1
|
Lai Q, Zhao Y, Yan H, Peng H. Advances in diagnosis, treatment and prognostic factors of gastrointestinal DLBCL. Leuk Res 2023; 135:107406. [PMID: 37944240 DOI: 10.1016/j.leukres.2023.107406] [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: 08/12/2023] [Revised: 10/08/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
Gastrointestinal diffuse large B-cell lymphoma (GI-DLBCL) is an extremely aggressive form of B-cell non-Hodgkin lymphoma (BNHL) which has complex histological characteristics and manifests a high degree of heterogeneity in terms of clinical, morphological, immunological, and genetic features. GI-DLBCL mainly spreads by infiltrating neighboring lymph nodes, and common gastrointestinal complications (GICS) such as obstruction, perforation, or bleeding, frequently arise during the progression of the disease, posing significant challenges in both diagnosing and treating the condition. Meanwhile, the incidence of GI-DLBCL has been gradually increasing in recent years, and its strong invasiveness makes it prone to being misdiagnosed or completely missed. In clinical practice, over half of the patients diagnosed with the disease are in stage III or stage IV. What makes it worse is that certain patients may not exhibit a favorable response to chemotherapy. All these lead to intricacies in management of this disease. Unfortunately, there is currently no large prospective study or evidence-based medical evidence to provide clear guidance on treatment decisions for this specific type of lymphoma. Neither do physicians have a consensus regarding the optimal approach to address this condition. Recent studies have identified the presence of various prognostic factors that significantly impact survival in GI-DLBCL, which demonstrates the unique particularity of GI-DLBCL, and could help optimize the clinical decision.
Collapse
Affiliation(s)
- Qinqiao Lai
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yan Zhao
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Haiqing Yan
- Department of gastric and abdominal cancer ward, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Hongling Peng
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Engineering Research Center of Cell Immunotherapy for Hematopoietic Malignancies, Changsha, Hunan, China.
| |
Collapse
|
2
|
Gheybi K, Buckley E, Vitry A, Roder D. Associations of advanced age with comorbidity, stage and primary subsite as contributors to mortality from colorectal cancer. Front Public Health 2023; 11:1101771. [PMID: 37089488 PMCID: PMC10116414 DOI: 10.3389/fpubh.2023.1101771] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/16/2023] [Indexed: 04/09/2023] Open
Abstract
BackgroundAlthough survival from colorectal cancer (CRC) has improved substantially in recent decades, people with advanced age still have a high likelihood of mortality from this disease. Nonetheless, few studies have investigated how cancer stage, subsite and comorbidities contribute collectively to poor prognosis of older people with CRC. Here, we decided to explore the association of age with mortality measures and how other variables influenced this association.MethodsUsing linkage of several administrative datasets, we investigated the risk of death among CRC cases during 2003–2014. Different models were used to explore the association of age with mortality measures and how other variables influenced this association.ResultsOur results indicated that people diagnosed at a young age and with lower comorbidity had a lower likelihood of all-cause and CRC-specific mortality. Aging had a greater association with mortality in early-stage CRC, and in rectal cancer, compared that seen with advanced-stage CRC and right colon cancer, respectively. Meanwhile, people with different levels of comorbidity were not significantly different in terms of their increased likelihood of mortality with advanced age. We also found that while most comorbidities were associated with all-cause mortality, only dementia [SHR = 1.43 (1.24–1.64)], Peptic ulcer disease [SHR = 1.12 (1.02–1.24)], kidney disease [SHR = 1.11 (1.04–1.20)] and liver disease [SHR = 1.65 (1.38–1.98)] were risk factors for CRC-specific mortality.ConclusionThis study showed that the positive association of advanced age with mortality in CRC depended on stage and subsite of the disease. We also found only a limited number of comorbidities to be associated with CRC-specific mortality. These novel findings implicate the need for more attention on factors that cause poor prognosis in older people.
Collapse
Affiliation(s)
- Kazzem Gheybi
- University of South Australia Allied Health and Human Performance, Adelaide, SA, Australia
- University of South Australia, Cancer Epidemiology and Population Health, Adelaide, SA, Australia
- Charles Perkins Centre, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
| | - Elizabeth Buckley
- University of South Australia Allied Health and Human Performance, Adelaide, SA, Australia
- University of South Australia, Cancer Epidemiology and Population Health, Adelaide, SA, Australia
| | - Agnes Vitry
- University of South Australia Clinical and Health Sciences, Adelaide, SA, Australia
| | - David Roder
- University of South Australia Allied Health and Human Performance, Adelaide, SA, Australia
- University of South Australia, Cancer Epidemiology and Population Health, Adelaide, SA, Australia
- *Correspondence: David Roder
| |
Collapse
|
3
|
Khdhir M, El Annan T, El Amine MA, Shareef M. Complications of lymphoma in the abdomen and pelvis: clinical and imaging review. Abdom Radiol (NY) 2022; 47:2937-2955. [PMID: 35690955 PMCID: PMC10509750 DOI: 10.1007/s00261-022-03567-5] [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: 03/28/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 01/18/2023]
Abstract
Involvement of the abdomen and pelvis is common in lymphoma. Nodal and extranodal abdominal and pelvic lymphoma may present with various complications. Complications are most common in high-grade lymphomas, especially diffuse large B-cell lymphoma. Complications may occur as the initial manifestation of lymphoma, during treatment course, or late following complete disease remission. Most complications are associated with worse prognosis and increased mortality. Imaging is essential in evaluation of disease extent and diagnosis of complications. Therefore, radiologists should be familiar with the clinical context and imaging features of abdominal and pelvic lymphoma complications. We provide a comprehensive, organ system-based approach, and clinical and imaging review of complications of abdominal and pelvic lymphoma along with radiologic images of illustrated cases of the most commonly encountered complications.
Collapse
Affiliation(s)
- Mihran Khdhir
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon.
| | - Tamara El Annan
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon
| | | | - Muhammed Shareef
- Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, New Haven, CT, USA
| |
Collapse
|
4
|
Rudresha AH, Hassan SA, Sreevalli A, Lokanatha D, Babu MCS, Lokesh KN, Rajeev LK, Saldanha S, Thottian AGF, Sharma K, Jacob LA. Pre-phase strategy to mitigate first cycle effect in diffuse large B cell lymphoma. J Egypt Natl Canc Inst 2022; 34:20. [PMID: 35527285 DOI: 10.1186/s43046-022-00116-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
CONTEXT Treatment-related toxicities in DLBCL (diffuse large B cell lymphoma) patients are higher in the initial phase of treatment (first cycle effect). Implementation of pre-phase treatment before definitive chemotherapy had been shown to alleviate some of these side-effects in a non-randomized study conducted earlier in our institute (Lakshmaiah et. al., Eur J Haematol 100:644-8, 2018). AIMS This study was aimed at validating the role of pre-phase treatment in newly diagnosed DLBCL patients. SETTINGS AND DESIGN All newly diagnosed patients with DLBCL above the age of 18 years were evaluated for eligibility and prospectively enrolled. A single-arm prospective study was conducted at the Department of Medical Oncology, in our institute from July 2015 to December 2019. METHODS AND MATERIAL Patients received vincristine and prednisolone as pre-phase treatment for 7 days after which definitive chemotherapy was instituted on day 1. They were followed up for 30 days post-first cycle chemotherapy. STATISTICAL ANALYSIS USED Paired Student's t tests and Wilcoxon signed-ranks test were used for comparison of various clinical variables as appropriate. P value of less than 0.05 was considered significant. RESULTS Among the 180 patients who were included in study, performance status improvement was noted in significant number of patients (p < 0.001). 38.4% achieved an ECOG (Eastern Cooperative Oncology Group) performance status of 0 post-pre-phase therapy. Febrile neutropenia was observed in 12.8% in the present cohort as compared to the historical non-pre-phase cohort (34%). CONCLUSIONS Pre-phase therapy significantly improves the performance status and diminishes neutropenia rates in DLBCL patients.
Collapse
Affiliation(s)
- A H Rudresha
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Dr. M H Marigowda Rd., Hombegowda Nagar, Bengaluru, Karnataka, 560029, India
| | - Syed Adil Hassan
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Dr. M H Marigowda Rd., Hombegowda Nagar, Bengaluru, Karnataka, 560029, India
| | - A Sreevalli
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Dr. M H Marigowda Rd., Hombegowda Nagar, Bengaluru, Karnataka, 560029, India
| | - D Lokanatha
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Dr. M H Marigowda Rd., Hombegowda Nagar, Bengaluru, Karnataka, 560029, India
| | - M C Suresh Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Dr. M H Marigowda Rd., Hombegowda Nagar, Bengaluru, Karnataka, 560029, India
| | - K N Lokesh
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Dr. M H Marigowda Rd., Hombegowda Nagar, Bengaluru, Karnataka, 560029, India
| | - L K Rajeev
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Dr. M H Marigowda Rd., Hombegowda Nagar, Bengaluru, Karnataka, 560029, India
| | - Smitha Saldanha
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Dr. M H Marigowda Rd., Hombegowda Nagar, Bengaluru, Karnataka, 560029, India
| | - Antony G F Thottian
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Dr. M H Marigowda Rd., Hombegowda Nagar, Bengaluru, Karnataka, 560029, India
| | - Kanika Sharma
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Dr. M H Marigowda Rd., Hombegowda Nagar, Bengaluru, Karnataka, 560029, India
| | - Linu Abraham Jacob
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Dr. M H Marigowda Rd., Hombegowda Nagar, Bengaluru, Karnataka, 560029, India.
| |
Collapse
|
5
|
Oberic L, Peyrade F, Puyade M, Bonnet C, Dartigues-Cuillères P, Fabiani B, Ruminy P, Maisonneuve H, Abraham J, Thieblemont C, Feugier P, Salles G, Bijou F, Pica GM, Damaj G, Haioun C, Casasnovas RO, Farhat H, Le Calloch R, Waultier-Rascalou A, Malak S, Paget J, Gat E, Tilly H, Jardin F. Subcutaneous Rituximab-MiniCHOP Compared With Subcutaneous Rituximab-MiniCHOP Plus Lenalidomide in Diffuse Large B-Cell Lymphoma for Patients Age 80 Years or Older. J Clin Oncol 2021; 39:1203-1213. [PMID: 33444079 DOI: 10.1200/jco.20.02666] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The prognosis of elderly patients with diffuse large B-cell lymphoma (DLBCL) is worse than that of young patients. An attenuated dose of chemotherapy-cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab (R-miniCHOP)-is a good compromise between efficacy and safety in very elderly patients. In combination with R-CHOP (R2-CHOP), lenalidomide has an acceptable level of toxicity and may mitigate the negative prognosis of the non-germinal center B-cell-like phenotype. The Lymphoma Study association conducted a multicentric, phase III, open-label, randomized trial to compare R-miniCHOP and R2-miniCHOP. PATIENTS AND METHODS Patients of age 80 years or older with untreated DLBCL were randomly assigned into the R-miniCHOP21 group or the R2-miniCHOP21 group for six cycles and stratified according to CD10 expression and age. The first cycle of rituximab was delivered by IV on D1 after a prephase and then delivered subcutaneously on D1 of cycles 2-6. Lenalidomide was delivered at a dose of 10 mg once daily on D1-D14 of each cycle. The primary end point was overall survival (OS). RESULTS A total of 249 patients with new DLBCL were randomly assigned (127 R-miniCHOP and 122 R2-miniCHOP). The median age was 83 years (range, 80-96), and 55% of the patients were classified as non-GCB. The delivered dose for each R-miniCHOP compound was similar in both arms. Over a median follow-up of 25.1 months, the intention-to-treat analysis revealed that R2-miniCHOP did not improve OS (2-year OS 66% in R-miniCHOP and 65.7% in R2-miniCHOP arm, P = .98) in the overall population or in the non-GCB population. Grade 3-4 adverse events occurred in 53% of patients with R-miniCHOP and in 81% of patients with R2-miniCHOP. CONCLUSION The addition of lenalidomide to R-miniCHOP does not improve OS. Rituximab delivered subcutaneously was safe in this population.
Collapse
Affiliation(s)
- Lucie Oberic
- Department of Hematology, Institut Universitaire du Cancer, Toulouse-Oncopole, Toulouse, France
| | - Frederic Peyrade
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Mathieu Puyade
- Department of Oncology-Haematology and Cell Therapy, CHU, Poitiers, INSERM, Inserm CIC 1402, Poitiers, France
| | - Christophe Bonnet
- Clinical Hematology Unit, CHU Liège, Liège Université, Campus Universitaire de Sart Tilman, Liège, Belgique
| | - Peggy Dartigues-Cuillères
- Anapath Research Unit (EA) EA4340 and Pathology Laboratory, Versailles University and APHP, Ambroise Paré Hospital, Boulogne, France
| | - Bettina Fabiani
- Department of Pathology, Hopital Saint-Antoine, APHP, Paris, France
| | | | - Hervé Maisonneuve
- Department of Clinical Hematology, Centre Hospitalier Départemental Vendée, La Roche-sur-Yon, France
| | - Julie Abraham
- Department of Hematology, CHU Dupuytren, Limoges, France
| | - Catherine Thieblemont
- APHP, Hopital Saint-Louis, Hemato-oncologie; Université de Paris, Paris Diderot, Paris, France
| | - Pierre Feugier
- Department of Haematology, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre Les Nancy, France
| | - Gilles Salles
- Department of Hematology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Benite, France
| | - Fontanet Bijou
- Department of Hematology, Hospital Bergonié, Bordeaux, France
| | - Gian-Matteo Pica
- Department of Hematology, Centre Hospitalier Métropole Savoie, Chambery, France
| | - Gandhi Damaj
- Department of Hematology, CHU Caen, Caen, France
| | - Corinne Haioun
- Department of Hematology, Henri Mondor University Hospital, UPEC, Creteil, France
| | | | - Hassan Farhat
- Department of Hematology, Centre Hospitalier de Versailles André Mignot, Versailles, France
| | - Ronan Le Calloch
- Centre hospitalier de Quimper Cornouaille/Université de Bretagne Occidentale, France
| | | | - Sandra Malak
- Department of Hematology, CLCC Rene Huguenin Institut Curie, Saint-Cloud, France
| | - Jerome Paget
- LYSARC, The Lymphoma Academic Research Organisation, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Elodie Gat
- LYSARC, The Lymphoma Academic Research Organisation, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Hervé Tilly
- Department of Hematology, Centre Henri Becquerel, UNIROUEN, University of Normandy, INSERM U1245, Rouen, France
| | - Fabrice Jardin
- Department of Hematology, Centre Henri Becquerel, UNIROUEN, University of Normandy, INSERM U1245, Rouen, France
| |
Collapse
|
6
|
Bartlett NL. Approaches to aggressive B-cell lymphomas in less fit patients. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2020; 2020:140-147. [PMID: 33275710 PMCID: PMC7727524 DOI: 10.1182/hematology.2020000099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Treating unfit patients with aggressive B-cell lymphoma poses the dilemma of balancing potential cure while minimizing toxicity because of frailty and comorbidities. Age greater than 80 years and common comorbidities such as cardiovascular disease and poorly controlled diabetes mellitus often preclude the use of full-dose anthracyclines and steroids, the backbones of standard regimens for aggressive B-cell lymphomas. Assessing patient fitness remains subjective, with no consensus on best practice or how to integrate assessment tools into decision making. Incorporation of prephase steroids for all unfit patients may markedly improve performance status with consideration of standard dose therapy, especially in patients less than age 80. Although randomized studies are lacking, current data suggest patients age ≥ 80 years are considered unfit a priori and should receive dose-reduced anthracycline regimens or anthracycline-free regimens. Severe toxicity is highest after the first cycle of chemotherapy. Dose reductions for cycle 1 in unfit patients with plans to escalate as tolerated is often an effective strategy. Unfit patients often benefit from comanagement with gerontologists, cardio-oncologists, and endocrinologists depending on age and the nature of comorbidities. Palliative therapy for patients with newly diagnosed aggressive B-cell lymphoma results in median survivals of less than 3 months, and in general, should only be considered in patients with untreatable comorbidities such as advanced dementia or refractory metastatic solid tumors. Incorporating new, potentially less toxic agents such as novel antibodies, antibody-drug conjugates, and bispecific antibodies into first-line therapy is an exciting future direction with potential for substantial benefit in less fit patients.
Collapse
Affiliation(s)
- Nancy L Bartlett
- Washington University School of Medicine, Siteman Cancer Center, St. Louis, MO
| |
Collapse
|
7
|
Malpica L, Mufuka B, Galeotti J, Tan X, Grover N, Clark SM, Beaven A, Muss H, Dittus C. A retrospective study on prephase therapy prior to definitive multiagent chemotherapy in aggressive lymphomas. Leuk Lymphoma 2020; 61:1508-1511. [PMID: 32037934 DOI: 10.1080/10428194.2020.1725505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Luis Malpica
- Division of Hematology-Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Bolanle Mufuka
- Department of Internal Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Jonathan Galeotti
- Department of Pathology, University of North Carolina, Chapel Hill, NC, USA
| | - Xianming Tan
- Department of Biostatistics Shared Resource, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Natalie Grover
- Division of Hematology-Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Stephen M Clark
- Department of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Anne Beaven
- Division of Hematology-Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Hyman Muss
- Division of Hematology-Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Christopher Dittus
- Division of Hematology-Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
8
|
Aoki T, Yamada A, Takahashi M, Niikura R, Toyama K, Ushiku T, Kurokawa M, Momose T, Fukayama M, Koike K. Development and internal validation of a risk scoring system for gastrointestinal events requiring surgery in gastrointestinal lymphoma patients. J Gastroenterol Hepatol 2019; 34:693-699. [PMID: 30151937 DOI: 10.1111/jgh.14452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/18/2018] [Accepted: 08/19/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM The predictors of severe gastrointestinal (GI) events in GI lymphoma patients are unclear. We aimed to develop a risk scoring system for GI events requiring surgery. METHODS In this retrospective study of 192 patients with GI lymphoma, the state of lymphoma, macroscopic findings, examination results, and International Prognostic Index were assessed. We developed a risk score for GI events that required surgery and assessed its accuracy by calculating the area under the receiver operating characteristic curve (AUC). Internal validation was performed using bootstrap resampling. RESULTS Severe GI events occurred in 21 (11%) patients. We developed a 4-point scoring system (the FLASH score) comprising the following three independent predictors (weighted by regression coefficients): (i) focal appearance and large size (≥ 40 mm), 1 point; (ii) aggressive lymphoma of the small bowel, 2 points; and (iii) high (18)F-fluorodeoxyglucose positron emission tomography uptake, 1 point. The score predicted severe GI events with an AUC value of 0.91 (internal validation; AUC, 0.86). Risk was classified into three categories: the GI event rate was 0% in the low-risk group (0 points), 9% in the intermediate-risk group (1-2 points), and 61% in the high-risk group (3-4 points) (AUC, 0.89). CONCLUSIONS We developed and internally validated a risk scoring system (the FLASH score) that included macroscopic findings to predict severe GI events in GI lymphoma patients. Patients with high scores are candidates for elective surgery to prevent GI events.
Collapse
Affiliation(s)
- Tomonori Aoki
- Department of Gastroenterology Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Atsuo Yamada
- Department of Gastroenterology Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miwako Takahashi
- Division of Nuclear Medicine, Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryota Niikura
- Department of Gastroenterology Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiro Toyama
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsuo Ushiku
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mineo Kurokawa
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshimitsu Momose
- Division of Nuclear Medicine, Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masashi Fukayama
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
9
|
Lakshmaiah KC, Asati V, Babu K G, D L, Jacob LA, M C SB, K N L, L K R, A H R, Saldanha S, Koppaka D, Patidar R, C S P. Role of prephase treatment prior to definitive chemotherapy in patients with diffuse large B-cell lymphoma. Eur J Haematol 2018; 100:644-648. [PMID: 29569279 DOI: 10.1111/ejh.13068] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND During the treatment of diffuse large B-cell lymphoma (DLBCL) patients, treatment-related toxicities are higher in the initial phase of treatment (First cycle effect). Toxicities can be tumor lysis syndrome, deterioration in performance status, febrile neutropenia, and rarely mortality. Prephase treatment before definitive chemotherapy is used in European countries to alleviate these toxicities. METHODS This was a non-randomized study carried out with the aim to evaluate the role of prephase treatment given prior to definitive chemotherapy in newly diagnosed DLBCL patients. Patients were divided into 2 cohorts "prephase cohort" and "non-prephase cohort." Prephase cohort received prephase treatment consisting of vincristine (1 mg) on -6th day and prednisolone 100 mg daily for 7 days (-6th day to day 0). Prephase treatment was followed by CHOP/R-CHOP chemotherapy on day 1. Non-prephase cohort received chemotherapy without prephase. Both groups were followed up for 30 days post-first cycle chemotherapy. RESULTS A total of 100 patients with DLBCL (50 in each cohort) were enrolled. There was a significant improvement in performance status of the patients who received prephase. A majority of 92% patients attained ECOG performance status of either 0 or 1 before starting chemotherapy in the prephase cohort. Febrile neutropenia was lower (16%) in the prephase cohort as compared with the non-prephase cohort (34%; P = .037). CONCLUSION Prephase treatment prior to definitive chemotherapy (CHOP ± Rituximab) improves the performance status and decreases first cycle effect in DLBCL patients.
Collapse
Affiliation(s)
- K C Lakshmaiah
- Department of Medical Oncology, Kidwai Cancer Institute, Bengaluru, India
| | - Vikas Asati
- Department of Medical Oncology, Kidwai Cancer Institute, Bengaluru, India
| | - Govind Babu K
- Department of Medical Oncology, Kidwai Cancer Institute, Bengaluru, India
| | - Lokanath D
- Department of Medical Oncology, Kidwai Cancer Institute, Bengaluru, India
| | - Linu Abraham Jacob
- Department of Medical Oncology, Kidwai Cancer Institute, Bengaluru, India
| | - Suresh Babu M C
- Department of Medical Oncology, Kidwai Cancer Institute, Bengaluru, India
| | - Lokesh K N
- Department of Medical Oncology, Kidwai Cancer Institute, Bengaluru, India
| | - Rajeev L K
- Department of Medical Oncology, Kidwai Cancer Institute, Bengaluru, India
| | - Rudresh A H
- Department of Medical Oncology, Kidwai Cancer Institute, Bengaluru, India
| | - Smitha Saldanha
- Department of Medical Oncology, Kidwai Cancer Institute, Bengaluru, India
| | - Deepak Koppaka
- Department of Medical Oncology, Kidwai Cancer Institute, Bengaluru, India
| | - Rajesh Patidar
- Department of Medical Oncology, Kidwai Cancer Institute, Bengaluru, India
| | - Premalata C S
- Department of Pathology, Kidwai Cancer Institute, Bengaluru, India
| |
Collapse
|