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Tedjaseputra A, Gilbertson M, Low M, Fedele PL, Kumar B, Simpson I, Grigoriadis G, Shortt J, Opat S, Gregory GP. Excellent outcomes of transformed lymphomas in the rituximab era without autologous stem cell transplantation: an Australian, single-centre experience. Intern Med J 2020; 51:1825-1834. [PMID: 32609419 DOI: 10.1111/imj.14965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/21/2020] [Accepted: 06/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Histologic transformation (HT) is an important event with adverse prognosis in the natural history of indolent lymphomas. There is minimal data on HT in the Australian setting. AIM To characterise patients with biopsy-proven HT and their outcomes identified at a tertiary Australian Hospital. METHODS All patients with biopsy-proven HT during a 15-year period (2002-2017) were included. Clinico-pathological data were systematically collected from review of patient records. Survival estimates were assessed by the Kaplan-Meier method and compared using the log-rank test. Associations between variables and clinical outcomes were evaluated using Cox's proportional hazards model. RESULTS A cohort of 45 patients was identified with a median age of 66 years and the majority (59%) having high-risk disease (Revised-International Prognostic Index score ≥ 3). R-CHOP induction was used in 69% with an overall response rate of 82% (complete response (CR), 75%). 61% of these induction-responders received consolidation, with autologous stem cell transplant (ASCT) performed in only 17% and rituximab maintenance given to 31%. With a median follow-up of 47 months (range: 4-136), the 5-year overall survival (OS) was 69% (95% CI: 52%, 81%). Chemotherapy-naivety at HT was associated with a superior rate of CR (84% vs. 54%, p = 0.057) and 5-year OS (82% vs. 46%, p = 0.012). Rituximab maintenance was associated with a durable progression-free survival in induction-responders. CONCLUSIONS Excellent OS was observed in this modern cohort of patients treated with rituximab-containing induction and low rate of consolidation by ASCT, particularly in those who were chemotherapy-naïve at HT. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Michael Gilbertson
- Department of Clinical Haematology, Monash Health, Melbourne, Australia.,School of Clinical Sciences at Monash Health, Monash University
| | - Michael Low
- Department of Clinical Haematology, Monash Health, Melbourne, Australia.,School of Clinical Sciences at Monash Health, Monash University
| | - Pasquale L Fedele
- Department of Clinical Haematology, Monash Health, Melbourne, Australia.,School of Clinical Sciences at Monash Health, Monash University
| | - Beena Kumar
- School of Clinical Sciences at Monash Health, Monash University.,Department of Anatomical Pathology, Monash Health, Melbourne, Australia
| | - Ian Simpson
- School of Clinical Sciences at Monash Health, Monash University.,Department of Anatomical Pathology, Monash Health, Melbourne, Australia
| | - George Grigoriadis
- Department of Clinical Haematology, Monash Health, Melbourne, Australia.,School of Clinical Sciences at Monash Health, Monash University
| | - Jake Shortt
- Department of Clinical Haematology, Monash Health, Melbourne, Australia.,School of Clinical Sciences at Monash Health, Monash University
| | - Stephen Opat
- Department of Clinical Haematology, Monash Health, Melbourne, Australia.,School of Clinical Sciences at Monash Health, Monash University
| | - Gareth P Gregory
- Department of Clinical Haematology, Monash Health, Melbourne, Australia.,School of Clinical Sciences at Monash Health, Monash University
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Huet S, Sujobert P, Salles G. From genetics to the clinic: a translational perspective on follicular lymphoma. Nat Rev Cancer 2018; 18:224-239. [PMID: 29422597 DOI: 10.1038/nrc.2017.127] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Follicular lymphoma (FL) is the most frequent indolent B cell lymphoma and is still considered to be incurable. In recent years, whole-exome sequencing studies of large cohorts of patients have greatly improved our knowledge of the FL mutational landscape. Moreover, the prolonged evolution of this disease has enabled some insights regarding the early pre-lymphoma lesions as well as the clonal evolution after treatment, allowing an evolutionary perspective on lymphomagenesis. Deciphering the earliest initiating lesions and identifying the molecular alterations leading to disease progression currently represent important goals; accomplishing these could help identify the most relevant targets for precision therapy.
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Affiliation(s)
- Sarah Huet
- Cancer Research Center of Lyon, INSERM 1052 CNRS5286, 'Clinical and experimental models of lymphomagenesis' Team, Equipe labellisée Ligue Contre le Cancer Oullins, France
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, 165 chemin du Grand Revoyet, Pierre Bénite 69495, France
- Université Lyon-1, ISPB-Faculté de Pharmacie de Lyon, Lyon, France
| | - Pierre Sujobert
- Cancer Research Center of Lyon, INSERM 1052 CNRS5286, 'Clinical and experimental models of lymphomagenesis' Team, Equipe labellisée Ligue Contre le Cancer Oullins, France
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, 165 chemin du Grand Revoyet, Pierre Bénite 69495, France
- Université Lyon-1, Faculté de Médecine et de Maïeutique Lyon-Sud Charles Mérieux, Oullins, France
| | - Gilles Salles
- Cancer Research Center of Lyon, INSERM 1052 CNRS5286, 'Clinical and experimental models of lymphomagenesis' Team, Equipe labellisée Ligue Contre le Cancer Oullins, France
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, 165 chemin du Grand Revoyet, Pierre Bénite 69495, France
- Université Lyon-1, Faculté de Médecine et de Maïeutique Lyon-Sud Charles Mérieux, Oullins, France
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Gleeson M, Hawkes EA, Peckitt C, Wotherspoon A, Attygalle A, Sharma B, Du Y, Ethell M, Potter M, Dearden C, Horwich A, Chau I, Cunningham D. Outcomes for transformed follicular lymphoma in the rituximab era: the Royal Marsden experience 2003–2013. Leuk Lymphoma 2016; 58:1805-1813. [DOI: 10.1080/10428194.2016.1265114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mary Gleeson
- The Royal Marsden Hospital, London and Surrey, United Kingdom
| | - Eliza A. Hawkes
- Department of Oncology and Clinical Haematology, Austin Health, Heidelberg, Melbourne, Australia
- Eastern Health, Melbourne, Australia
| | - Clare Peckitt
- The Royal Marsden Hospital, London and Surrey, United Kingdom
| | | | - Ayoma Attygalle
- The Royal Marsden Hospital, London and Surrey, United Kingdom
| | | | - Yong Du
- The Royal Marsden Hospital, London and Surrey, United Kingdom
| | - Mark Ethell
- The Royal Marsden Hospital, London and Surrey, United Kingdom
| | - Mike Potter
- The Royal Marsden Hospital, London and Surrey, United Kingdom
| | - Claire Dearden
- The Royal Marsden Hospital, London and Surrey, United Kingdom
| | - Alan Horwich
- The Royal Marsden Hospital, London and Surrey, United Kingdom
| | - Ian Chau
- The Royal Marsden Hospital, London and Surrey, United Kingdom
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