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Geurts YM, Neppelenbroek SIM, Aleman BMP, Janus CPM, Krol ADG, van Spronsen DJ, Plattel WJ, Roesink JM, Verschueren KMS, Zijlstra JM, Koene HR, Nijziel MR, Schimmel EC, de Jongh E, Ong F, Te Boome LCJ, van Rijn RS, Böhmer LH, Ta BDP, Visser HPJ, Posthuma EFM, Bilgin YM, Muller K, van Kampen D, So-Osman C, Vermaat JSP, de Weijer RJ, Kersten MJ, van Leeuwen FE, Schaapveld M. Treatment-specific risk of subsequent malignant neoplasms in five-year survivors of diffuse large B-cell lymphoma. ESMO Open 2024; 9:102248. [PMID: 38350338 PMCID: PMC10937196 DOI: 10.1016/j.esmoop.2024.102248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The introduction of rituximab significantly improved the prognosis of diffuse large B-cell lymphoma (DLBCL), emphasizing the importance of evaluating the long-term consequences of exposure to radiotherapy, alkylating agents and anthracycline-containing (immuno)chemotherapy among DLBCL survivors. METHODS Long-term risk of subsequent malignant neoplasms (SMNs) was examined in a multicenter cohort comprising 2373 5-year DLBCL survivors treated at ages 15-61 years in 1989-2012. Observed SMN numbers were compared with expected cancer incidence to estimate standardized incidence ratios (SIRs) and absolute excess risks (AERs/10 000 person-years). Treatment-specific risks were assessed using multivariable Cox regression. RESULTS After a median follow-up of 13.8 years, 321 survivors developed one or more SMNs (SIR 1.5, 95% CI 1.3-1.8, AER 51.8). SIRs remained increased for at least 20 years after first-line treatment (SIR ≥20-year follow-up 1.5, 95% CI 1.0-2.2, AER 81.8) and were highest among patients ≤40 years at first DLBCL treatment (SIR 2.7, 95% CI 2.0-3.5). Lung (SIR 2.0, 95% CI 1.5-2.7, AER 13.4) and gastrointestinal cancers (SIR 1.5, 95% CI 1.2-2.0, AER 11.8) accounted for the largest excess risks. Treatment with >4500 mg/m2 cyclophosphamide/>300 mg/m2 doxorubicin versus ≤2250 mg/m2/≤150 mg/m2, respectively, was associated with increased solid SMN risk (hazard ratio 1.5, 95% CI 1.0-2.2). Survivors who received rituximab had a lower risk of subdiaphragmatic solid SMNs (hazard ratio 0.5, 95% CI 0.3-1.0) compared with survivors who did not receive rituximab. CONCLUSION Five-year DLBCL survivors have an increased risk of SMNs. Risks were higher for survivors ≤40 years at first treatment and survivors treated with >4500 mg/m2 cyclophosphamide/>300 mg/m2 doxorubicin, and may be lower for survivors treated in the rituximab era, emphasizing the need for studies with longer follow-up for rituximab-treated patients.
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Affiliation(s)
- Y M Geurts
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam
| | | | - B M P Aleman
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam
| | - C P M Janus
- Department of Radiotherapy, Erasmus Medical Centre, Rotterdam
| | - A D G Krol
- Department of Radiation Oncology, Leiden University Medical Centre, Leiden
| | - D J van Spronsen
- Department of Hematology, Radboud University Medical Centre, Nijmegen
| | - W J Plattel
- Department of Hematology, University Medical Centre Groningen, Groningen
| | - J M Roesink
- Department of Radiotherapy, University Medical Centre Utrecht, Utrecht
| | | | - J M Zijlstra
- Department of Hematology, Amsterdam UMC location Vrije Universiteit, Cancer Centre Amsterdam, Amsterdam
| | - H R Koene
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein
| | - M R Nijziel
- Catharina Cancer Institute, Department of Hemato-Oncology, Catharina Hospital, Eindhoven
| | | | - E de Jongh
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht
| | - F Ong
- Department of Radiotherapy, Medisch Spectrum Twente, Enschede
| | - L C J Te Boome
- Department of Hematology, Haaglanden Medical Centre, The Hague
| | - R S van Rijn
- Department of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden
| | - L H Böhmer
- Department of Hematology, Haga Teaching Hospital, The Hague
| | - B D P Ta
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht
| | - H P J Visser
- Department of Hematology, Noordwest Ziekenhuisgroep Alkmaar, Alkmaar
| | - E F M Posthuma
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft
| | - Y M Bilgin
- Department of Internal Medicine, ADRZ, Goes
| | | | - D van Kampen
- Zuidwest Radiotherapeutisch Instituut, Vlissingen
| | - C So-Osman
- Department of Hematology, Erasmus Medical Centre, Rotterdam; Unit Transfusion Medicine, Sanquin Blood Supply Foundation, Amsterdam
| | - J S P Vermaat
- Department of Hematology, Leiden University Medical Centre, Leiden
| | - R J de Weijer
- Department of Hematology, University Medical Centre Utrecht, Utrecht
| | - M J Kersten
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Cancer Centre Amsterdam and LYMMCARE, Amsterdam, The Netherlands
| | - F E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam
| | - M Schaapveld
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam.
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Lim W, Moon S, Lee NR, Shin HG, Yu SY, Lee JE, Kim I, Ko KP, Park SK. Group I pharmaceuticals of IARC and associated cancer risks: systematic review and meta-analysis. Sci Rep 2024; 14:413. [PMID: 38172159 PMCID: PMC10764325 DOI: 10.1038/s41598-023-50602-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
We aimed to summarize the cancer risk among patients with indication of group I pharmaceuticals as stated in monographs presented by the International Agency for Research on Cancer working groups. Following the PRISMA guidelines, a comprehensive literature search was conducted using the PubMed database. Pharmaceuticals with few studies on cancer risk were identified in systematic reviews; those with two or more studies were subjected to meta-analysis. For the meta-analysis, a random-effects model was used to calculate the summary relative risks (SRRs) and 95% confidence intervals (95% CIs). Heterogeneity across studies was presented using the Higgins I square value from Cochran's Q test. Among the 12 group I pharmaceuticals selected, three involved a single study [etoposide, thiotepa, and mustargen + oncovin + procarbazine + prednisone (MOPP)], seven had two or more studies [busulfan, cyclosporine, azathioprine, cyclophosphamide, methoxsalen + ultraviolet (UV) radiation therapy, melphalan, and chlorambucil], and two did not have any studies [etoposide + bleomycin + cisplatin and treosulfan]. Cyclosporine and azathioprine reported increased skin cancer risk (SRR = 1.32, 95% CI 1.07-1.62; SRR = 1.56, 95% CI 1.25-1.93) compared to non-use. Cyclophosphamide increased bladder and hematologic cancer risk (SRR = 2.87, 95% CI 1.32-6.23; SRR = 2.43, 95% CI 1.65-3.58). Busulfan increased hematologic cancer risk (SRR = 6.71, 95% CI 2.49-18.08); melphalan was associated with hematologic cancer (SRR = 4.43, 95% CI 1.30-15.15). In the systematic review, methoxsalen + UV and MOPP were associated with an increased risk of skin and lung cancer, respectively. Our results can enhance persistent surveillance of group I pharmaceutical use, establish novel clinical strategies for patients with indications, and provide evidence for re-categorizing current group I pharmaceuticals into other groups.
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Affiliation(s)
- Woojin Lim
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, 03080, Republic of Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, 03080, Republic of Korea
| | - Sungji Moon
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, 03080, Republic of Korea
- Interdisciplinary Program in Cancer Biology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Na Rae Lee
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, 04933, Republic of Korea
| | - Ho Gyun Shin
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, 04933, Republic of Korea
| | - Su-Yeon Yu
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, 04933, Republic of Korea
| | - Jung Eun Lee
- Department of Food and Nutrition, Seoul National University College of Human Ecology, Seoul, 08826, Republic of Korea
| | - Inah Kim
- Department of Occupational and Environmental Medicine, Hanyang University College of Medicine, Seoul, 04763, Republic of Korea
| | - Kwang-Pil Ko
- Clinical Preventive Medicine Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea.
- Cancer Research Institute, Seoul National University, Seoul, 03080, Republic of Korea.
- Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea.
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Zhan Z, Guo W, Li J, Wan X, Guo J, Bai O. Clinical features and prognosis of double primary malignant neoplasms in patients with non-hodgkin lymphoma. Discov Oncol 2023; 14:54. [PMID: 37133771 PMCID: PMC10156874 DOI: 10.1007/s12672-023-00667-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/23/2023] [Indexed: 05/04/2023] Open
Abstract
To investigate the clinical features, survival, and prognostic factors of patients with double primary malignant neoplasms (DPMNs) comprising non-Hodgkin lymphoma (NHL) and malignant solid tumors. Of the 2352 patients diagnosed with NHL, 105 (4.46%) patients were diagnosed with DPMNs, 42 (40.0%) had NHL first (the NHL-first group) and 63 (60.0%) had solid tumor first (the ST-first group). Females were more frequent in the ST-first group, and the interval time between the two tumors was longer. More NHLs in early stages and originating from extranodal sites were observed in the NHL-first group. Male, age ≥ 55 years at diagnosis of the first tumor, interval time <60 months, NHL diagnosed first, NHL arising from an extranodal site, DPMNs without breast cancer, and no surgery for the first primary tumor were associated with poorer overall survival (OS). Interval time <60 months and NHL diagnosed first were independent risk factors that affected the prognosis of patients with DPMNs. Therefore, careful monitoring and follow-up are especially important for these patients. 50.5% (53/105) of patients with DPMNs did not receive chemotherapy or radiotherapy prior to the diagnosis of the second tumor. We further compared the baseline characteristics of diffuse large B-cell lymphoma(DLBCL) patients with and without solid tumors, the former had a higher proportion of extranodal DLBCL, suggesting that extranodal DLBCL is more likely to develop solid tumors than nodal DLBCL.
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Affiliation(s)
- Zhumei Zhan
- Department of Hematology, The First Hospital of Jilin University, No. 71 Xinmin Street, Chaoyang District, Changchun, Jilin, 130021, China
| | - Wei Guo
- Department of Hematology, The First Hospital of Jilin University, No. 71 Xinmin Street, Chaoyang District, Changchun, Jilin, 130021, China
| | - Jia Li
- Department of Hematology, The First Hospital of Jilin University, No. 71 Xinmin Street, Chaoyang District, Changchun, Jilin, 130021, China
| | - Xin Wan
- Department of Hematology, The First Hospital of Jilin University, No. 71 Xinmin Street, Chaoyang District, Changchun, Jilin, 130021, China
| | - Jing Guo
- Department of Hematology, The First Hospital of Jilin University, No. 71 Xinmin Street, Chaoyang District, Changchun, Jilin, 130021, China
| | - Ou Bai
- Department of Hematology, The First Hospital of Jilin University, No. 71 Xinmin Street, Chaoyang District, Changchun, Jilin, 130021, China.
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Zhan Z, Guo W, Wan X, Bai O. Second primary malignancies in non-Hodgkin lymphoma: epidemiology and risk factors. Ann Hematol 2023; 102:249-259. [PMID: 36622391 DOI: 10.1007/s00277-023-05095-8] [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: 06/03/2022] [Accepted: 01/02/2023] [Indexed: 01/10/2023]
Abstract
With the advancements in therapeutics for non-Hodgkin lymphoma (NHL), the long-term survival of patients with NHL has markedly increased. Second primary malignancies (SPMs) have become an increasingly relevant long-term concern for NHL survivors. The etiology of SPMs is multifactorial and involves multiple steps. Germline alterations, immune dysregulation, and clonal hematopoiesis contribute to the accumulation of intrinsic adverse factors, and external factors such as lifestyle; exposure to infectious factors; and late effects of radiotherapy, chemotherapy, high-dose therapy, and autologous hematopoietic stem cell transplantation further increase SPM risk. Therapy-related myeloid neoplasms (t-MNs) are a devastating complication of cytotoxic chemotherapeutic agents. However, as targeted therapies begin to replace cytotoxic chemotherapy, the incidence of t-MNs is likely to decline, particularly for indolent B-cell NHL.
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Affiliation(s)
- Zhumei Zhan
- Department of Hematology, The First Hospital of Jilin University, No. 71 Xinmin Street, Chaoyang District, Changchun, 130021, Jilin, China
| | - Wei Guo
- Department of Hematology, The First Hospital of Jilin University, No. 71 Xinmin Street, Chaoyang District, Changchun, 130021, Jilin, China
| | - Xin Wan
- Department of Hematology, The First Hospital of Jilin University, No. 71 Xinmin Street, Chaoyang District, Changchun, 130021, Jilin, China
| | - Ou Bai
- Department of Hematology, The First Hospital of Jilin University, No. 71 Xinmin Street, Chaoyang District, Changchun, 130021, Jilin, China.
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Synchronous/Metachronous Multiple Primary Malignancies: Review of Associated Risk Factors. Diagnostics (Basel) 2022; 12:diagnostics12081940. [PMID: 36010291 PMCID: PMC9406460 DOI: 10.3390/diagnostics12081940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022] Open
Abstract
The incidence of secondary primary malignancy (SPM) has been reported to range from 1.33% to 5.8%, according to the location of the primary cancer and the follow-up duration. The highest occurrence rate of SPM, of 36.6% within 6 months, has been reported in lung cancer. Genitourinary malignancies were reported to be the third-most-common SPM in several reports. However, the incidence of genitourinary malignancy as the first primary cancer associated with SPM has not been reported. Several risk factors are related to the occurrence of SPM, including viral infection chemotherapy, radiation, genetics, smoking, betel quid chewing, and environmental factors. An early survey for SPM is indicated in first primary malignancy patients with these associated factors. In this study, we summarize several risk factors related to the occurrence of SPMs and preventive tests, which may help in their early detection and, consequently, better survival.
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Abstract
The nitrogen mustards are powerful cytotoxic and lymphoablative agents and have been used for more than 60 years. They are employed in the treatment of cancers, sarcomas, and hematologic malignancies. Cyclophosphamide, the most versatile of the nitrogen mustards, also has a place in stem cell transplantation and the therapy of autoimmune diseases. Adverse effects caused by the nitrogen mustards on the central nervous system, kidney, heart, bladder, and gonads remain important issues. Advances in analytical techniques have facilitated the investigation of the pharmacokinetics of the nitrogen mustards, especially the oxazaphosphorines, which are prodrugs requiring metabolic activation. Enzymes involved in the metabolism of cyclophosphamide and ifosfamide are very polymorphic, but a greater understanding of the pharmacogenomic influences on their activity has not yet translated into a personalized medicine approach. In addition to damaging DNA, the nitrogen mustards can act through other mechanisms, such as antiangiogenesis and immunomodulation. The immunomodulatory properties of cyclophosphamide are an area of current exploration. In particular, cyclophosphamide decreases the number and activity of regulatory T cells, and the interaction between cyclophosphamide and the intestinal microbiome is now recognized as an important factor. New derivatives of the nitrogen mustards continue to be assessed. Oxazaphosphorine analogs have been synthesized in attempts to both improve efficacy and reduce toxicity, with varying degrees of success. Combinations of the nitrogen mustards with monoclonal antibodies and small-molecule targeted agents are being evaluated. SIGNIFICANCE STATEMENT: The nitrogen mustards are important, well-established therapeutic agents that are used to treat a variety of diseases. Their role is continuing to evolve.
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Affiliation(s)
- Martin S Highley
- Plymouth Oncology Centre, Derriford Hospital, and Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom (M.S.H.); Department of Animal Physiology and Neurobiology (B.L.) and Laboratory for Experimental Oncology (E.A.D.B.), University of Leuven, Leuven, Belgium; Oncology Department, University Hospital Antwerp, Edegem, Belgium (H.P.); and London Oncology Clinic, London, United Kingdom (P.G.H.)
| | - Bart Landuyt
- Plymouth Oncology Centre, Derriford Hospital, and Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom (M.S.H.); Department of Animal Physiology and Neurobiology (B.L.) and Laboratory for Experimental Oncology (E.A.D.B.), University of Leuven, Leuven, Belgium; Oncology Department, University Hospital Antwerp, Edegem, Belgium (H.P.); and London Oncology Clinic, London, United Kingdom (P.G.H.)
| | - Hans Prenen
- Plymouth Oncology Centre, Derriford Hospital, and Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom (M.S.H.); Department of Animal Physiology and Neurobiology (B.L.) and Laboratory for Experimental Oncology (E.A.D.B.), University of Leuven, Leuven, Belgium; Oncology Department, University Hospital Antwerp, Edegem, Belgium (H.P.); and London Oncology Clinic, London, United Kingdom (P.G.H.)
| | - Peter G Harper
- Plymouth Oncology Centre, Derriford Hospital, and Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom (M.S.H.); Department of Animal Physiology and Neurobiology (B.L.) and Laboratory for Experimental Oncology (E.A.D.B.), University of Leuven, Leuven, Belgium; Oncology Department, University Hospital Antwerp, Edegem, Belgium (H.P.); and London Oncology Clinic, London, United Kingdom (P.G.H.)
| | - Ernst A De Bruijn
- Plymouth Oncology Centre, Derriford Hospital, and Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom (M.S.H.); Department of Animal Physiology and Neurobiology (B.L.) and Laboratory for Experimental Oncology (E.A.D.B.), University of Leuven, Leuven, Belgium; Oncology Department, University Hospital Antwerp, Edegem, Belgium (H.P.); and London Oncology Clinic, London, United Kingdom (P.G.H.)
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Rolf D, Reinartz G, Rehn S, Kittel C, Eich HT. Development of Organ-Preserving Radiation Therapy in Gastric Marginal Zone Lymphoma. Cancers (Basel) 2022; 14:cancers14040873. [PMID: 35205623 PMCID: PMC8869852 DOI: 10.3390/cancers14040873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Gastric marginal zone lymphoma of the stomach is a rare cancer type primarily treated with oral proton pump inhibitors. If the disease does not respond to this, radiation is the treatment of choice. This review presents the development of radiation therapy over the last decades. Earlier, the stomach was surgically removed and irradiation was performed using large-field techniques and high doses of radiation. Currently, the standard treatment is the use of small-volume radiation therapy (with few side effects) with the preservation of the stomach, which provides excellent outcomes. In addition, this paper provides an outlook on current studies and possible future developments. Abstract Gastric marginal zone lymphoma (gMZL) of mucosa-associated lymphoid tissue (MALT) may persist even after H. pylori eradication, or it can be primarily Helicobacter pylori (H. pylori) independent. For patients without the successful eradication of lymphoma, or with progressive disease, treatment options have historically included partial or total gastrectomy. Presently, in these instances, curative radiation therapy (RT) is the current standard of care. This review emphasizes the historically changing role of radiation therapy in gMZL, progressing from large-volume RT without surgery, to localized RT, on its own, as a curative organ-preserving treatment. This overview shows the substantial progress in radiation therapy during the recent two to three decades, from high-dose, large-field techniques to low-dose, localized target volumes based on advanced imaging, three-dimensional treatment planning, and advanced treatment delivery techniques. RT has evolved from very large extended field techniques (EF) with prophylactic treatment of the whole abdomen and the supradiaphragmatic lymph nodes, applying doses between 30 and 50 Gy, to involved-field RT (IF), to the current internationally recommended involved site radiation therapy (ISRT) with a radiation dose of 24–30 Gy in gMZL. Stage-adapted RT is a highly effective and safe treatment with excellent overall survival rates and very rare acute or late treatment-related toxicities, as shown not only in retrospective studies, but also in large prospective multicenter studies, such as those conducted by the German Study Group on Gastrointestinal Lymphoma (DSGL). Further de-escalation of the radiation treatments with low-dose 20 Gy, as well as ultra-low-dose 4 Gy radiation therapy, is under investigation within ongoing prospective clinical trials of the International Lymphoma Radiation Oncology Group (ILROG) and of the German Lymphoma Alliance (GLA).
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Cyclophosphamide Induces Durable Molecular and Clinical Responses in Patients with Relapsed T-LGL Leukemia. Blood Adv 2022; 6:2685-2687. [PMID: 34996100 PMCID: PMC9043937 DOI: 10.1182/bloodadvances.2021006263] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/16/2021] [Indexed: 11/20/2022] Open
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Cancers after HLA-matched related bone marrow transplantation for aplastic anemia. Bone Marrow Transplant 2022; 57:83-88. [PMID: 34657145 PMCID: PMC8738111 DOI: 10.1038/s41409-021-01498-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 02/08/2023]
Abstract
We analyzed subsequent cancers in 329 patients with aplastic anemia given HLA-matched related marrow grafts. Median follow-up: 26 (range 1-47) years. Conditioning: cyclophosphamide ± antithymocyte globulin; graft-vs.-host disease (GVHD) prevention: methotrexate ± cyclosporine. The long follow-up and homogeneous treatment allowed definitive analyses of incidence, nature, time of onset, and potential causes of cancers. Fifty-three cancers occurred in 46 patients, 42 had solid tumors and 4 blood cancers. Of the 42, 22 had non-melanoma skin and 7 oropharyngeal cancers. The remainder had a spectrum of other cancers including two liver cancers from pre-transplant hepatitis C. The 26-year cumulative incidence (CI) of cancer was 11% and mortality 5%. Excluding non-melanoma skin cancers, the 26-year CI of cancer was 7%. Cancers were 2.03-fold more than expected from SEER data; that number was 1.89-fold after excluding liver cancers. Nearly all cancers developed between 14 and 34 years. Skin and oropharyngeal cancers showed significant association with chronic GVHD, whereby GVHD had resolved in most patients within 7 years of transplantation. Thus, tumors evolved after a lag time of 7-27 years. Other cancers showed no clear associations with chronic GVHD or drugs used for transplantation. Results reemphasize the importance of preventing chronic GVHD.
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Wenge DV, Wethmar K, Mikesch JH, Reicherts C, Schliemann C, Mesters R, Kessler T, Khandanpour C, Kerkhoff A, Schmitz N, Berdel WE, Lenz G, Stelljes M. Allogeneic hematopoietic stem cell transplantation for therapy-related myeloid neoplasms following treatment of a lymphoid malignancy. Leuk Lymphoma 2021; 62:1930-1939. [PMID: 33779471 DOI: 10.1080/10428194.2021.1894645] [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] [Indexed: 10/21/2022]
Abstract
Advances in lymphoma treatment lead to increasing numbers of long-term survivors. Thus, secondary therapy-related myeloid neoplasms (t-MN) gain clinical relevance. We analyzed 38 t-MN patients receiving an allogeneic stem cell transplantation (SCT) after successful cytotoxic treatment of Hodgkin lymphoma (n = 9), non-Hodgkin lymphoma (n = 24), and multiple myeloma (n = 5), who had developed t-AML (n = 20) or t-MDS (n = 18). Overall survival (OS) and relapse-free survival at 3 years after allogeneic SCT were 43% and 39%. The cumulative incidences of relapse and non-relapse mortality (NRM) at 3 years were 19% and 42%. More than one therapy line for the lymphoid malignancy resulted in a significantly higher NRM rate and inferior 3-year-OS. Our data indicate that allogeneic SCT for patients with t-MN after treatment of a lymphoid malignancy leads to OS rates comparable to patients transplanted for de novo MN. Multiple lines of lymphoma therapy increase NRM and lead to inferior survival after allogeneic SCT.
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Affiliation(s)
- Daniela V Wenge
- Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Klaus Wethmar
- Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Jan-Henrik Mikesch
- Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Christian Reicherts
- Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Christoph Schliemann
- Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Rolf Mesters
- Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Torsten Kessler
- Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Cyrus Khandanpour
- Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Andrea Kerkhoff
- Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Norbert Schmitz
- Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Georg Lenz
- Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Matthias Stelljes
- Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany
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Zhang Z, Pan T, Liu C, Shan X, Xu Z, Hong H, Lin H, Chen J, Sun H. Cyclophosphamide induced physiological and biochemical changes in mice with an emphasis on sensitivity analysis. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 211:111889. [PMID: 33461014 DOI: 10.1016/j.ecoenv.2020.111889] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/21/2020] [Accepted: 12/31/2020] [Indexed: 06/12/2023]
Abstract
The widespread use of cyclophosphamide (CP) in medical treatment had caused ubiquitous contamination in the environment. To data, many studies have been carried out on the toxic effect of CP. However, among these toxic effects of CP, which are the most sensitive remains unclear. Present study aimed to investigate the toxicity of CP on mice and evaluate the sensitivity of physiological-biochemical parameters upon exposure of mice to CP. Results showed that as compared with the control group, CP caused significant reduction in body weight (p < 0.01), spleen coefficient (p < 0.01), leukocyte density (p < 0.01) and alanine transaminase (ALT) in kidney (p < 0.01); However superoxide dismutase (SOD), malondialdehyde (MDA), ALT in liver and creatinine (Cr) in kidney significantly (p < 0.05) increased. Among the suppressed physiological and biochemical parameters, the sensitivity to CP toxicity was generally ranked as body weight > leukocyte density > ALT in kidney > spleen coefficient; while among the stimulated parameters, the sensitivity was ranked as MDA (liver) > Cr (kidney) > ALT (liver). Overall, the most sensitive parameters to CP toxicity may be associated with growth, immune system and the normal function of liver and kidney.
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Affiliation(s)
- Zhiying Zhang
- College of Geography and Environmental Science, Zhejiang Normal University, Jinhua, China
| | - Ting Pan
- College of Geography and Environmental Science, Zhejiang Normal University, Jinhua, China
| | - Chunrong Liu
- College of Geography and Environmental Science, Zhejiang Normal University, Jinhua, China
| | - Xiaoyun Shan
- Jinhua Municipal Central Hospital, Jinhua, China
| | - Zeqiong Xu
- College of Geography and Environmental Science, Zhejiang Normal University, Jinhua, China
| | - Huachang Hong
- College of Geography and Environmental Science, Zhejiang Normal University, Jinhua, China.
| | - Hongjun Lin
- College of Geography and Environmental Science, Zhejiang Normal University, Jinhua, China
| | - Jianrong Chen
- College of Geography and Environmental Science, Zhejiang Normal University, Jinhua, China; Jinhua Municipal Central Hospital, Jinhua, China
| | - Hongjie Sun
- College of Geography and Environmental Science, Zhejiang Normal University, Jinhua, China.
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12
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Hesla AC, Papakonstantinou A, Tsagkozis P. Current Status of Management and Outcome for Patients with Ewing Sarcoma. Cancers (Basel) 2021; 13:1202. [PMID: 33801953 PMCID: PMC7998375 DOI: 10.3390/cancers13061202] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 12/16/2022] Open
Abstract
Ewing sarcoma is the second most common bone sarcoma in children after osteosarcoma. It is a very aggressive malignancy for which systemic treatment has greatly improved outcome for patients with localized disease, who now see survival rates of over 70%. However, for the quarter of patients presenting with metastatic disease, survival is still dismal with less than 30% of patients surviving past 5 years. Patients with disease relapse, local or distant, face an even poorer prognosis with an event-free 5-year survival rate of only 10%. Unfortunately, Ewing sarcoma patients have not yet seen the benefit of recent years' technical achievements such as next-generation sequencing, which have enabled researchers to study biological systems at a level never seen before. In spite of large multinational studies, treatment of Ewing sarcoma relies entirely on chemotherapeutic agents that have been largely unchanged for decades. As many promising modern therapies, including monoclonal antibodies, small molecules, and immunotherapy, have been disappointing to date, there is no clear candidate as to which drug should be investigated in the next large-scale clinical trial. However, the mechanisms driving tumor development in Ewing sarcoma are slowly unfolding. New entities of Ewing-like tumors, with fusion transcripts that are related to the oncogenic EWSR1-FLI1 fusion seen in the majority of Ewing tumors, are being mapped. These tumors, although sharing much of the same morphologic features as classic Ewing sarcoma, behave differently and may require a different treatment. There are also controversies regarding local treatment of Ewing sarcoma. The radiosensitive nature of the disease and the tendency for Ewing sarcoma to arise in the axial skeleton make local treatment very challenging. Surgical treatment and radiotherapy have their pros and cons, which may give rise to different treatment strategies in different centers around the world. This review article discusses some of these controversies and reproduces the highlights from recent publications with regard to diagnostics, systemic treatment, and surgical treatment of Ewing sarcoma.
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13
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Dinnessen MA, Visser O, Tonino SH, Poel MW, Blijlevens NM, Kersten MJ, Lugtenburg PJ, Dinmohamed AG. The impact of prior malignancies on the development of second malignancies and survival in follicular lymphoma: A population‐based study. EJHAEM 2020; 1:489-497. [PMID: 35844986 PMCID: PMC9175939 DOI: 10.1002/jha2.108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/20/2022]
Abstract
We assessed the impact of a prior malignancy diagnosis (PMD) – as a potential proxy for genetic cancer susceptibility – on the development of a second primary malignancy (SPM) and mortality in follicular lymphoma (FL) patients. From the nationwide Netherlands Cancer Registry, we selected all adult FL patients diagnosed in 1994‐2012 (n = 8028) and PMDs and SPMs relative to FL, with follow‐up until 2017. We constructed two Fine and Gray models – with death as a competing risk – to assess the association between a PMD and SPM incidence. A PMD was associated with an increased incidence of SPMs (subdistribution hazard ratio [SHR], 1.30; 95% confidence interval [CI], 1.03‐1.64) – especially carcinomas of the respiratory tract (SHR, 1.83; 95% CI, 1.10‐3.05) and cutaneous squamous cell carcinomas (SHR, 1.58; 95% CI, 1.01‐2.45) – and a higher risk of mortality in a multivariable model (HR, 1.43; 95% CI, 1.19‐1.71). However, when additionally adjusted for the receipt of systemic therapy and/or radiotherapy before FL diagnosis, only patients who received such therapies had an increased incidence of SPMs (SHR, 1.40; 95% CI, 1.02‐1.93). In conclusion, patients with a PMD had a higher rate of SPMs and mortality than those without a PMD, which might have resulted from therapy‐related carcinogenesis.
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Affiliation(s)
- Manette A.W. Dinnessen
- Department of Research and Development Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
| | - Otto Visser
- Department of Registration Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
| | - Sanne H. Tonino
- Department of Hematology Cancer Center Amsterdam LYMMCARE (Lymphoma and Myeloma Center Amsterdam) Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Marjolein W.M. Poel
- Department of Internal Medical Division of Hematology Maastricht University Medical Center Maastricht The Netherlands
| | | | - Marie José Kersten
- Department of Hematology Cancer Center Amsterdam LYMMCARE (Lymphoma and Myeloma Center Amsterdam) Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | | | - Avinash G. Dinmohamed
- Department of Research and Development Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
- Department of Hematology Cancer Center Amsterdam LYMMCARE (Lymphoma and Myeloma Center Amsterdam) Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
- Amsterdam UMC Vrije Universiteit Amsterdam Department of Hematology Cancer Center Amsterdam Amsterdam The Netherlands
- Department of Public Health Erasmus University Medical Center Rotterdam The Netherlands
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14
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Sonne SJ, Shieh WS, Srivastava SK, Smith BT. Lymphoma masquerading as occlusive retinal vasculitis: A case study. Am J Ophthalmol Case Rep 2020; 19:100777. [PMID: 32613135 PMCID: PMC7320315 DOI: 10.1016/j.ajoc.2020.100777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 05/11/2020] [Accepted: 06/06/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose To describe a case of retinal lymphoma presenting as an occlusive retinal vasculitis without vitritis that was exquisitely responsive to intravitreal dexamethasone implant (IVDI). Observation A 66-year old male presented with decreased vision in the right eye and was diagnosed with occlusive retinal vasculitis and prominent cystoid macular edema though he lacked vitritis. A complete systemic workup for infectious, inflammatory, and infiltrative etiologies was unremarkable. Intravenous methylprednisolone and cyclophosphamide had no clinical effect. Due to persistent perivascular exudates and refractory macular edema, IVDI was administered with marked improvement in vision and clinical findings. Subsequent retinal vasculitis in the left eye responded to IVDI as well. The patient remained disease free for months while on weekly adalimumab. He then presented with acute vision loss in the left eye due to a lymphomatous subretinal infiltration and a new lesion in the corpus callosum. He has remained disease free for more than two years after intravitreal methotrexate injections and rituximab with an autologous stem cell transplant. Conclusion and importance Lymphoma may present as an occlusive retinal vasculitis without vitritis and can be masked due to its response to IVDI.
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Affiliation(s)
- Scott J Sonne
- Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | | | - Bradley T Smith
- The Retina Institute, St. Louis, MO, USA.,Washington University, Department of Ophthalmology and Visual Sciences, St. Louis, MO, USA
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15
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Challenges and Opportunities for High-grade B-Cell Lymphoma With MYC and BCL2 and/or BCL6 Rearrangement (Double-hit Lymphoma). Am J Clin Oncol 2019; 42:304-316. [PMID: 29419530 DOI: 10.1097/coc.0000000000000427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The most common subtype of non-Hodgkin lymphoma, diffuse large B-cell lymphoma, is cured in approximately two thirds of patients after initial therapy. The remaining one-third of patients who suffer relapse or become refractory have very poor survival outcomes despite salvage chemotherapy with or without stem cell transplantation. A considerable proportion of relapsed or refractory large B cells belong to the WHO subtype known as high-grade B-cell lymphoma with rearrangement of MYC and BCL2 and/or BCL6, also known as double-hit lymphoma (DHL). Most DHL patients present with Ann Arbor's stage III/IV, a comparatively higher rate of extranodal involvement including bone marrow and central nervous system infiltration, high levels of lactate dehydrogenase, and an elevated Ki67 expression in the tumor cells. Newer therapeutic approaches, including targeted therapy against BCL2, MYC, or other associated pathways, are needed. In addition, recent therapies that harness the immune system, such as checkpoint inhibitors and chimeric antigen receptor T-cell therapy, are changing the paradigm of treatment for non-Hodgkin lymphoma and could impact the outcome of DHL.
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16
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Huang Z, Hu Z, Ouyang J, Huang C. Electroacupuncture regulates the DREAM/NF-κB signalling pathway and ameliorates cyclophosphamide-induced immunosuppression in mice. Acupunct Med 2019; 37:292-300. [PMID: 31192694 DOI: 10.1136/acupmed-2017-011593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Immune responses inhibit invasion by pathogens and antigens. Thus, it is important to promote the immune response in immunosuppressed patients. OBJECTIVE To examine whether electroacupuncture (EA) promotes the immune response by regulating the downstream regulatory element antagonist modulator / nuclear factor kappa B (DREAM/NF-κB) signalling pathway in a mouse model of cyclophosphamide (CP)-induced immunosuppression, and determine the most effective frequency. METHODS Twenty-four Kunming mice were intraperitoneally injected with CP to establish an immunosuppression model and six mice were injected with the same volume of normal saline as a control. The 24 mice were randomly divided into four groups: manual acupuncture, 2 Hz EA treatment, 100 Hz EA treatment and alternating 2/100 Hz EA treatment. After EA treatment for 3 days, immune response, natural killer (NK) cell toxicity and the expression of cytokines and DREAM/NF-κB were assessed. RESULTS EA treatment, especially at alternating 2/100 Hz frequency, improved spleen and thymus indices, increased lactate dehydrogenase and acid phosphatase levels, promoted concanavalin A- and lipopolysaccharide-induced splenocyte proliferation, increased NK cell toxicity and ameliorated CP-induced immunosuppression in mice. Additionally, 2/100 Hz EA treatment increased interleukin (IL)-2, IL-6, IL-12, tumour necrosis factor-α and interferon-γ levels and decreased IL-10 levels in CP-induced immunosuppressed mice. Finally, it was found that 2/100 Hz EA treatment increased p-IκBα and NF-κB expression and decreased DREAM and IκBα expression, suggesting that this treatment activates the NF-κB signalling pathway. CONCLUSION 2/100 Hz EA treatment might be an effective way to enhance immune responses in CP-induced immunosuppressed mice.
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Affiliation(s)
- Zhihua Huang
- Institute for Medical Sciences of Pain, Department of Physiology, School of Basic Medical Sciences, Gannan Medical University, Ganzhou, China
| | - Zhiping Hu
- Institute for Medical Sciences of Pain, Department of Physiology, School of Basic Medical Sciences, Gannan Medical University, Ganzhou, China
| | - Juan Ouyang
- Institute for Medical Sciences of Pain, Department of Physiology, School of Basic Medical Sciences, Gannan Medical University, Ganzhou, China
| | - Cheng Huang
- Institute for Medical Sciences of Pain, Department of Physiology, School of Basic Medical Sciences, Gannan Medical University, Ganzhou, China
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17
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Jiang Y, Miao Z, Wang J, Chen J, Lv Y, Xing D, Wang X, Wang Y, Cao Z, Zhao Z. Clinical characteristics and prognosis associated with multiple primary malignant tumors in non-Hodgkin lymphoma patients. TUMORI JOURNAL 2019; 105:474-482. [PMID: 30945608 DOI: 10.1177/0300891619839475] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Patients with non-Hodgkin lymphoma (NHL) occasionally present with multiple primary malignant tumors (MPMTs). This study aimed to determine the clinical characteristics, survival, and risk factors of these patients. METHODS The median follow-up of 92 patients was 13.5 months (range 0.3-72). Overall, 21 patients had synchronous MPMTs and 71 had metachronous MPMTs. We classified patients in the latter group into metachronous first group (n=27) and metachronous second group (n=44). RESULTS Diffuse large B-cell lymphoma was the most frequent histologic lymphoma type. The digestive system was the commonest site affected by the solid cancer. The 1- and 2-year survival rates were 86.5% and 70.5%, respectively. The overall survival (OS) rates were 67.9% and 36.2% at 2 and 3 years, respectively, in the metachronous first group; 73.8% and 73.8%, respectively, in the metachronous second group; and 68.1% and 56.7%, respectively, in the synchronous tumor group. There was no difference in the survival rate among the 3 groups before 2 years, but after 2 years, a shorter OS rate was observed in the metachronous first group than in the metachronous second group and synchronous tumor group. For all patients, age >60 years, male sex, and ⩾3 involved nodal sites were considered independent prognostic factors associated with survival. CONCLUSIONS OS time was shorter in patients with NHL who developed a second tumor than in those who were diagnosed with solid cancer synchronously and second neoplasm after previous solid tumors. Long-term follow-up and effective treatment should be provided to these patients.
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Affiliation(s)
- Yanan Jiang
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Zhaoyi Miao
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Jinhuan Wang
- Department of Oncology, Second Hospital of Tianjin Medical University, Institute of Urology Tianjin, China
| | - Jing Chen
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yangyang Lv
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Donghui Xing
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xiaofang Wang
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yafei Wang
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Zeng Cao
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Zhigang Zhao
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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18
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Chua CC, Fleming S, Wei AH. Clinicopathological aspects of therapy-related acute myeloid leukemia and myelodysplastic syndrome. Best Pract Res Clin Haematol 2019; 32:3-12. [PMID: 30927972 DOI: 10.1016/j.beha.2019.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 02/11/2019] [Accepted: 02/15/2019] [Indexed: 12/15/2022]
Abstract
Therapy-related myeloid neoplasm (t-MN) is a rare but devastating consequence of chemotherapy and/or radiotherapy used for the treatment of solid cancers and various hematologic malignancies. Our current understanding of the etiology is that hematopoietic clones that are contemporaneous with the primary cancer and resistant to the cytotoxic exposure have the potential to undergo selective expansion and transformation to t-MN. Consequently, a large proportion of cases are associated with adverse risk factors, resulting in limited effective treatment options. Despite the emergence of some therapies with promising activity in t-MN, most effects are short-lived and allogeneic stem cell transplantation remains the only curative option for eligible patients. This review summarizes the current literature on t-AML and t-MDS, with the aim of providing practical recommendations on the clinical evaluation and management of these conditions.
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Affiliation(s)
- Chong Chyn Chua
- The Alfred Hospital and Monash University, Melbourne, VIC, Australia.
| | - Shaun Fleming
- The Alfred Hospital and Monash University, Melbourne, VIC, Australia.
| | - Andrew H Wei
- The Alfred Hospital and Monash University, Melbourne, VIC, Australia.
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19
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Ghione P, Cavallo F, Visco C, Chen Z, Castellino A, Tisi MC, Dogliotti I, Nicolosi M, Boccadoro M, Leonard JP, Vitolo U, Martin P. A retrospective study of R-DHAP/Ox for early progressing follicular lymphoma. Br J Haematol 2017; 183:828-831. [PMID: 29265185 DOI: 10.1111/bjh.15057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Paola Ghione
- Molecular Biotechnologies and Health Sciences, Universita' di Torino, Torino, Italy
| | - Federica Cavallo
- Molecular Biotechnologies and Health Sciences, Universita' di Torino, Torino, Italy
| | - Carlo Visco
- Cell Therapy and Haematology, San Bortolo Hospital, Vicenza, Italy
| | - Zhengming Chen
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
| | - Alessia Castellino
- Haematology 2, Citta' della Salute e della Scienza di Torino, Torino, Italy
| | - Maria C Tisi
- Cell Therapy and Haematology, San Bortolo Hospital, Vicenza, Italy
| | - Irene Dogliotti
- Molecular Biotechnologies and Health Sciences, Universita' di Torino, Torino, Italy
| | - Maura Nicolosi
- Haematology 2, Citta' della Salute e della Scienza di Torino, Torino, Italy
| | - Mario Boccadoro
- Molecular Biotechnologies and Health Sciences, Universita' di Torino, Torino, Italy
| | - John P Leonard
- Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Umberto Vitolo
- Haematology 2, Citta' della Salute e della Scienza di Torino, Torino, Italy
| | - Peter Martin
- Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY, USA
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20
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Magnano L, Montoto S, González-Barca E, Briones J, Sancho JM, Muntañola A, Salar A, Besalduch J, Escoda L, Moreno C, Domingo-Domenech E, Estany C, Oriol A, Altés A, Pedro C, Gardella S, Asensio A, Vivancos P, Fernández de Sevilla A, Ribera JM, Colomer D, Campo E, López-Guillermo A. Long-term safety and outcome of fludarabine, cyclophosphamide and mitoxantrone (FCM) regimen in previously untreated patients with advanced follicular lymphoma: 12 years follow-up of a phase 2 trial. Ann Hematol 2017; 96:639-646. [DOI: 10.1007/s00277-017-2920-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/29/2016] [Indexed: 11/25/2022]
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21
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De Sanctis V, Alfò M, Di Rocco A, Ansuinelli M, Russo E, Osti MF, Valeriani M, Minniti G, Grapulin L, Musio D, Bracci S, Spagnoli A, Moleti ML, Tombolini V, Martelli M. Second cancer incidence in primary mediastinal B-cell lymphoma treated with methotrexate with leucovorin rescue, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin regimen with or without rituximab and mediastinal radiotherapy: Results from a monoinstitutional cohort analysis of long-term survivors. Hematol Oncol 2017; 35:554-560. [PMID: 28078727 DOI: 10.1002/hon.2377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 07/04/2016] [Accepted: 11/13/2016] [Indexed: 11/11/2022]
Abstract
Our aim is to assess the incidence of second cancer in long-time surviving primary mediastinal B-cell lymphoma (PMBCL) patients treated with combined radiochemoimmunotherapy (standard methotrexate with leucovorin rescue, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin with rituximab and mediastinal radiation therapy at a dose of 30 to 36 Gy). For this purpose, 92 points were evaluated. After a median overall survival of 137 months (range 76-212), we recorded second cancer in 3 of 80 long-surviving patients (3.75%) with cumulative incidence of 3.47% at 15 years and 11% at 17 years, with a 17-year second cancer-free survival of 82%. We observed 2 papillary thyroid cancers with a standardized incidence ratio (SIR) of 7.97 and an absolute excess risk (AER) of 17. 84 and 1 acute myeloid leukemia (AML) with an SIR of 66.53 and an AER of 10.05. No breast cancer occurred. Although we should take into account the limits of the proposed statistical analysis, combined modality treatment was related to a significant SIR and AER for thyroid cancer and acute myeloid leukemia.
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Affiliation(s)
- Vitaliana De Sanctis
- Department of Medicine and Surgery and Translational Medicine, Unit of Radiotherapy, S Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Marco Alfò
- Department of Statistical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Alice Di Rocco
- Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Michela Ansuinelli
- Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Eleonora Russo
- Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Mattia F Osti
- Department of Medicine and Surgery and Translational Medicine, Unit of Radiotherapy, S Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Maurizio Valeriani
- Department of Medicine and Surgery and Translational Medicine, Unit of Radiotherapy, S Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Giuseppe Minniti
- Department of Medicine and Surgery and Translational Medicine, Unit of Radiotherapy, S Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli (IS), Italy
| | - Lavinia Grapulin
- Department of Radiological, Oncological and Anatomo-pathological Sciences, Unit of Radiotherapy, Policlinico Umberto I, Sapienza" University of Rome, Rome, Italy
| | - Daniela Musio
- Department of Radiological, Oncological and Anatomo-pathological Sciences, Unit of Radiotherapy, Policlinico Umberto I, Sapienza" University of Rome, Rome, Italy
| | - Stefano Bracci
- Department of Medicine and Surgery and Translational Medicine, Unit of Radiotherapy, S Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Alessandra Spagnoli
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Maria Luisa Moleti
- Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Vincenzo Tombolini
- Department of Radiological, Oncological and Anatomo-pathological Sciences, Unit of Radiotherapy, Policlinico Umberto I, Sapienza" University of Rome, Rome, Italy
| | - Maurizio Martelli
- Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
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22
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van Daalen EE, Rizzo R, Kronbichler A, Wolterbeek R, Bruijn JA, Jayne DR, Bajema IM, Rahmattulla C. Effect of rituximab on malignancy risk in patients with ANCA-associated vasculitis. Ann Rheum Dis 2016; 76:1064-1069. [PMID: 27899372 DOI: 10.1136/annrheumdis-2016-209925] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 11/10/2016] [Accepted: 11/12/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) treated with cyclophosphamide have an increased malignancy risk compared with the general population. We investigated whether treatment with rituximab instead of cyclophosphamide has decreased the malignancy risk in patients with AAV. METHODS The study included patients with AAV treated at a tertiary vasculitis referral centre between 2000 and 2014. The malignancy incidence in these patients was compared with the incidence in the general population by calculating standardised incidence ratios (SIRs), adjusted for sex, age and calendar year. Malignancy incidence was compared between rituximab-treated and cyclophosphamide-treated patients. RESULTS Of the 323 included patients, 33 developed a total of 45 malignancies during a mean follow-up of 5.6 years. This represented a 1.89-fold increased (95% CI 1.38 to 2.53) malignancy risk, and a non-significantly increased risk if non-melanoma skin cancer was excluded (SIR, 1.09; 95% CI 0.67 to 1.69). The risk of non-melanoma skin cancer was 4.58-fold increased (95% CI 2.96 to 6.76). Cyclophosphamide-treated patients had an increased malignancy risk compared with the general population (SIR, 3.10; 95% CI 2.06 to 4.48). In contrast, rituximab-treated patients had a malignancy risk similar to the general population (SIR, 0.67; 95% CI 0.08 to 2.43). The malignancy risk in cyclophosphamide-treated patients was 4.61-fold higher (95% CI 1.16 to 39.98) than in rituximab-treated patients. CONCLUSIONS The malignancy risk in patients with AAV was lower in rituximab-treated patients than in cyclophosphamide-treated patients. Notably, rituximab treatment was not associated with an increased malignancy risk compared with the general population. Rituximab could therefore be a safe alternative to cyclophosphamide in the treatment of AAV.
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Affiliation(s)
- Emma E van Daalen
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Raffaella Rizzo
- Nephrology, Dialysis and Hypertension Unit, St Orsola-Malpighi University Hospital, Bologna, Italy.,Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Andreas Kronbichler
- Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK.,Department of Internal Medicine IV (Nephrology and Hypertension), Medical University of Innsbruck, Innsbruck, Austria
| | - Ron Wolterbeek
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan A Bruijn
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - David R Jayne
- Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Ingeborg M Bajema
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Chinar Rahmattulla
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands.,Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
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23
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Abou Zahr A, Kavi AM, Mukherjee S, Zeidan AM. Therapy-related myelodysplastic syndromes, or are they? Blood Rev 2016; 31:119-128. [PMID: 27923516 DOI: 10.1016/j.blre.2016.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/14/2016] [Accepted: 11/22/2016] [Indexed: 12/12/2022]
Abstract
The incidence of therapy-related myelodysplastic syndromes (t-MDS) is increasing as the number of cancer survivors is increasing. While t-MDS is currently defined descriptively by prior receipt of chemotherapy and/or radiotherapy, some forms of MDS that occur post localized radiation monotherapy, biologically and clinically resemble de novo (d)-MDS more than t-MDS, and therefore may not be truly therapy-related. Although patients with t-MDS, as a group, fare worse than patients with d-MDS, a variation in individual outcomes of patients with t-MDS has increasingly been appreciated. As such, accurate risk stratification is important for counseling of patients and for clinical decision making. Most of the current clinical tools used for prognostication in t-MDS were developed for d-MDS and were not specifically validated in patients with t-MDS. The management of patients with t-MDS remains challenging, highlighting the importance of developing effective prevention strategies as well as newer, targeted, and rationally-designed therapeutic interventions.
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Affiliation(s)
- Abdallah Abou Zahr
- Section of Hematology/Oncology, Department of Internal Medicine, Mount Sinai Beth Israel, New York City, New York, NY, USA
| | - Ami M Kavi
- Department of Internal Medicine, Mount Sinai Beth Israel, New York City, New York, NY, USA
| | - Sudipto Mukherjee
- Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Amer M Zeidan
- Section of Hematology, Department of Medicine, Yale University, New Haven, CT, USA.
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24
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Demoor-Goldschmidt C, Agape P, Barillot I, Mahé MA. [Radiotherapy in localized stages of follicular and diffuse non-Hodgkin's lymphomas]. Cancer Radiother 2016; 20:530-4. [PMID: 27614527 DOI: 10.1016/j.canrad.2016.07.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 07/22/2016] [Indexed: 11/25/2022]
Abstract
Treatment with monoclonal antibodies, especially rituximab, is more and more frequent and questions the interest of radiotherapy in limited stages of diffuse B-cell large cell and follicular non-Hodgkin's lymphomas. From a review of literature, it appears that radiotherapy is of interest in bulky disease, patients with incomplete metabolic response, elderly patients receiving short chemotherapy and those with recurrence after exclusive chemotherapy. Finally, this article gives recommendations on available techniques of radiotherapy and doses to be delivered.
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Affiliation(s)
- C Demoor-Goldschmidt
- Inserm, UMRS 1018, institut Gustave-Roussy, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - P Agape
- Département d'oncologie médicale, institut de cancérologie de l'Ouest-René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - I Barillot
- Centre universitaire de cancérologie Henry-s-Kaplan, CHU, 37000 Tours, France
| | - M A Mahé
- Département de radiothérapie, institut de cancérologie de l'Ouest-René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France.
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25
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Lam CJK, Curtis RE, Dores GM, Engels EA, Caporaso NE, Polliack A, Warren JL, Young HA, Levine PH, Elmi AF, Fraumeni JF, Tucker MA, Morton LM. Risk Factors for Melanoma Among Survivors of Non-Hodgkin Lymphoma. J Clin Oncol 2015; 33:3096-104. [PMID: 26240221 DOI: 10.1200/jco.2014.60.2094] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Previous studies have reported that survivors of non-Hodgkin lymphoma (NHL) have an increased risk of developing cutaneous melanoma; however, risks associated with specific treatments and immune-related risk factors have not been quantified. PATIENTS AND METHODS We evaluated second melanoma risk among 44,870 1-year survivors of first primary NHL diagnosed at age 66 to 83 years from 1992 to 2009 and included in the Surveillance, Epidemiology, and End Results-Medicare database. Information on NHL treatments, autoimmune diseases, and infections was derived from Medicare claims. RESULTS A total of 202 second melanoma cases occurred among survivors of NHL, including 91 after chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and 111 after other NHL subtypes (cumulative incidence by age 85 years: CLL/SLL, 1.37%; other NHL subtypes, 0.78%). Melanoma risk after CLL/SLL was significantly increased among patients who received infused fludarabine-containing chemotherapy with or without rituximab (n=18: hazard ratio [HR], 1.92; 95% CI, 1.09 to 3.40; n=10: HR, 2.92; 95% CI, 1.42 to 6.01, respectively). Significantly elevated risks also were associated with T-cell activating autoimmune diseases diagnosed before CLL/SLL (n=36: HR, 2.27; 95% CI, 1.34 to 3.84) or after CLL/SLL (n=49: HR, 2.92; 95% CI, 1.66 to 5.12). In contrast, among patients with other NHL subtypes, melanoma risk was not associated with specific treatments or with T-cell/B-cell immune conditions. Generally, infections were not associated with melanoma risk, except for urinary tract infections (CLL/SLL), localized scleroderma, pneumonia, and gastrohepatic infections (other NHLs). CONCLUSION Our findings suggest immune perturbation may contribute to the development of melanoma after CLL/SLL. Increased vigilance is warranted among survivors of NHL to maximize opportunities for early detection of melanoma.
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Affiliation(s)
- Clara J K Lam
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel.
| | - Rochelle E Curtis
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Graça M Dores
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Eric A Engels
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Neil E Caporaso
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Aaron Polliack
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Joan L Warren
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Heather A Young
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Paul H Levine
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Angelo F Elmi
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Joseph F Fraumeni
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Margaret A Tucker
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Lindsay M Morton
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
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26
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The concept and evolution of involved site radiation therapy for lymphoma. Int J Clin Oncol 2015; 20:849-54. [DOI: 10.1007/s10147-015-0863-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/14/2015] [Indexed: 01/22/2023]
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27
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Martini V, Marconato L, Poggi A, Riondato F, Aresu L, Cozzi M, Comazzi S. Canine small clear cell/T-zone lymphoma: clinical presentation and outcome in a retrospective case series. Vet Comp Oncol 2015; 14 Suppl 1:117-26. [DOI: 10.1111/vco.12155] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 04/22/2015] [Accepted: 04/24/2015] [Indexed: 12/18/2022]
Affiliation(s)
- V. Martini
- Department of Veterinary Sciences and Public Health; University of Milan; Milan Italy
| | | | - A. Poggi
- Department of Veterinary Science; University of Turin; Turin Italy
| | - F. Riondato
- Department of Veterinary Science; University of Turin; Turin Italy
| | - L. Aresu
- Department of Comparative Biomedicine and Food Science; University of Padua; Padua Italy
| | - M. Cozzi
- Department of Veterinary Sciences and Public Health; University of Milan; Milan Italy
| | - S. Comazzi
- Department of Veterinary Sciences and Public Health; University of Milan; Milan Italy
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28
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Chien SH, Liu CJ, Hong YC, Teng CJ, Hu YW, Ku FC, Yeh CM, Chiou TJ, Gau JP, Tzeng CH. Development of second primary malignancy in patients with non-Hodgkin lymphoma: a nationwide population-based study. J Cancer Res Clin Oncol 2015; 141:1995-2004. [PMID: 25971624 DOI: 10.1007/s00432-015-1979-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 04/23/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND With the improved survival of non-Hodgkin lymphoma (NHL) patients, development of second primary malignancy (SPM) has become an increasingly important issue in these long-term survivors. METHODS We conducted a retrospective study to analyze NHL patients diagnosed between January 1997 and December 2010 in Taiwan. Standardized incidence ratios (SIRs) were applied to compare the risk of SPMs in NHL patients and the general population. Multivariate analysis was performed to determine the independent predictors of SPM. RESULT NHL patients have a significantly greater risk of developing SPM [SIR 1.43; 95 % confidence interval (CI) 1.32-1.55; p < 0.001). A significantly high SIR was noted for leukemia, myeloma, and neoplasms of the bone and soft tissue, thyroid, central nervous system, skin, stomach, head and neck, liver and biliary tract, and the lungs and mediastinum. Multivariate analysis revealed that age ≥60 years [hazard ratios (HR) 2.04], being male (HR 1.22), comorbidities of chronic obstructive pulmonary disease (HR 1.34), liver cirrhosis (HR 1.50), hepatitis C infection (HR 1.94) and therapy containing radiotherapy (HR 1.38) were the significant predictors for SPM occurrence. The median follow-up time and survival time were 3.37 and 9.45 years, respectively. CONCLUSION This Taiwanese population-based study provides updated data about the risk of SPM in NHL patients, demonstrating an approximately 1.5 time greater risk of SPM compared to the general population. A high risk of SPM for myeloma and hepatocellular carcinoma is unique to Asian patients.
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Affiliation(s)
- Sheng-Hsuan Chien
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Chung Hong
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Hematology and Oncology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chung-Jen Teng
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Oncology and Hematology, Department of Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Yu-Wen Hu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fan-Chen Ku
- Department of Hematology and Oncology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Chiu-Mei Yeh
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Tzeon-Jye Chiou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jyh-Pyng Gau
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Cheng-Hwai Tzeng
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
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29
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Gemcitabine, navelbine, and doxorubicin as treatment for patients with refractory or relapsed T-cell lymphoma. BIOMED RESEARCH INTERNATIONAL 2015; 2015:606752. [PMID: 25866797 PMCID: PMC4383323 DOI: 10.1155/2015/606752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 09/16/2014] [Indexed: 12/02/2022]
Abstract
T-cell lymphoma (TCL) is resistant to conventional chemotherapy. We retrospectively evaluated the therapeutic efficiency and toxicity of gemcitabine, navelbine, and doxorubicin (GND) in patients with refractory or relapsed TCL. From 2002 to 2012, 69 patients with refractory or relapsed TCL received GND treatment in our hospital. The treatment protocol comprised gemcitabine (800 mg/m2, group 1; 1000 mg/m2, group 2) on days 1 and 8, navelbine (25 mg/m2) on day 1, and doxorubicin (20 mg/m2) on day 1, repeated every 3 weeks. The overall response rate (ORR) was 65.2%. The median overall survival (OS) was 36 months. The 5-year estimated OS rate was 32.4%. The GND regimen was well tolerated. Subgroup analysis demonstrated that the ORR and CR for group 1 were similar. A longer median OS was observed for group 1. Significant difference in grades 3-4 toxicities was observed between groups 1 and 2 (P = 0.035). Our study indicated that gemcitabine (800 mg/m2) on days 1 and 8 every 21 days was favorable for pretreated TCL patients.
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30
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Lisik-Habib M, Czernek U, Dębska-Szmich S, Krakowska M, Kubicka-Wołkowska J, Potemski P. Secondary cancer in a survivor of Hodgkin's lymphoma: A case report and review of the literature. Oncol Lett 2014; 9:964-966. [PMID: 25621073 PMCID: PMC4301521 DOI: 10.3892/ol.2014.2799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 10/31/2014] [Indexed: 12/15/2022] Open
Abstract
Hodgkin’s lymphoma (HL) is one of the most curable malignant diseases in adults. However, HL patients have a higher risk of developing second malignancies compared with the general population. The population of adult cancer survivors is growing, thus, the long-term effects of cancer treatment, including secondary cancer development, have become an increasingly important concern in the field of oncology. The current study presents the case of a female HL survivor who developed two secondary malignancies within 29 years of follow-up. Furthermore, a review of the literature was conducted, which focused on secondary breast and gastrointestinal cancers in HL survivors.
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Affiliation(s)
- Maja Lisik-Habib
- Department of Chemotherapy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz 93-513, Poland
| | - Urszula Czernek
- Department of Chemotherapy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz 93-513, Poland
| | - Sylwia Dębska-Szmich
- Department of Chemotherapy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz 93-513, Poland
| | - Magdalena Krakowska
- Department of Chemotherapy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz 93-513, Poland
| | - Joanna Kubicka-Wołkowska
- Department of Chemotherapy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz 93-513, Poland
| | - Piotr Potemski
- Department of Chemotherapy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz 93-513, Poland
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31
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Benjamini O, Jain P, Trinh L, Qiao W, Strom SS, Lerner S, Wang X, Burger J, Ferrajoli A, Kantarjian H, O'Brien S, Wierda W, Estrov Z, Keating M. Second cancers in patients with chronic lymphocytic leukemia who received frontline fludarabine, cyclophosphamide and rituximab therapy: distribution and clinical outcomes. Leuk Lymphoma 2014; 56:1643-50. [PMID: 25308294 DOI: 10.3109/10428194.2014.957203] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients with chronic lymphocytic leukemia (CLL) are known to have an increased incidence of second cancers, but the contribution of commonly used frontline therapies to the incidence of second cancers is unclear. We report on the characteristics, incidence, outcomes and factors associated with second cancers in 234 patients receiving fludarabine, cyclophosphamide and rituximab (FCR) based regimens in the frontline setting. The risk of second cancers was 2.38 times higher than the expected risk in the general population. Ninety-three patients (40%) had other cancers before and 66 patients (28%) after FCR. Rates of therapy related acute myeloid leukemia/myelodysplastic syndrome (t-AML/MDS) (5.1%) and Richter transformation (RT) (9%) were high, while solid tumors were not increased. Overall survival of patients with second cancers after frontline FCR was shorter (median of 4.5 years) compared to patients with and without prior cancers. Second cancer risk after frontline FCR is mainly due to high rates of t-AML/MDS and RT, and as speculated the survival of affected patients is shorter.
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32
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Morton LM, Swerdlow AJ, Schaapveld M, Ramadan S, Hodgson DC, Radford J, van Leeuwen FE. Current knowledge and future research directions in treatment-related second primary malignancies. EJC Suppl 2014; 12:5-17. [PMID: 26217162 PMCID: PMC4250537 DOI: 10.1016/j.ejcsup.2014.05.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 03/26/2014] [Indexed: 01/13/2023] Open
Abstract
Currently, 17-19% of all new primary malignancies occur in survivors of cancer, causing substantial morbidity and mortality. Research has shown that cancer treatments are important contributors to second malignant neoplasm (SMN) risk. In this paper we summarise current knowledge with regard to treatment-related SMNs and provide recommendations for future research. We address the risks associated with radiotherapy and systemic treatments, modifying factors of treatment-related risks (genetic susceptibility, lifestyle) and the potential benefits of screening and interventions. Research priorities were identified during a workshop at the 2014 Cancer Survivorship Summit organised by the European Organisation for Research and Treatment of Cancer. Recently, both systemic cancer treatments and radiotherapy approaches have evolved rapidly, with the carcinogenic potential of new treatments being unknown. Also, little knowledge is available about modifying factors of treatment-associated risk, such as genetic variants and lifestyle. Therefore, large prospective studies with biobanking, high quality treatment data (radiation dose-volume, cumulative drug doses), and data on other cancer risk factors are needed. International collaboration will be essential to have adequate statistical power for such investigations. While screening for SMNs is included in several follow-up guidelines for cancer survivors, its effectiveness in this special population has not been demonstrated. Research into the pathogenesis, tumour characteristics and survival of SMNs is essential, as well as the development of interventions to reduce SMN-related morbidity and mortality. Prediction models for SMN risk are needed to inform initial treatment decisions, balancing chances of cure and SMNs and to identify high-risk subgroups of survivors eligible for screening.
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Affiliation(s)
- Lindsay M. Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Anthony J. Swerdlow
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, United Kingdom
| | - Michael Schaapveld
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Safaa Ramadan
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - David C. Hodgson
- Radiation Medicine Program, Princess Margaret Hospital, University Health Network, and Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - John Radford
- The University of Manchester and The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Flora E. van Leeuwen
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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33
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A dose-escalating phase I of imatinib mesylate with fixed dose of metronomic cyclophosphamide in targeted solid tumours. Br J Cancer 2013; 109:2574-8. [PMID: 24149182 PMCID: PMC3833229 DOI: 10.1038/bjc.2013.648] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 09/10/2013] [Accepted: 09/16/2013] [Indexed: 12/30/2022] Open
Abstract
Background: Preclinical findings suggest that imatinib mesylate (IM) and metronomic cyclophosphamide (MC) combination provides synergistic antiangiogenic activity on both pericytes and endothelial cells. Methods: We have designed a 3+3 dose-escalating phase I trial with a fixed dose of MC (50 mg two times daily) plus IM (400 mg per day; 300 and 400 mg two times daily). Enrolled patients had IM- and sutininib-refractory advanced gastrointestinal stromal tumours (GIST) (n=17), chordoma (n=7) and mucosal melanoma (n=2). Dose-limiting toxicities were monitored for the first 6 weeks. Progression-free survival (PFS) and response assessment are based on RECIST 1.0 guidelines. Pharmacokinetics of IM were measured before and after exposure to MC. Results: No dose-limiting toxicity was observed. Fourteen patients of the expanded cohort received 400 mg two times daily of IM with MC. Apart from a case of possibly related acute leukaemia occurring after 4 years of treatment, we did not see unexpected toxicity. No drug–drug pharmacokinetic interaction was observed. There was no objective response. We have observed long-lasting stable disease in chordoma patients (median PFS=10.2 months; range, 4.2–18+) and short-term stable disease in heavily GIST pretreated patients (median PFS=2.3 months; range, 2.1–6.6). Conclusion: This combination is feasible and may warrant further exploration in refractory GIST or chordoma patients.
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