide treatment decisions in these older, frailer, non-transplant-eligible patients, considering the impact of age and comorbidities on such choices.
Collapse
Affiliation(s)
- Jessalyn A Weaver
- Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Yi Peng
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Yuanyuan Ji
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - David Gilbertson
- Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Daniel F Pease
- Hematology/Oncology, Department of Medicine, Hennepin County Medical Center/University of Minnesota, 715 8th St, Minneapolis, MN 55404, USA
| | - Vicki A Morrison
- Hematology/Oncology, Department of Medicine, Hennepin County Medical Center/University of Minnesota, 715 8th St, Minneapolis, MN 55404, USA.
| |
Collapse
|
4
|
Wang X, Li W, Wang X, Liu X, Feng C, Li Y, Li J. The effectiveness and harms of bortezomib in combination with chemotherapy for mantle cell lymphoma: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20961. [PMID: 32664099 PMCID: PMC7360284 DOI: 10.1097/md.0000000000020961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chemotherapy with or without consolidation followed by autologous hematopoietic stem cell transplantation is the first-line treatment for mantle cell lymphoma. However, the effectiveness and safety of bortezomib-based chemotherapy for patients with mantle cell lymphoma is still uncertain. METHODS In this systematic review, the electronic databases of Cochrane Central Register of Controlled Trials, EMBASE, and PUBMED will be searched from inception to May 1, 2020. Randomized controlled trials that assessed the effectiveness and safety of bortezomib in combination with chemotherapy for patients with mantle cell lymphoma will be included. The patient's important outcomes include overall survival, progression-free survival, overall response rate, quality of life, and serious adverse events (eg, grade III-IV peripheral neuropathy, neutropenia, and infection). All process of the study selection, data extraction, and methodology evaluation will be carried out by 2 authors independently. RevMan 5.3 software will be utilized for statistical analysis. RESULTS This study will provide a detailed summary of latest evidence related to the effectiveness and safety of bortezomib in combination with chemotherapy in overall survival, progression-free survival, overall response rate, quality of life, and serious adverse events for patients with mantle cell lymphoma CONCLUSION:: The findings of this study may provide possible guidance for bortezomib in combination with chemotherapy for patients with mantle cell lymphoma. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD 42020154938.
Collapse
Affiliation(s)
- Xiaoxia Wang
- Department of Pharmacy, Gansu Gem Flower Hospital, Xigu District
| | - Wen Li
- Department of Oncology, Gansu Gem Flower Hospital, No. 733, Fuli Road, Xigu District
| | - Xin Wang
- The Second People's Hospital of Lan Zhou, Chengguan District
| | - Xiaoli Liu
- Department of Pharmacy, Gansu Gem Flower Hospital, Xigu District
| | - Cuijuan Feng
- Gansu Health Vocational College, Lanzhou New District
| | - Yihan Li
- Emergency Department, Gansu Gem Flower Hospital, No. 733, Fuli Road, Xigu District, Lanzhou City, Gansu Province, China
| | - Jing Li
- Department of Pharmacy, Gansu Gem Flower Hospital, Xigu District
| |
Collapse
|
5
|
Li SJ, Hao J, Mao Y, Si YL. Effects of the Proteasome Inhibitor Bortezomib in Combination with Chemotherapy for the Treatment of Mantle Cell Lymphoma: A Meta-analysis. Turk J Haematol 2019; 37:13-19. [PMID: 31464119 PMCID: PMC7057744 DOI: 10.4274/tjh.galenos.2019.2019.0128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objective: The efficacy and the safety of bortezomib-based chemotherapy were characterized in mantle cell lymphoma (MCL) patients. Materials and Methods: The PubMed, Cochrane Library, Clinical Key, Science Direct, Oxford Journals, and China National Knowledge Internet databases were searched up to 1 May 2019. The selected trials needed to match the inclusion criteria and be carried out to evaluate quality appraisal and the synthesis of efficacy and safety. The enrolled MCL patients using bortezomib-based chemotherapy or chemotherapy alone needed to have been compared. The overall response rate (ORR), progression-free survival (PFS), and overall survival (OS) were combined to evaluate the efficacy while serious adverse events (SAEs) (grade III-IV peripheral neuropathy, neutropenia, and infection) were used to evaluate the safety. The heterogeneity of the results were analyzed simultaneously. Results: A total of 620 patients were enrolled across four studies in our meta-analysis, and the pooled results showed that the PFS [hazard ratio (HR)=0.66, 95% confidence interval (CI)=0.54-0.82; p=0.0001)] and OS (HR=0.73, 95% CI=0.55-0.96; p=0.03) of patients with bortezomib-based chemotherapy were better than those of patients with chemotherapy alone, unlike ORR (risk ratio=1.46, 95% CI=0.85-2.49; p=0.17), while SAEs were prominent in the combination group. Conclusion: MCL patients who are ineligible for transplant or high-dose chemotherapy could benefit from bortezomib-based chemotherapy.
Collapse
Affiliation(s)
- Shi-Jun Li
- Tianjin 4th Central Hospital, Clinic of Hematology, Tianjin, China
| | - Jian Hao
- Tianjin 4th Central Hospital, Clinic of Hematology, Tianjin, China
| | - Yu Mao
- Renmin Hospital, Clinic of Oncology, Tianjin, China
| | - Yu-Ling Si
- Tianjin 4th Central Hospital, Clinic of Hematology, Tianjin, China
| |
Collapse
|
6
|
Knudsen MKH, Rasmussen PK, Coupland SE, Esmaeli B, Finger PT, Graue GF, Grossniklaus HE, Khong JJ, McKelvie PA, Mulay K, Ralfkiaer E, Sjö LD, Vemuganti GK, Thuro BA, Curtin J, Heegaard S. Clinicopathological Features of Ocular Adnexal Mantle-Cell Lymphoma in an International Multicenter Cohort. JAMA Ophthalmol 2019; 135:1367-1374. [PMID: 29121219 DOI: 10.1001/jamaophthalmol.2017.4810] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance To our knowledge, the clinical features of ocular adnexal mantle-cell lymphoma (OA-MCL) have not previously been evaluated in a large multicenter cohort. Objective To characterize the clinical features of OA-MCL. Design, Setting, and Participants This retrospective multicenter study included patient data collected from January 1, 1980, through December 31, 2015, at 6 eye cancer centers in 4 countries. Medical records of 55 patients with OA-MCL were reviewed; the median length of follow-up was 33 months. Main Outcomes and Measures Overall survival, disease-specific survival, and progression-free survival were the primary end points. Results Fifty-five patients were included; ocular adnexal MCL was found to be most common in older individuals (mean age, 70 years) and men (n = 42 of 55; 76%). Patients with OA-MCL frequently presented with disseminated lymphoma (n = 34 of 55; 62%), and were likely to experience stage IVE disease (n = 35 of 55; 64%), with bilateral involvement (n = 27 of 55; 47%), tumor masses (n = 27 of 36; 75%), and involvement of the orbit (n = 32 of 55; 58%). Chemotherapy with or without external beam radiation therapy was the most frequently used treatment. Overall survival rates for the entire cohort were 65% at 3 years (95% CI, 52%-78%) and 34% at 5 years (95% CI, 21%-47%). Disease-specific survival after 5 years was 38% for the entire cohort (95% CI, 25%-51%); the disease-specific survival adjusted by eye cancer center was better in patients who had received rituximab in addition to the chemotherapy regimen (hazard ratio, 3.3; 95% CI, 1.0-14.7; P = .06). The median progression-free survival was 2.3 years (95% CI, 1.8-2.7 years) in patients who experienced recurrence after primary treatment, and 4.1 years (95% CI, 3.9-4.3 years) in patients who presented with a relapse of systemic lymphoma in the ocular adnexal region. Conclusions and Relevance These results suggest that the distinctive features of OA-MCL are its appearance in older male individuals, advanced stage and bilateral manifestation at the time of diagnosis, and aggressive course. The prognosis of patients with OA-MCL might be improved by addition of rituximab to chemotherapy treatment.
Collapse
Affiliation(s)
- Marina K H Knudsen
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter K Rasmussen
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sarah E Coupland
- Department of Cellular and Molecular Pathology, University of Liverpool, Liverpool, England
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston
| | | | | | | | - Jwu Jin Khong
- Orbital, Plastic, and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Penny A McKelvie
- Orbital, Plastic, and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Kaustubh Mulay
- National Reporting Centre for Ophthalmic Pathology, Centre for Sight, and Ocular Pathology, LV Prasad Eye Institute, Hyderabad, India
| | - Elisabeth Ralfkiaer
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lene D Sjö
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Geeta K Vemuganti
- Visiting Faculty, Ophthalmic Pathology Services, LV Prasad Eye Institute, Hyderabad, India,School of Medical Sciences, University of Hyderabad, Hyderabad, India
| | - Bradley A Thuro
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston
| | - Jeremy Curtin
- Orbital, Plastic, and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Steffen Heegaard
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,Department of Ophthalmology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
7
|
Wang Y, Deng M, Chen Q, Li Y, Guo X, Shi P, He L, Xie S, Yu L, Zhang H, Xu B. Apatinib exerts anti-tumor activity to non-Hodgkin lymphoma by inhibition of the Ras pathway. Eur J Pharmacol 2018; 843:145-153. [PMID: 30423319 DOI: 10.1016/j.ejphar.2018.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/08/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023]
Abstract
Apatinib is a tyrosine kinase inhibitor that selectively targets vascular endothelial growth factor receptor-2 (VEGFR-2). Although apatinib has shown promising anti-tumor activity against several types of tumor, its role and underlying mechanism against non-Hodgkin lymphoma (NHL) remain to be explored. Here, we report that apatinib dramatically inhibited in vitro the proliferation of various human NHL cell lines, including Burkitt lymphoma (BL), mantle cell lymphoma (MCL), and diffuse large B-cell lymphoma (DLBCL), in a dose-dependent manner. Moreover, administration of apatinib markedly delayed tumor growth in vivo in a xenograft mouse model derived from human DLBCL OCI-ly3 cells, in association with significantly prolonged survival of tumor-bearing mice. Mechanistically, apatinib suppressed activation of VEGFR2 (manifested by reduced VEGFR2 phosphorylation), accompanied by inhibition of the Ras pathway (reflected by down-regulation Ras, Raf, pMEK1/2, pERK1/2) in OCI-ly1 (GCB subtype of DLBCL) and SU-DHL2 (ABC subtype of DLBCL) cells. Of note, apatinib sharply impaired angiogenesis in vivo in tumor tissues. Together, these results indicate that apatinib displays a marked cytotoxic activity against various types of NHL cells (including BL, MCL, and GCB- or ABC-DLBCL) both in vitro and in vivo. They also suggest that anti-NHL activity of apatinib might be associated with inhibition of tumor cell growth and induction of apoptosis as well as anti-angiogenesis by targeting VEGFR2 and its downstream Ras/Raf/MEK/ERK pathway.
Collapse
Affiliation(s)
- Yan Wang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Manman Deng
- Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, Medical College of Xiamen University, Xiamen, Fujian 361003, China
| | - Qinwei Chen
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Yin Li
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Xutao Guo
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Pengcheng Shi
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Lingli He
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Siting Xie
- Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, Medical College of Xiamen University, Xiamen, Fujian 361003, China
| | - Lian Yu
- Department of Hematology and Rheumatology, Longyan First Hospital, Affiliated to Fujian Medical University, Longyan, Fujian 364000, China.
| | - Haiping Zhang
- Department of Pathology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, China.
| | - Bing Xu
- Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, Medical College of Xiamen University, Xiamen, Fujian 361003, China.
| |
Collapse
|
8
|
SOX11 augments BCR signaling to drive MCL-like tumor development. Blood 2018; 131:2247-2255. [PMID: 29615403 DOI: 10.1182/blood-2018-02-832535] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/23/2018] [Indexed: 11/20/2022] Open
Abstract
Mantle cell lymphoma (MCL) is characterized by increased B-cell receptor (BCR) signaling, and BTK inhibition is an effective therapeutic intervention in MCL patients. The mechanisms leading to increased BCR signaling in MCL are poorly understood, as mutations in upstream regulators of BCR signaling such as CD79A, commonly observed in other lymphomas, are rare in MCL. The transcription factor SOX11 is overexpressed in the majority (78% to 93%) of MCL patients and is considered an MCL-specific oncogene. So far, attempts to understand SOX11 function in vivo have been hampered by the lack of appropriate animal models, because germline deletion of SOX11 is embryonically lethal. We have developed a transgenic mouse model (Eμ-SOX11-EGFP) in the C57BL/6 background expressing murine SOX11 and EGFP under the control of a B-cell-specific IgH-Eμ enhancer. The overexpression of SOX11 exclusively in B cells exhibits oligoclonal B-cell hyperplasia in the spleen, bone marrow, and peripheral blood, with an immunophenotype (CD5+CD19+CD23-) identical to human MCL. Furthermore, phosphocytometric time-of-flight analysis of the splenocytes from these mice shows hyperactivation of pBTK and other molecules in the BCR signaling pathway, and serial bone marrow transplant from transgenic donors produces lethality with decreasing latency. We report here that overexpression of SOX11 in B cells promotes BCR signaling and a disease phenotype that mimics human MCL.
Collapse
|
9
|
Chin CC, Shiau J, Wu WC. Mantle cell lymphoma presented as enteric intussusception and involved gallbladder. JOURNAL OF CANCER RESEARCH AND PRACTICE 2017. [DOI: 10.1016/j.jcrpr.2016.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
10
|
Boltezar L, Pintaric K, Pretnar J, Pohar Perme M, Novakovic BJ. Long-term outcomes of high dose treatment and autologous stem cell transplantation in follicular and mantle cell lymphomas - a single centre experience. Radiol Oncol 2017; 51:81-87. [PMID: 28265236 PMCID: PMC5330167 DOI: 10.1515/raon-2016-0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 05/24/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Advanced follicular lymphoma (FL) and mantle cell lymphoma (MCL) are incurable diseases with conventional treatment. The high dose treatment (HDT) with autologous stem cell transplantation (ASCT), however, offers a certain proportion of these patients the prospect of a prolonged disease-free and overall survival. The aim of this study was to investigate the event free survival (EFS) and overall survival (OS) in patients with FL and MCL treated with ASCT. PATIENTS AND METHODS Seventeen patients with FL and 29 patients with MCL were included, 15 of them were transplanted to consolidate the response to second line treatment and 24 to consolidate their first remission, respectively. All were conditioned with total body irradiation (TBI) and high dose cyclophosphamide between 2006 and 2014 and all were transplanted with peripheral blood stem cells. RESULTS The estimated 5-year OS for FL was 87.8% (95% confidence interval [CI] 59.5%-96.8%) and for MCL 79.3% (95% CI 56.1%-91.1%), respectively. The estimated 5-year EFS for FL was 76.0% (95% CI 48.0%-90.3%) and for MCL 69.8% (95% CI 45.5%-84.8%), respectively. There were no secondary hematological malignancies observed in either group. CONCLUSIONS Based on above results, the ASCT with TBI is a good treatment option in terms of long-term survival for patients with follicular and mantle cell lymphoma demonstrating a relatively low rate of late toxicities and secondary malignancies.
Collapse
Affiliation(s)
- Lucka Boltezar
- Department of Medical Oncology, Institute of Oncology Ljubljana, Slovenia
| | | | - Jože Pretnar
- Department of Hematology, University Clinical Centre Ljubljana, Slovenia
| | - Maja Pohar Perme
- Department of Biostatistics and Medical Informatics, University of Ljubljana, Slovenia
| | | |
Collapse
|
11
|
Doval DC, Bhurani D, Nair R, Gujral S, Malhotra P, Ramanan G, Mohan R, Biswas G, Dattatreya S, Agarwal S, Pendharkar D, Julka PK, Advani SH, Dhaliwal RS, Tayal J, Sinha R, Kaur T, Rath GK. Indian Council of Medical Research Consensus Document for the Management of Non-Hodgkin's Lymphoma (High Grade). Indian J Med Paediatr Oncol 2017; 38:51-58. [PMID: 28469337 PMCID: PMC5398107 DOI: 10.4103/0971-5851.203500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This consensus document is based on the guidelines related to the management of Non Hodgkin's Lymphoma (High grade) in the Indian population as proposed by the core expert committee. Accurate diagnosis in hematolymphoid neoplasm requires a combination of detailed history,clinical examination, and various investigations including routine laboratory tests, good quality histology section (of tumor and also bone marrow aspirate/biopsy), immunostaining, cytogenetic and molecular studies and radiology investigations. The staging system used for adult high grade lymphomas is based on the Ann Arbor system and includes various parameters like clinical, haematology, biochemistry, serology and radiology. Response should be evaluated with radiological evaluation after 3-4 cycles and at the end of treatment based on criteria including and excluding PET. Treatment of high grade lymphomas is based on histologic subtype, extent of disease, and age of the patient. Autologous stem cell transplantation after high dose chemotherapy is effective in the treatment of relapsed NHL. Newer RT techniques like 3 dimensional conformal radiation therapy (3D-CRT) and intensity modulated radiation therapy (IMRT) can significantly reduce radiation doses to surrounding normal tissues in lymphoma patients. Patients should be followed up every 3 to 4 months for the first 2 years, followed by 6 monthly for the next 3 years and then annually.
Collapse
Affiliation(s)
- Dinesh Chandra Doval
- Department of Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Dinesh Bhurani
- Department of Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Reena Nair
- Department of Hemato oncology, Tata Memorial Centre, Kolkata, West Bengal, India
| | - Sumeet Gujral
- Department of Hemato Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Pankaj Malhotra
- Department of Clinical Haematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ganpati Ramanan
- Department of Medical Oncology, Apollo MultiSpecialty Hospital, Chennai, Tamil Nadu, India
| | - Ravi Mohan
- Department of Internal Medicine and Medical Oncology, Guntur Medical College, Guntur, Andhra Pradesh, India
| | - Ghanshyam Biswas
- Department of Medical Oncology, Sparsh Hospitals and Critical Care, Bhubaneswar, Odisha, India
| | - Satya Dattatreya
- Department of Medical Oncology, Omega Hospital, Hyderabad, Telangana, India
| | - Shyam Agarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - Dinesh Pendharkar
- Division of Non Communicable Disease, Indian Council of Medical Research, New Delhi, India
| | - Pramod Kumar Julka
- Department of Radiotherapy, Dr. BR Ambedkar Institute of Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Suresh H Advani
- Department of Medical Oncology, SL Raheja Hospital, Mumbai, Maharashtra, India
| | | | - Juhi Tayal
- Department of Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Rupal Sinha
- Department of Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Tanvir Kaur
- Division of Non Communicable Disease, Indian Council of Medical Research, New Delhi, India
| | - Goura K Rath
- Department of Radiotherapy, Dr. BR Ambedkar Institute of Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
12
|
van Keep M, Gairy K, Seshagiri D, Thilakarathne P, Lee D. Cost-effectiveness analysis of bortezomib in combination with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (VR-CAP) in patients with previously untreated mantle cell lymphoma. BMC Cancer 2016; 16:598. [PMID: 27488675 PMCID: PMC4972997 DOI: 10.1186/s12885-016-2633-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/27/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mantle cell lymphoma (MCL) is a rare and aggressive form of non-Hodgkin's lymphoma. Bortezomib is the first product to be approved for the treatment of patients with previously untreated MCL, for whom haematopoietic stem cell transplantation is unsuitable, and is used in combination with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (VR-CAP). The National Institute of Health and Care Excellence recently recommended the use of VR-CAP in the UK following a technology appraisal. We present the cost effectiveness analysis performed as part of that assessment: VR-CAP versus the current standard of care regimen of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) in a UK setting. METHODS A lifetime economic model was developed with health states based upon line of treatment and progression status. Baseline patient characteristics, dosing, safety and efficacy were based on the LYM-3002 trial. As overall survival data were immature, survival was modelled by progression status, and post-progression survival was assumed equal across arms. Utilities were derived from LYM-3002 and literature, and standard UK cost sources were used. RESULTS Treatment with VR-CAP compared to R-CHOP gave an incremental quality-adjusted life year (QALY) gain of 0.81 at an additional cost of £16,212, resulting in a base case incremental cost-effectiveness ratio of £20,043. Deterministic and probabilistic sensitivity analyses showed that treatment with VR-CAP was cost effective at conventional willingness-to-pay thresholds (£20,000-£30,000 per QALY). CONCLUSIONS VR-CAP is a cost-effective option for previously untreated patients with MCL in the UK.
Collapse
Affiliation(s)
| | - Kerry Gairy
- Janssen-Cilag, 50-100 Holmers Farm Way, High Wycombe, HP12 4EG UK
| | | | | | - Dawn Lee
- BresMed, 84 Queen Street, Sheffield, S1 2DW UK
| |
Collapse
|
13
|
Alwasaidi TA, Hamadah A, Altouri S, Tay J, McDiarmid S, Faught C, Allan D, Huebsch L, Bredeson C, Bence-Bruckler I. Outcomes of both abbreviated hyper-CVAD induction followed by autologous hematopoietic cell transplantation and conventional chemotherapy for mantle cell lymphoma: a 10-year single-centre experience with literature review. Cancer Med 2015; 4:1817-27. [PMID: 26432256 PMCID: PMC5123787 DOI: 10.1002/cam4.543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/20/2015] [Accepted: 08/25/2015] [Indexed: 11/24/2022] Open
Abstract
We retrospectively evaluated consecutive patients diagnosed with Mantle cell lymphoma (MCL) between 01 January 2000 and 31 December 2009. Eighty eight patients with MCL were included in the analysis of whom 46 (52%) received abbreviated Hyper‐CVAD (a total of two cycles; with addition of Rituximab since 2005) with an intention of proceeding to autologous hematopoietic cell transplantation (auto‐HCT), with a median age of 58 years. Response rate to induction at auto‐HCT time was 89% and complete response was 61%. Forty four patients received an auto‐HCT with a 5‐year progression‐free survival (PFS) and overall survival (OS) were 31.2% and 62.5%, respectively. There were 42 nontransplant eligible patients with a median age of 72 years, and 5‐year PFS and OS were 0.0% and 39.9%, respectively. The median survival and PFS in the auto‐HCT eligible group were 68 and 33 months, compared to 32 and 12 months in nontransplant eligible group, without a plateauing of the survival curves in either group. Treatment‐related mortality in the auto‐HCT eligible group was 10.9% (n = 5); two patients died during R‐Hyper‐CVAD and 3 (6.8%) experienced transplant‐related mortality. An abbreviated R‐Hyper‐CVAD‐based induction strategy followed by consolidative auto‐HCT is feasible and provides moderate potential of long‐term survival. Further research to define risk‐adapted strategies; to optimize disease control, is required.
Collapse
Affiliation(s)
- Turki Abdulaziz Alwasaidi
- Ottawa Hospital Blood and Marrow Transplant Program, Ottawa, Ontario, Canada.,College of Medicine at Taibah University, Almadinah Almunawarh, Saudi Arabia
| | - Abdulaziz Hamadah
- Ottawa Hospital Blood and Marrow Transplant Program, Ottawa, Ontario, Canada.,Department of Medical Oncology, Cancer Center, Kuwait, Kuwait
| | - Sultan Altouri
- Ottawa Hospital Blood and Marrow Transplant Program, Ottawa, Ontario, Canada
| | - Jason Tay
- Ottawa Hospital Blood and Marrow Transplant Program, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sheryl McDiarmid
- Ottawa Hospital Blood and Marrow Transplant Program, Ottawa, Ontario, Canada
| | - Carolyn Faught
- Ottawa Hospital Blood and Marrow Transplant Program, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - David Allan
- Ottawa Hospital Blood and Marrow Transplant Program, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lothar Huebsch
- Ottawa Hospital Blood and Marrow Transplant Program, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Christopher Bredeson
- Ottawa Hospital Blood and Marrow Transplant Program, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Isabelle Bence-Bruckler
- Ottawa Hospital Blood and Marrow Transplant Program, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
14
|
Abstract
Mantle cell lymphoma (MCL) is a hematological malignancy with unfavorable prognosis. Bortezomib, a potent, selective and reversible inhibitor of the 26S proteasome, was shown to be active in MCL and is currently implemented in therapeutic combinations. Single-agent bortezomib has demonstrated clinical efficacy in relapsed and refractory MCL with objective response in up to 47% of the patients. However, complete remission rates are low and duration of response is relatively short. In previously untreated patients, the addition of bortezomib to induction chemotherapy is also promising. Further evaluation of bortezomib alone or in combination with other drugs for the treatment of MCL is warranted to improve the quality of life and survival of patients. This review explores bortezomib as therapy in patients with MCL.
Collapse
Affiliation(s)
- Tadeusz Robak
- Department of Hematology, Medical University of Lodz, 93-510 Lodz, ul. Ciołkowskiego 2, Poland
| |
Collapse
|
15
|
Direct and immune-mediated cytotoxicity of interleukin-21 contributes to antitumor effects in mantle cell lymphoma. Blood 2015; 126:1555-64. [PMID: 26194763 DOI: 10.1182/blood-2015-01-624585] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 07/06/2015] [Indexed: 12/18/2022] Open
Abstract
Mantle cell lymphoma (MCL) is a distinct subtype of non-Hodgkin lymphoma characterized by overexpression of cyclin D1 in 95% of patients. MCL patients experience frequent relapses resulting in median survival of 3 to 5 years, requiring more efficient therapeutic regimens. Interleukin (IL)-21, a member of the IL-2 cytokine family, possesses potent antitumor activity against a variety of cancers not expressing the IL-21 receptor (IL-21R) through immune activation. Previously, we established that IL-21 exerts direct cytotoxicity on IL-21R-expressing diffuse large B-cell lymphoma cells. Herein, we demonstrate that IL-21 possesses potent cytotoxicity against MCL cell lines and primary tumors. We identify that IL-21-induced direct cytotoxicity is mediated through signal transducer and activator of transcription 3-dependent cMyc upregulation, resulting in activation of Bax and inhibition of Bcl-2 and Bcl-XL. IL-21-mediated cMyc upregulation is only observed in IL-21-sensitive cells. Further, we demonstrate that IL-21 leads to natural killer (NK)-cell-dependent lysis of MCL cell lines that were resistant to direct cytotoxicity. In vivo treatment with IL-21 results in complete FC-muMCL1 tumor regression in syngeneic mice via NK- and T-cell-dependent mechanisms. Together, these data indicate that IL-21 has potent antitumor activity against MCL cells via direct cytotoxic and indirect, immune-mediated effects.
Collapse
|
16
|
Keklik M, Yildirim A, Keklik E, Ertan S, Deniz K, Ozturk F, Ileri I, Cerci I, Camlica D, Cetin M, Eser B. Pericardial, pleural and peritoneal involvement in a patient with primary gastric mantle cell lymphoma. Scott Med J 2015; 60:e21-4. [PMID: 25636307 DOI: 10.1177/0036933015570528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Primary gastric mantle cell lymphoma is a rare form of gastointestinal tumour. Although peritoneal carcinomatosis accompanied by malignant ascites is relatively common, mantle cell lymphoma presenting with ascites is rare. Also, effusions involving pericardial and pleural cavities are uncommon during the course of lymphomas. We report the first case in which pericardial, pleural and peritoneal effusion of a primary gastric mantle cell lymphoma.
Collapse
Affiliation(s)
- Muzaffer Keklik
- Medical Doctor, Department of Hematology, Faculty of Medicine, Erciyes University, Turkey
| | - Afra Yildirim
- Medical Doctor, Department of Radiology, Faculty of Medicine, Erciyes University, Turkey
| | - Ertugrul Keklik
- Medical Doctor, Department of Physiology, Faculty of Medicine, Erciyes University, Turkey
| | - Sirac Ertan
- Medical Doctor, Department of Pathology, Faculty of Medicine, Erciyes University, Turkey
| | - Kemal Deniz
- Associate Professor, Department of Pathology, Faculty of Medicine, Erciyes University, Turkey
| | - Fahir Ozturk
- Medical Doctor, Department of Internal Medicine, Faculty of Medicine, Erciyes University, Turkey
| | - Ibrahim Ileri
- Medical Doctor, Department of Internal Medicine, Faculty of Medicine, Erciyes University, Turkey
| | - Ilkcan Cerci
- Medical Doctor, Department of Internal Medicine, Faculty of Medicine, Erciyes University, Turkey
| | - Demet Camlica
- Laboratory Technician, Flow Cytometry Unit, Faculty of Medicine, Erciyes University, Turkey
| | - Mustafa Cetin
- Professor, Department of Hematology, Faculty of Medicine, Erciyes University, Turkey
| | - Bulent Eser
- Professor, Department of Hematology, Faculty of Medicine, Erciyes University, Turkey
| |
Collapse
|
17
|
Abstract
Primary gastrointestinal (GI) lymphomas are uncommon diseases that can involve the whole GI tract. The etiologies of the disease remain unclear, and potential risk factors include celiac disease, Helicobacter pylori infection, use of immunosuppressive agents, human immunodeficiency virus (HIV) or Epstein-Barr virus (EBV) infection and inflammatory bowel disease, etc. Diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue (MALT) lymphoma are the most common subtypes of GI lymphomas. B-cell lymphomas of the GI tract are more common in Western countries, while in Asia-Pacific region T-cell lymphomas are more frequently reported. In this review, lymphomas in the esophagus, stomach and intestine are described, including their epidemiology, histology, clinical manifestations, endoscopic findings, radiological features and treatment.
Collapse
Affiliation(s)
- Jiang Chen Peng
- State Key Laboratory for Oncogenes and Related Genes, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai Institute of Digestive Disease, Shanghai Inflammatory Bowel Disease Research Center, Shanghai, China
| | | | | |
Collapse
|
18
|
Lee JJ, Kim MS, Choi HY, Park KS, Lee SB. Comparison of Ocular Adnexal Mantle Cell Lymphoma and MALT Lymphoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.6.815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jong Joo Lee
- Department of Ophthalmology, Chungnam National University, School of Medicine, Daejeon, Korea
| | - Min Su Kim
- Department of Ophthalmology, Chungnam National University, School of Medicine, Daejeon, Korea
| | - Hee Young Choi
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | | | - Sung Bok Lee
- Department of Ophthalmology, Chungnam National University, School of Medicine, Daejeon, Korea
| |
Collapse
|
19
|
Uziel O, Cohen O, Beery E, Nordenberg J, Lahav M. The effect of Bortezomib and Rapamycin on Telomerase Activity in Mantle Cell Lymphoma. Transl Oncol 2014; 7:741-51. [PMID: 25500084 PMCID: PMC4311042 DOI: 10.1016/j.tranon.2014.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 09/11/2014] [Accepted: 09/17/2014] [Indexed: 11/06/2022] Open
Abstract
Mantle cell lymphoma (MCL) is a hematological malignancy with unfavorable prognosis. Novel therapeutic approaches for treating the disease are aimed at the mechanisms regulating growth signals, cellular proliferation, and survival pathways of the malignant clones. Bortezomib (Brt), a proteasome inhibitor with pleiotropic activities was shown to be active in MCL and is currently implemented in therapeutic combinations for this disease. Telomerase activity is essential for survival of malignant cells and as such is considered a valid therapeutic target. This study evaluated the effects of bortezomib on telomerase activity and its regulation in MCL cells in vitro and ex vivo. Our study shows that bortezomib exerts a cytotoxic effect in a dose dependent manner in two MCL cell lines, with differential sensitivity. While the IC50 for HBL-2 cells ranged between 2.5 ng/ml to 1.5 ng/ml during 24-72 h respectively, the IC50 for the NCEB cells was twice. Bortezomib differentially inhibited telomerase activity (TA): in HBL-2 cells there was a decline of 20%-55% during 24-72 h respectively. However in NCEB cells the decline was much smaller, and did not exceed 25%. Inhibition of telomerase activity is shown to be operated by two separate mechanisms: reduction of the hTERT mRNA expression (controlled by the binding of transcription factors) and reduction in phosphorylation of the catalytic subunit of hTERT by its kinases, AKT and PKCα. A decrease in telomerase activity was demonstrated also in mononuclear cells, isolated from three MCL patients following incubation of the cells in the presence of bortezomib for 24-72 h. In one patient the decrease in TA ranged between 17%-37% respectively, in the second patient between 63%-76% and in the third patient between 70-100% for 24-72 h respectively. The current study indicates that a combination of bortezomib and rapamycin, (an m-Tor pathway inhibitor used in MCL treatment) induced synergistic inhibition of telomerase activity. In HBL-2 cells, the combined treatment of bortezomib and rapamycin decreased TA by 80% compared to the expected value (40%) and for NCEB cells a similar trend was observed. In contrast, there was neither additive nor synergistic effect of this combination on cell proliferation. In the light of the crucial role of telomerase in cancer cells, it was important to characterize the possible relations between telomerase and bortezomib and to distinguish the biochemical mechanisms of its regulation and its interactions with other signal transduction inhibitors such as rapamycin. The results of this work encourage the in vivo examination of the therapeutic potential of the combination of bortezomib and rapamycin in Mantle Cell Lymphoma patients.
Collapse
Affiliation(s)
- Orit Uziel
- Felsenstein Medical Research Center, Tel-Aviv University, Ramat-Aviv, Israel.
| | - Olga Cohen
- Felsenstein Medical Research Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Einat Beery
- Felsenstein Medical Research Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Jardena Nordenberg
- Felsenstein Medical Research Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Meir Lahav
- Felsenstein Medical Research Center, Tel-Aviv University, Ramat-Aviv, Israel; Medicine A and Endocrinology Lab, Beilinson Medical Center Petah-Tikva and Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| |
Collapse
|
20
|
Tomuleasa C, Braicu C, Irimie A, Craciun L, Berindan-Neagoe I. Nanopharmacology in translational hematology and oncology. Int J Nanomedicine 2014; 9:3465-79. [PMID: 25092977 PMCID: PMC4113407 DOI: 10.2147/ijn.s60488] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Nanoparticles have displayed considerable promise for safely delivering therapeutic agents with miscellaneous therapeutic properties. Current progress in nanotechnology has put forward, in the last few years, several therapeutic strategies that could be integrated into clinical use by using constructs for molecular diagnosis, disease detection, cytostatic drug delivery, and nanoscale immunotherapy. In the hope of bringing the concept of nanopharmacology toward a viable and feasible clinical reality in a cancer center, the present report attempts to present the grounds for the use of cell-free nanoscale structures for molecular therapy in experimental hematology and oncology.
Collapse
Affiliation(s)
- Ciprian Tomuleasa
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania ; Department of Hematology, Ion Chiricuta Cancer Center, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cornelia Braicu
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alexandra Irimie
- Department of Prosthetic Dentistry and Dental Materials, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Lucian Craciun
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioana Berindan-Neagoe
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania ; Department of Immunology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania ; Department of Functional Genomics and Experimental Pathology, the Oncological Institute "Prof Dr Ion Chiricuta", Cluj-Napoca, Romania
| |
Collapse
|
21
|
Gopal AK, Tarantolo SR, Bellam N, Green DJ, Griffin M, Feldman T, Mato AR, Eisenfeld AJ, Stromatt SC, Goy A. Phase 1b study of otlertuzumab (TRU-016), an anti-CD37 monospecific ADAPTIR™ therapeutic protein, in combination with rituximab and bendamustine in relapsed indolent lymphoma patients. Invest New Drugs 2014; 32:1213-25. [PMID: 24927856 DOI: 10.1007/s10637-014-0125-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/03/2014] [Indexed: 12/20/2022]
Abstract
PURPOSE CD37 is cell surface tetraspanin present on normal and malignant B cells. Otlertuzumab (TRU-016) is a novel humanized anti-CD37 protein therapeutic that triggers direct caspase independent apoptosis of malignant B cells and induces antibody-dependent cell-mediated cytotoxicity. This study evaluated the safety, pharmacokinetics, and efficacy of otlertuzumab administered in combination with rituximab and bendamustine to patients with relapsed, indolent B-cell non-Hodgkin Lymphoma (NHL). METHODS Patients with relapsed or refractory NHL received otlertuzumab (10 or 20 mg/kg) intravenously (IV) on days 1 and 15, bendamustine (90 mg/m(2)) on days 1 and 2, and rituximab (375 mg/m(2)) on day 1 for up to six 28 day cycles. Responses were determined using standard criteria. RESULTS Twelve patients were treated with 6 patients at each dose level; median age was 57 years (range, 51-79), and median number of prior regimens was 3 (range, 1-4). All patients had relapsed after prior rituximab including 7 refractory to their most recent previous treatment. In the 10 and 20 mg/kg dose cohorts, the mean half-life was 8 and 10 days following the first dose, and 12 or 14 days following 12 doses of otlertuzumab, respectively. Overall response rate was 83% (10/12) with 4 CRs (32%). The most frequent adverse events were neutropenia, nausea, fatigue, leukopenia, and insomnia; most were grade 1 or 2. CONCLUSIONS Otlertuzumab in combination with rituximab and bendamustine was well tolerated and induced responses in the majority of patients with relapsed indolent B-NHL. NCI Clinical Trials Network registration: NCT01317901.
Collapse
Affiliation(s)
- Ajay K Gopal
- Department of Medicine, University of Washington, Box 358081, 825 Eastlake Ave E.,, MS G3200, Seattle, WA, USA,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Kahl BS, Spurgeon SE, Furman RR, Flinn IW, Coutre SE, Brown JR, Benson DM, Byrd JC, Peterman S, Cho Y, Yu A, Godfrey WR, Wagner-Johnston ND. A phase 1 study of the PI3Kδ inhibitor idelalisib in patients with relapsed/refractory mantle cell lymphoma (MCL). Blood 2014; 123:3398-405. [PMID: 24615778 PMCID: PMC4260977 DOI: 10.1182/blood-2013-11-537555] [Citation(s) in RCA: 204] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 01/21/2014] [Indexed: 11/20/2022] Open
Abstract
Idelalisib, an oral inhibitor of phosphatidylinositol-3-kinase δ (PI3Kδ), was evaluated in a 48-week phase 1 study (50-350 mg daily or twice daily) enrolling 40 patients with relapsed or refractory mantle cell lymphoma (MCL). Primary outcome was safety and dose-limiting toxicity (DLT). Secondary outcomes were pharmacokinetic parameters, pharmacodynamic effects, overall response rate (ORR), progression-free survival (PFS), and duration of response (DOR). Patients without DLT and no evidence of disease progression after 48 weeks enrolled in the extension study. Patients had median age of 69 years (range, 52-83) and received median of 4 prior therapies (1-14); 17 of 40 patients (43%) were refractory to their most recent treatment. Median duration of idelalisib treatment was 3.5 months (range, 0.7-30.7), with 6 (15%) continuing extension treatment. Common grade ≥3 adverse events (AEs) included (total%/grade ≥3%) diarrhea (40/18), nausea (33/5), pyrexia (28/0), fatigue (25/3), rash (23/3), decreased appetite (20/15), upper respiratory infection (20/0), pneumonia (13/10), and alanine transaminase or aspartate transaminase elevations (60/20). ORR was 16 of 40 patients (40%), with CR in 2 of 40 patients (5%). Median DOR was 2.7 months, median PFS was 3.7 months, and 1-year PFS was 22%. These data provide proof of concept that targeting PI3Kδ is a viable strategy and worthy of additional study in MCL. This trial was registered at www.clinicaltrials.gov as #NCT00710528.
Collapse
Affiliation(s)
- Brad S Kahl
- Department of Medicine, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Stephen E Spurgeon
- Department of Medicine, Oregon Health and Sciences University, Portland, OR
| | - Richard R Furman
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Ian W Flinn
- Sarah Cannon Research Institute, Nashville, TN
| | | | | | - Don M Benson
- Department of Medicine, Ohio State University, Columbus, OH
| | - John C Byrd
- Department of Medicine, Ohio State University, Columbus, OH
| | | | | | | | | | | |
Collapse
|
23
|
Kuo PY, Leshchenko VV, Fazzari MJ, Perumal D, Gellen T, He T, Iqbal J, Baumgartner-Wennerholm S, Nygren L, Zhang F, Zhang W, Suh KS, Goy A, Yang DT, Chan WC, Kahl BS, Verma AK, Gascoyne RD, Kimby E, Sander B, Ye BH, Melnick AM, Parekh S. High-resolution chromatin immunoprecipitation (ChIP) sequencing reveals novel binding targets and prognostic role for SOX11 in mantle cell lymphoma. Oncogene 2014; 34:1231-40. [PMID: 24681958 DOI: 10.1038/onc.2014.44] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 01/07/2014] [Accepted: 01/19/2014] [Indexed: 12/18/2022]
Abstract
Sex determining region Y-box 11 (SOX11) expression is specific for mantle cell lymphoma (MCL) as compared with other non-Hodgkin's lymphomas. However, the function and direct-binding targets of SOX11 in MCL are largely unknown. We used high-resolution chromatin immunoprecipitation sequencing to identify the direct target genes of SOX11 in a genome-wide, unbiased manner and elucidate its functional significance. Pathway analysis identified WNT, PKA and TGF-beta signaling pathways as significantly enriched by SOX11-target genes. Quantitative chromatin immunoprecipitation sequencing and promoter reporter assays confirmed that SOX11 directly binds to individual genes and modulates their transcription activities in these pathways in MCL. Functional studies using RNA interference demonstrate that SOX11 directly regulates WNT in MCL. We analyzed SOX11 expression in three independent well-annotated tissue microarrays from the University of Wisconsin (UW), Karolinska Institute and British Columbia Cancer Agency. Our findings suggest that high SOX11 expression is associated with improved survival in a subset of MCL patients, particularly those treated with intensive chemotherapy. Transcriptional regulation of WNT and other biological pathways affected by SOX11-target genes may help explain the impact of SOX11 expression on patient outcomes.
Collapse
Affiliation(s)
- P-Y Kuo
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - V V Leshchenko
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M J Fazzari
- 1] Department of Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA [2] Department of Genetics, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
| | - D Perumal
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - T Gellen
- Albert Einstein Cancer Center, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
| | - T He
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Iqbal
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - S Baumgartner-Wennerholm
- Department of Medicine, Center for Haematology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - L Nygren
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - F Zhang
- Bioinformatics Laboratory, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - W Zhang
- Bioinformatics Laboratory, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - K S Suh
- Genomics and Biomarkers Program, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - A Goy
- Genomics and Biomarkers Program, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - D T Yang
- Department of Pathology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - W-C Chan
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - B S Kahl
- Department of Medicine, School of Medicine and Public Health, and The UW Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
| | - A K Verma
- Albert Einstein Cancer Center, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
| | - R D Gascoyne
- Department of Pathology and Experimental Therapeutics, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - E Kimby
- Department of Medicine, Center for Haematology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - B Sander
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - B H Ye
- Department of Cell Biology, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
| | - A M Melnick
- 1] Hematology and Oncology Division, Weill Cornell Medical College, New York, NY, USA [2] Department of Pharmacology, Weill Cornell Medical College, New York, NY, USA
| | - S Parekh
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
24
|
Kosulin K, Rauch M, Ambros PF, Pötschger U, Chott A, Jäger U, Drach J, Nader A, Lion T. Screening for adenoviruses in haematological neoplasia: High prevalence in mantle cell lymphoma. Eur J Cancer 2014; 50:622-7. [DOI: 10.1016/j.ejca.2013.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 10/15/2013] [Accepted: 10/18/2013] [Indexed: 12/11/2022]
|
25
|
Coiffier B. Clinical efficacy and management of temsirolimus in patients with relapsed or refractory mantle cell lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 13:351-9. [PMID: 23763923 DOI: 10.1016/j.clml.2013.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 04/10/2013] [Accepted: 04/17/2013] [Indexed: 11/30/2022]
Abstract
Most patients with mantle cell lymphoma (MCL) relapse within a few years of treatment. Conventional agents provide little benefit, thus identification of new therapies is critical to improve patient outcomes. Temsirolimus, an inhibitor of mammalian target of rapamycin, is an effective, well-tolerated option authorized in Europe for treatment of patients with relapsed/refractory MCL. Intravenous temsirolimus has been extensively studied in MCL and has consistently demonstrated single-agent antitumor activity. In the pivotal phase III trial, treatment with temsirolimus 175 mg weekly for 3 weeks followed by 75 mg weekly (175/75 mg) resulted in significant improvements in progression-free survival (P = .0009) and objective response rate (P = .002) vs. investigator's choice of therapy. Hematologic toxicities (thrombocytopenia, neutropenia) were the principal grade 3/4 adverse events associated with temsirolimus 175/75 mg. Other toxicities included increases in serum cholesterol and triglycerides, hyperglycemia, fatigue, and dyspnea. Overall, the safety profile of temsirolimus is acceptable in this setting, and most toxicities are manageable with dose modification or medical intervention. Clinical studies of temsirolimus in relapsed or refractory MCL patients aim to clarify the optimal treatment schedule and to assess rational combinations with other therapeutic agents, such as rituximab or chemotherapy. Practical considerations are discussed for the clinical use of temsirolimus in patients with MCL.
Collapse
Affiliation(s)
- Bertrand Coiffier
- Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Benite, France.
| |
Collapse
|
26
|
Penchovsky R. Engineering Gene Control Circuits with Allosteric Ribozymes in Human Cells as a Medicine of the Future. Bioinformatics 2013. [DOI: 10.4018/978-1-4666-3604-0.ch047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Systems and synthetic biology promise to develop new approaches for analysis and design of complex gene expression regulatory networks in living cells with many practical applications to the pharmaceutical and biotech industries. In this chapter the development of novel universal strategies for exogenous control of gene expression is discussed. They are based on designer allosteric ribozymes that can function in the cell. The synthetic riboswitches are obtained by a patented computational procedure that provides fast and accurate modular designs with various Boolean logic functions. The riboswitches can be designed to sense in the cell either the presence or the absence of disease indicative RNA(s) or small molecules, and to switch on or off the gene expression of any exogenous protein. In addition, the riboswitches can be engineered to induce RNA interference or microRNA pathways that can conditionally down regulate the expression of key proteins in the cell. That can prevent a disease’s development. Therefore, the presented synthetic riboswitches can be used as truly universal cellular biosensors. Nowadays, disease indicative RNA(s) can be precisely identified by employing next-generation sequencing technologies with high accuracy . The methods can be employed not only for exogenous control of gene expression but also for re-programming the cell fate, anticancer, and antiviral gene therapies. Such approaches may be employed as potent molecular medicines of the future.
Collapse
|
27
|
Abstract
Genomic profiling of mantle cell lymphoma (MCL) cells has enabled a better understanding of the complex mechanisms underlying the pathogenesis of disease. Besides the t(11;14)(q13;q32) leading to cyclin D1 overexpression, MCL exhibits a characteristic pattern of DNA copy number aberrations that differs from those detected in other B-cell lymphomas. These genomic changes disrupt selected oncogenes and suppressor genes that are required for lymphoma development and progression, many of which are components of cell cycle, DNA damage response and repair, apoptosis, and cell-signaling pathways. Additionally, some of them may represent effective therapeutic targets. A number of genomic and molecular abnormalities have been correlated with the clinical outcome of patients with MCL and are considered prognostic factors. However, only a few genomic markers have been shown to predict the response to current or novel targeted therapies. One representative example is the high-level amplification of the BCL2 gene, which predicts a good response to pro-apoptotic BH3 mimetic drugs. In summary, genomic analyses have contributed to the substantial advances made in the comprehension of the pathogenesis of MCL, providing a solid basis for the identification of optimal therapeutic targets and for the design of new molecular therapies aiming to cure this fatal disease.
Collapse
Affiliation(s)
- Melissa Rieger Menanteau
- Division of Oncology, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | | |
Collapse
|
28
|
Prasad A, Shrivastava A, Papadopoulos E, Kuzontkoski PM, Reddy MVR, Gillum AM, Kumar R, Reddy EP, Groopman JE. Combined administration of rituximab and on 013105 induces apoptosis in mantle cell lymphoma cells and reduces tumor burden in a mouse model of mantle cell lymphoma. Clin Cancer Res 2012; 19:85-95. [PMID: 23124440 DOI: 10.1158/1078-0432.ccr-12-1425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Mantle cell lymphoma (MCL) is an incurable B-cell lymphoma, and new therapeutic strategies are urgently needed. EXPERIMENTAL DESIGN The effects of ON 013105, a novel benzylstyryl sulfone kinase inhibitor, alone or with doxorubicin or rituximab, were examined in Granta 519 and Z138C cells. For in vivo studies, CB17/SCID mice were implanted subcutaneously with Z138C cells and treated with various combinations of ON 013105, doxorubicin, and rituximab. Tumor burden and body weight were monitored for 28 days. RESULTS ON 013105 induced mitochondria-mediated apoptosis in MCL cells. Death was preceded by translocation of tBid to the mitochondria and cytochrome c release. In addition, ON 013105-treated cells exhibited reduced levels of cyclin D1, c-Myc, Mcl-1, and Bcl-xL. Using nuclear magnetic resonance (NMR) spectroscopy, we showed specific binding of ON 013105 to eIF4E, a critical factor for the initiation of protein translation. We proffer that this drug-protein interaction preferentially prevents the translation of the aforementioned proteins and may be the mechanism by which ON 013105 induces apoptosis in MCL cells. Efficacy studies in a mouse xenograft model showed that ON 013105 inhibited MCL tumor growth and that combining ON 013105 with rituximab reduced tumor burden further with negligible unwanted effects. CONCLUSIONS Our findings suggest that ON 013105, alone or in combination with rituximab, may be a potent therapeutic agent to treat MCLs.
Collapse
Affiliation(s)
- Anil Prasad
- Division of Experimental Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Petranovic D, Pilcic G, Peitl M, Cubranic A, Valkovic T, Nacinovic AD, Lucin K, Jonjic N. Primary gastric mantle cell lymphoma. Hematol Rep 2012; 4:e1. [PMID: 22567215 PMCID: PMC3343450 DOI: 10.4081/hr.2012.e1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 12/07/2011] [Accepted: 12/09/2011] [Indexed: 11/23/2022] Open
Abstract
Mantle cell lymphoma represents 2.5-7% all of non Hodgkin's lymphomas. Stomach is the most common site of extranodal lymphoma. However, that is not the case with mantle cell lymphoma, which is extremely rare. We present a case of 71-year-old woman admitted to the Internal Clinic of the University Clinical Hospital Center Rijeka, because of stomach discomfort and melena. Endoscopy and computed tomography revealed a polyp in gastric antrum. Histopathologic, immunohistochemic and genetic methods were also performed and the results were consistent with primary gastric mantle cell lymphoma without periepigastric and/or local or distant abdominal lymph node involvement.
Collapse
Affiliation(s)
- Duska Petranovic
- Department of Internal medicine, University Hospital Center Rijeka
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Petković I, Mihailović D, Krstić M, Pejčić I, Vrbić S, Balić M. PRIMARNI MANTLE CELL LIMFOM GASTROINTESTINALNOG TRAKTAPRIKAZ BOLESNIKA. ACTA MEDICA MEDIANAE 2012. [DOI: 10.5633/amm.2012.0307s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
31
|
Petković I, Mihailović D, Krstić M, Pejčić I, Vrbić S, Balić M. PRIMARY MANTLE CELL LYMPHOMA OF GASTROINTESTINAL TRACT- A CASE REPORT. ACTA MEDICA MEDIANAE 2012. [DOI: 10.5633/amm.2012.0307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
32
|
Abstract
Mantle cell lymphoma (MCL) is a type of non-Hodgkin's lymphoma (NHL) with treatment outcomes that have historically been poorer than those observed with other NHL subtypes. Patients typically present with advanced-stage disease and frequent extranodal involvement; the median age at diagnosis is >60 years. Recent improvements in progression-free and overall survival have been observed with more dose-intensive strategies, although at least half of patients diagnosed with MCL are not eligible for such treatment approaches based on age and co-morbidities. In addition, therapy options for relapsed MCL are limited. Only bortezomib is approved for treatment of relapsed MCL in the US. Development of targeted therapy approaches to minimize toxicities while preserving anti-neoplastic properties is of particular importance in MCL. Multiple ongoing studies are attempting to build on the known efficacy of bortezomib by evaluating combination regimens with other targeted agents or cytotoxic chemotherapy. The mammalian target of rapamycin (mTOR) inhibitor temsirolimus has known activity in MCL, making this an attractive class of agents for further investigation in combination regimens. Rituximab and other monoclonal antibodies are being evaluated for novel roles in MCL treatment, including as maintenance therapy. Other classes of drugs being investigated in MCL are immunomodulatory agents, inhibitors of the phosphoinositide 3-kinase/Akt and B-cell receptor signalling pathways, and inhibitors of bcl-2 and histone deacetylase. Although many of the agents appear to have modest single-agent activity, the favourable toxicity profile of many agents will make them best suited for incorporation into combination regimens.
Collapse
Affiliation(s)
- Julie E Chang
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA.
| | | |
Collapse
|
33
|
Cheng F, Wang H, Horna P, Wang Z, Shah B, Sahakian E, Woan KV, Villagra A, Pinilla-Ibarz J, Sebti S, Smith M, Tao J, Sotomayor EM. Stat3 inhibition augments the immunogenicity of B-cell lymphoma cells, leading to effective antitumor immunity. Cancer Res 2012; 72:4440-8. [PMID: 22728650 DOI: 10.1158/0008-5472.can-11-3619] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Mantle cell lymphoma (MCL) is an aggressive and incurable subtype of B-cell non-Hodgkin lymphomas. Although patients often respond initially to first-line treatment with chemotherapy plus monoclonal antibodies, relapse and decreased response to further lines of treatment eventually occurs. Harnessing the immune system to elicit its exquisite specificity and long-lasting protection might provide sustained MCL immunity that could potentially eradicate residual malignant cells responsible for disease relapse. Here, we show that genetic or pharmacologic disruption of Stat3 in malignant B cells augments their immunogenicity leading to better activation of antigen-specific CD4(+) T cells and restoration of responsiveness of tolerized T cells. In addition, treatment of MCL-bearing mice with a specific Stat3 inhibitor resulted in decreased Stat3 phosphorylation in malignant B cells and anti-lymphoma immunity in vivo. Our findings therefore indicate that Stat3 inhibition may represent a therapeutic strategy to overcome tolerance to tumor antigens and elicit a strong immunity against MCL and other B-cell malignancies.
Collapse
Affiliation(s)
- Fengdong Cheng
- Departments of Malignant Hematology, Drug Discovery, and Hematopathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
CHOP and DHAP plus rituximab followed by autologous stem cell transplantation in mantle cell lymphoma: a phase 2 study from the Groupe d'Etude des Lymphomes de l'Adulte. Blood 2012; 121:48-53. [PMID: 22718839 DOI: 10.1182/blood-2011-09-370320] [Citation(s) in RCA: 202] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Treatment of mantle cell lymphoma (MCL) in younger patients remains a challenge. We report results of a phase 2 trial using cytarabine and rituximab as induction regimen before autologous stem cell transplantation. Patients younger than 66 years with stage 3 or 4 MCL were included. Treatment consisted of 3 courses of CHOP(21) with rituximab at the third one and 3 of R-DHAP. Responding patients were eligible for autologous stem cell transplantation with TAM6 or BEAM. Sixty patients were included. Median age was 57 years. Characteristics of patients were: BM involvement 85%, leukemic disease 48%, gastrointestinal involvement 52%, Performance Status > 16%, lactate dehydrogenase > 1N 38%, Mantle Cell Lymphoma International Prognostic Index (low 55%, intermediate 38%, high 13%). The overall response rate was 93% after (R)-CHOP and 95% after R-DHAP. Although uncommon after (R)-CHOP (12%), 57% of patients were in complete response after R-DHAP. With median follow-up of 67 months, median event-free survival is 83 months, and median overall survival is not reached. Five-year overall survival is 75%. Comparison with a previous study without rituximab shows improvement of outcome (median event-free survival, 51 vs 83 months). No toxic death or unexpected toxicities were observed. This study confirms that induction with rituximab and cytarabine-based regimens is safe and effective in MCL patients. This regimen is currently compared with R-CHOP(21) induction in a multicentric European protocol.
Collapse
|
35
|
Mantle cell lymphoma of the oral cavity with multiple foci: a case report and review of the literature. J Maxillofac Oral Surg 2012; 14:138-44. [PMID: 25838687 DOI: 10.1007/s12663-012-0383-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 04/04/2012] [Indexed: 12/18/2022] Open
Abstract
Non-Hodgkin lymphomas (NHLs) are often present outside the lymph nodes. Although primary extranodal NHLs form a substantial part of all NHLs, reports on oral primary extra nodal NHLs are rare. Mantle cell lymphoma (MCL) is a rare B-cell neoplasm that has only recently been defined as a distinct entity. MCL of the oral cavity is an uncommon diagnosis. Most oral MCLs occur in an elderly male population and have a possible predilection for the palate. The microscopic diagnosis can be challenging, given its similar appearance to other small cell lymphomas, requiring a comprehensive immunohistochemical panel for the accurate diagnosis. Like MCL occurring in other sites in the body, the prognosis and outcome of oral MCL appears to be poor.
Collapse
|
36
|
Kirschey S, Wagner S, Hess G. Relapsed and/or Refractory Mantle Cell Lymphoma: What Role for Temsirolimus? CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2012; 6:153-64. [PMID: 22550404 PMCID: PMC3306245 DOI: 10.4137/cmo.s7327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mantle Cell Lymphoma (MCL) is associated with a dismal prognosis. Recently, along with the improved understanding of the pathophysiology of this disease, new first line regimens have been established and in addition novel treatment options have entered the clinical arena. In consequence, prognosis of the disease has fortunately improved. We here focus on the rationale, current clinical knowledge and future concepts of Temsirolimus, an inhibitor of mTOR, in the treatment of MCL. At this time this drug has been shown to be effective as single agent for relapsed disease and early combination data show promising results. In addition, with a brief outline of other treatment options, we aim to guide at which place in the current treatment algorithms Temsirolimus can be integrated into the treatment of MCL patients.
Collapse
Affiliation(s)
- Sebastian Kirschey
- Department of Hematology, Oncology, and Pneumology, University Medical School, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz
| | | | | |
Collapse
|
37
|
Renner C, Zinzani PL, Gressin R, Klingbiel D, Dietrich PY, Hitz F, Bargetzi M, Mingrone W, Martinelli G, Trojan A, Bouabdallah K, Lohri A, Gyan E, Biaggi C, Cogliatti S, Bertoni F, Ghielmini M, Brauchli P, Ketterer N. A multicenter phase II trial (SAKK 36/06) of single-agent everolimus (RAD001) in patients with relapsed or refractory mantle cell lymphoma. Haematologica 2012; 97:1085-91. [PMID: 22315486 DOI: 10.3324/haematol.2011.053173] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Mantle cell lymphoma accounts for 6% of all B-cell lymphomas and is generally incurable. It is characterized by the translocation t(11;14) leading to cyclin D1 over-expression. Cyclin D1 is downstream of the mammalian target of rapamycin threonine kinase and can be effectively blocked by mammalian target of rapamycin inhibitors. We set out to examine the single agent activity of the orally available mammalian target of rapamycin inhibitor everolimus in a prospective, multicenter trial in patients with relapsed or refractory mantle cell lymphoma (NCT00516412). DESIGN AND METHODS Eligible patients who had received a maximum of three prior lines of chemotherapy were given everolimus 10 mg for 28 days (one cycle) for a total of six cycles or until disease progression. The primary endpoint was the best objective response. Adverse reactions, progression-free survival and molecular response were secondary endpoints. RESULTS Thirty-six patients (35 evaluable) were enrolled and treatment was generally well tolerated with Common Terminology Criteria grade ≥ 3 adverse events (>5%) including anemia (11%), thrombocytopenia (11%) and neutropenia (8%). The overall response rate was 20% (95% CI: 8-37%) with two complete remissions and five partial responses; 49% of the patients had stable disease. At a median follow-up of 6 months, the median progression-free survival was 5.5 months (95% CI: 2.8-8.2) overall and 17.0 (6.4-23.3) months for 18 patients who received six or more cycles of treatment. Three patients achieved a lasting complete molecular response, as assessed by polymerase chain reaction analysis of peripheral blood. CONCLUSIONS Everolimus as a single agent is well tolerated and has anti-lymphoma activity in relapsed or refractory mantle cell lymphoma. Further studies of everolimus in combination with chemotherapy or as a single agent for maintenance treatment are warranted.
Collapse
Affiliation(s)
- Christoph Renner
- Division of Oncology, University Hospital Zürich, Rämistrasse 100 8091 Zürich, Switzerland.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Cely I, Yiv S, Yin Q, Shahidzadeh A, Tang L, Cheng J, Uckun FM. Targeting Mantle Cell Lymphoma with Anti-SYK Nanoparticles. ACTA ACUST UNITED AC 2012; 1:1-9. [PMID: 23730399 DOI: 10.6000/1927-7229.2012.01.01.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The pentapeptide mimic 1,4-bis(9-O-dihydroquinidinyl)phthalazine / hydroquinidine 1,4-phathalazinediyl diether ("compound 61") (C-61) is the first reported inhibitor targeting the P-site of SYK. Here we report a nanotechnology platform to target C-61 to mantle cell lymphoma (MCL) cells. Liposomal nanoparticles (NP) loaded with C-61 were prepared using the standard thin film evaporation method. The entrapment of C-61 was obtained using the pH gradient procedure with lactobionic acid (LBA) being used as a low pH buffer inside the NP. Formulation F6A was selected as a lead candidate for further biological testing. The average diameter, zeta potential and C-61 content of the F6A NP was 40 nm, 0.1 mV, and 12.6 mg/ml, respectively. F6A induces apoptosis in SYK+ but not SYK- leukemia/lymphoma cells. We also evaluated the cytotoxic activity of F6A in the context of an in vitro artificial bone marrow assay platform based on a 3D scaffold with inverted colloidal crystal geometry mimicking the structural topology of actual bone marrow matrix. The ability of C-61 to induce apoptosis in ALL-1 cells was not adversely affected by the scaffolds. F6A, but not the drug-free NP formulation F6B, caused apoptosis of MCL cell lines MAVER-1 and MINO within 24h. Further development of rationally designed SYK inhibitors and their nanoscale formulations may provide the foundation for therapeutic innovation against a broad spectrum of lymphoid malignancies, including MCL.
Collapse
Affiliation(s)
- Ingrid Cely
- Developmental Therapeutics Program, Children's Hospital Los Angeles, Children's Center for Cancer and Blood Diseases, Los Angeles, CA 90027 ; Department of Pediatrics and Norris Comprehensive Cancer Center, University of Southern California Keck School of Medicine, Los Angeles, CA 90027
| | | | | | | | | | | | | |
Collapse
|
39
|
Jung HJ, Chen Z, McCarty N. Stem-like tumor cells confer drug resistant properties to mantle cell lymphoma. Leuk Lymphoma 2011; 52:1066-79. [PMID: 21599592 DOI: 10.3109/10428194.2011.562570] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We recently identified clonogenic malignant stem cell populations in human mantle cell lymphoma (MCL), a particularly deadly subtype of non-Hodgkin lymphoma (NHL). We discovered that CD45+CD19- MCL cells, which we termed MCL-initiating cells (MCL-ICs), are highly tumorigenic and display self-renewal capacity in vivo; in contrast, CD45+CD19+ MCL cells, which constitute the vast majority of cells within the tumors, show no self-renewal capacity and greatly reduced tumorigenicity. Given the newly appreciated role of cancer-initiating cells in the drug resistance of cancers, it is critical to investigate whether CD45+CD19- MCL-ICs play a role in the drug resistance of human MCL. We discovered that MCL-ICs were more resistant to clinically relevant chemotherapeutic agents, in combination or in a single regimen, compared to CD45+CD19+ cells, and that this drug resistance was largely due to quiescent properties with enriched ABC transporters. In conclusion, designing novel therapies to kill CD45+CD19- MCL-ICs may prevent relapse and increase patient survival.
Collapse
Affiliation(s)
- Hyun Joo Jung
- Center for Stem Cell Research, Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases (IMM), University of Texas-Health Science Center at Houston, Houston, Texas 77030, USA
| | | | | |
Collapse
|
40
|
A cyclin-D1 interaction with BAX underlies its oncogenic role and potential as a therapeutic target in mantle cell lymphoma. Proc Natl Acad Sci U S A 2011; 108:12461-6. [PMID: 21746927 DOI: 10.1073/pnas.1018941108] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The chromosomal translocation t(11;14)(q13;q32) leading to cyclin-D1 overexpression plays an essential role in the development of mantle cell lymphoma (MCL), an aggressive tumor that remains incurable with current treatment strategies. Cyclin-D1 has been postulated as an effective therapeutic target, but the evaluation of this target has been hampered by our incomplete understanding of its oncogenic functions and by the lack of valid MCL murine models. To address these issues, we generated a cyclin-D1-driven mouse model in which cyclin-D1 expression can be regulated externally. These mice developed cyclin-D1-expressing lymphomas capable of recapitulating features of human MCL. We found that cyclin-D1 inactivation was not sufficient to induce lymphoma regression in vivo; however, using a combination of in vitro and in vivo assays, we identified a novel prosurvival cyclin-D1 function in MCL cells. Specifically, we found that cyclin-D1, besides increasing cell proliferation through deregulation of the cell cycle at the G(1)-S transition, sequestrates the proapoptotic protein BAX in the cytoplasm, thereby favoring BCL2's antiapoptotic function. Accordingly, cyclin-D1 inhibition sensitized the lymphoma cells to apoptosis through BAX release. Thus, genetic or pharmacologic targeting of cyclin-D1 combined with a proapoptotic BH3 mimetic synergistically killed the cyclin-D1-expressing murine lymphomas, human MCL cell lines, and primary lymphoma cells. Our study identifies a role of cyclin-D1 in deregulating apoptosis in MCL cells, and highlights the potential benefit of simultaneously targeting cyclin-D1 and survival pathways in patients with MCL. This effective combination therapy also might be exploited in other cyclin-D1-expressing tumors.
Collapse
|
41
|
Cortelazzo S, Ponzoni M, Ferreri AJM, Dreyling M. Mantle cell lymphoma. Crit Rev Oncol Hematol 2011; 82:78-101. [PMID: 21658968 DOI: 10.1016/j.critrevonc.2011.05.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 05/02/2011] [Accepted: 05/04/2011] [Indexed: 10/25/2022] Open
Abstract
MCL is a well-characterized clinically aggressive lymphoma with a poor prognosis. Recent research findings have slightly improved the outcome of this neoplasm. The addition of rituximab to conventional chemotherapy has increased overall response rates, but it does not improve overall survival with respect to chemotherapy alone. The use of intensive frontline therapies including rituximab and consolidated by ASCT ameliorates response rate and prolongs progression-free survival, but any impact on survival remains to be proven. Furthermore, the optimal timing, cytoreductive regimen and conditioning regimen, and the clinical implications of achieving a disease remission even at molecular level remain to be elucidated. The development of targeted therapies as the consequence of better dissection of pathogenetic pathways in MCL might improve the outcome of conventional chemotherapy in most patients and spare the toxicity of intense therapy in a minority of MCL patients characterized by a relatively indolent disease. Patients not eligible for intensive regimens, such as hyperC-VAD, may be considered for less demanding therapies, such as the combination of rituximab either with CHOP or with purine analogues, or bendamustine. Allogeneic SCT can be an effective option for relapsed disease in patients who are fit enough and have a compatible donor. Maintenance rituximab may be considered after response to immunochemotherapy for relapsed disease, although there are currently no data to recommend this approach as the first-line strategy. As the optimal approach to the management of MCL is still evolving, it is critical that these patients be enrolled in clinical trials to identify better treatment options.
Collapse
Affiliation(s)
- Sergio Cortelazzo
- Hematology and Bone Marrow Transplantation Unit, Azienda Ospedaliera Bolzano, Italy
| | | | | | | |
Collapse
|
42
|
Lamm W, Kaufmann H, Raderer M, Hoffmann M, Chott A, Zielinski C, Drach J. Bortezomib combined with rituximab and dexamethasone is an active regimen for patients with relapsed and chemotherapy-refractory mantle cell lymphoma. Haematologica 2011; 96:1008-14. [PMID: 21486866 DOI: 10.3324/haematol.2011.041392] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Bortezomib belongs to a new class of anti-cancer agents, the proteasome inhibitors, and has documented activity in multiple myeloma and mantle cell lymphoma. Preclinical studies suggest that bortezomib has synergistic activity with rituximab, which provides a rationale for the exploration of treatment combinations. DESIGN AND METHODS The activity and safety of bortezomib in combination with rituximab and dexamethasone were investigated in patients with relapsed or chemotherapy-refractory mantle cell lymphoma. A treatment cycle consisted of bortezomib (1.3 mg/m² on days 1, 4, 8, and 11; six 21-day cycles), rituximab (375 mg/m², day 1) and dexamethasone (40 mg orally, days 1 to 4). Responding patients received four consolidating doses of rituximab. Sixteen patients with progressive mantle cell lymphoma after a median of three prior lines of therapy were enrolled. RESULTS The overall response rate was 81.3% (13 patients), with seven patients achieving a complete response (43.8%). Six of these patients were also negative for disease activity by positron emission tomography scanning. The median progression-free survival and overall survival were 12.1 and 38.6 months, respectively. In patients achieving a complete response, the median progression-free survival and overall survival have not yet been reached. Adverse events (greater than grade II) included thrombocytopenia (37.5%), fatigue (18.8%) and peripheral neuropathy (12.5%). Two patients discontinued bortezomib because of grade III neuropathy. CONCLUSIONS Bortezomib combined with rituximab and dexamethasone has promising activity and manageable toxicity in patients with heavily pretreated mantle cell lymphoma. Achievement of complete response emerged as an important factor for sustained disease control. This trial was registered at www.clinicaltrials.gov as #NCT00261612.
Collapse
Affiliation(s)
- Wolfgang Lamm
- Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, USA
| | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
Although recent progress has been made in the treatment of mantle cell lymphoma (MCL) the majority of patients experience relapse and ultimately die of their disease. The translocation t(11;14) is a prerequisite for the diagnosis of MCL and results in overexpression of cyclin D1. Its protein translation is controlled by mTOR, a key element of the PI3K/Akt pathway, and mTOR constitutes an attractive therapeutic target. Temsirolimus, a specific inhibitor of mTOR, has been evaluated in two Phase II trials in patients with relapsed MCL, and promising response rates up to 40% were found. Subsequently, a randomized Phase III trial was initiated, in which superiority in remission induction and progression-free survival could be demonstrated for a regimen of temsirolimus 175 mg for 3 weeks, followed by a 75-mg weekly application in comparison with established agents. This adds temsirolimus to the therapeutic armamentarium for the treatment of MCL. Further developments target combination therapy in MCL and other lymphoid neoplasms.
Collapse
Affiliation(s)
- Georg Hess
- Department of Hematology, Oncology and Pneumology, Universitätsmedizin der Johannes Gutenberg-Universität, K.ö.R, Langenbeckstrasse 1, Mainz, Germany.
| |
Collapse
|
44
|
Ghimire P, Wu GY, Zhu L. Primary gastrointestinal lymphoma. World J Gastroenterol 2011; 17:697-707. [PMID: 21390139 PMCID: PMC3042647 DOI: 10.3748/wjg.v17.i6.697] [Citation(s) in RCA: 247] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 11/11/2010] [Accepted: 11/18/2010] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal tract is the most common extranodal site involved by lymphoma with the majority being non-Hodgkin type. Although lymphoma can involve any part of the gastrointestinal tract, the most frequent sites in order of its occurrence are the stomach followed by small intestine and ileocecal region. Gastrointestinal tract lymphoma is usually secondary to the widespread nodal diseases and primary gastrointestinal tract lymphoma is relatively rare. Gastrointestinal lymphomas are usually not clinically specific and indistinguishable from other benign and malignant conditions. Diffuse large B-cell lymphoma is the most common pathological type of gastrointestinal lymphoma in essentially all sites of the gastrointestinal tract, although recently the frequency of other forms has also increased in certain regions of the world. Although some radiological features such as bulky lymph nodes and maintenance of fat plane are more suggestive of lymphoma, they are not specific, thus mandating histopathological analysis for its definitive diagnosis. There has been a tremendous leap in the diagnosis, staging and management of gastrointestinal lymphoma in the last two decades attributed to a better insight into its etiology and molecular aspect as well as the knowledge about its critical signaling pathways.
Collapse
|
45
|
Hill BT, Rybicki L, Smith S, Dean R, Kalaycio M, Pohlman B, Sweetenham J, Tench S, Sobecks R, Andresen S, Copelan E, Bolwell BJ. Treatment with hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone combined with cytarabine and methotrexate results in poor mobilization of peripheral blood stem cells in patients with mantle cell lymphoma. Leuk Lymphoma 2011; 52:986-93. [DOI: 10.3109/10428194.2010.551154] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
46
|
|
47
|
Nagel-Esposito AD, Kawasaki B, Jew R, Fujimoto L. Mantle cell lymphoma of the maxillary sinus invading the orbit. ACTA ACUST UNITED AC 2010; 82:22-31. [PMID: 21146791 DOI: 10.1016/j.optm.2010.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 05/17/2010] [Accepted: 06/17/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Lymphomas are the most common primary orbital tumor in adults 60 years of age and older. Mantle cell lymphoma (MCL) is a distinct subtype of B-cell non-Hodgkin's lymphoma. This case report describes a presentation of MCL with ocular involvement and discusses the management options. CASE REPORT A 63-year-old black male Vietnam veteran presented with symptoms of numbness of the right tooth and gum area with right maxillary facial pain, which he described as stabbing in nature. After extensive evaluation, the patient's symptoms were found to be caused by MCL of the right maxillary sinus invading the orbit. The lymphoma was treated successfully with a combination of high-dose corticosteroids and intensive chemotherapy and radiation therapy. CONCLUSIONS Because of the aggressive nature of MCL, early detection and diagnosis are keys to the patient's survival. Given the potential for ocular involvement, eye care professionals play an important role in the early detection and management of these patients, ensuring that they are promptly referred to a specialist, e.g., an ophthalmologist or oncologist, for appropriate testing and treatment.
Collapse
|
48
|
Sikalias N, Alexiou K, Demonakou M, Mylona SC, Papadaki T, Ekonomou N. Non-polypoidal, synchronous mantle-cell lymphoma of small intestine: a rare case. World J Surg Oncol 2010; 8:69. [PMID: 20707926 PMCID: PMC2933587 DOI: 10.1186/1477-7819-8-69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 08/13/2010] [Indexed: 11/10/2022] Open
Abstract
Herein is reported the case of a mantle cell lymphoma (MCL) with synchronous double intestinal location. A 74 - year old male presented with mild abdominal pain. CT scan imaging indicated invasion of lateral intestinal cavity by large mass formation. Exploratory laparotomy was performed and two solid extra-mural masses were isolated and excised. Histology revealed non- polypoid double synchronous lymphoma of mantle cell origin, an unusual presentation of the disease.
Collapse
Affiliation(s)
- Nikolaos Sikalias
- 1st Surgical Department, Sismanogleio General Hospital, (st, Sismanogliou 1st), Marousi-Athens (15126), Greece.
| | | | | | | | | | | |
Collapse
|
49
|
Mantle cell lymphoma salvage regimen: synergy between a reprogrammed oncolytic virus and two chemotherapeutics. Gene Ther 2010; 17:1506-16. [PMID: 20686506 PMCID: PMC2976793 DOI: 10.1038/gt.2010.103] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
MV-PNP HblindantiCD20 is a CD20-targeted and prodrug convertase-armed measles virus (MV) that temporarily controls growth of lymphoma xenografts in SCID mice in combination with fludarabine phosphate. Herein, we examine the replication of this targeted virus and of a vaccine-lineage MV in disease bulks and circulating cells from mantle cell lymphoma (MCL) patients, and show that only the targeted virus is specific for CD20-expressing cells. We then assessed the efficacy of different regimens of administration of this virus in combination with fludarabine and cyclophosphamide (CPA) in a MCL xenograft model. We show that CPA administration before virus enhances oncolytic efficacy, likely through temporary immunosuppression. An interval of one-week between intravenous virus administration and fludarabine treatment further enhanced oncolysis, by synchronizing maximum prodrug convertase expression with fludarabine availability. Finally, three 23-day courses of triple sequential treatment with CPA, virus and fludarabine treatment resulted in complete regression of the xenografts. Secondary disease symptoms interfered with survival, but average survival times increased from 22 to 77 days. These studies document a reprogrammed oncolytic virus consolidating the effects of two chemotherapeutics, a concept well-suited for a phase I clinical trial for MCL patients for whom conventional therapies have failed.
Collapse
|
50
|
Ogura M. Current treatment strategy and new agents in mantle cell lymphoma. Int J Hematol 2010; 92:25-32. [PMID: 20532841 DOI: 10.1007/s12185-010-0607-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 05/20/2010] [Indexed: 11/24/2022]
Abstract
Mantle cell lymphoma (MCL) is a well-recognized lymphoma subtype that accounts for about 5% of all patients with non-Hodgkin lymphoma. The clinical course of MCL ranges from an indolent disease to a rapidly progressive malignancy, with a poor prognosis and a median overall survival (OS) of about 3-5 years reported in earlier data sets. Knowledge of its biology has increased in the last few years. Unfortunately, this progress has not yet brought any major improvements in therapeutic approaches, which still remain highly unsatisfactory. Recent improvement has been achieved by the successful introduction of monoclonal antibodies and dose-intensified approaches including autologous stem cell transplantation strategies. However, with the exception of allogeneic hematopoietic stem cell transplantation, current treatment approaches are non-curative, and the corresponding survival curves are characterized by a delayed but continuous decline and a median survival of 4-6 years. In recent years, new insights into the biology of MCL have been obtained which have provided the rationale for the development of novel therapeutic strategies. Emerging new drugs such as bendamustine, proteasome inhibitors, antibodies, mTOR inhibitors, and immunomodulatory drugs and others are based on the dysregulated control of cell cycle machinery and impaired apoptotic pathways. The efficacy of these agents as monotherapy was demonstrated to be comparable to conventional chemotherapy in relapsed MCL, and combination strategies are currently being investigated in clinical trials.
Collapse
Affiliation(s)
- Michinori Ogura
- Department of Hematology and Oncology, Nagoya Daini Red Cross Hospital, 2-9 Myokencho, Showaku, Nagoya, Japan.
| |
Collapse
|