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Chen NC, Chang H, Kao HW, Ou CW, Kuo MC, Wang PN, Lin TL, Wu JH, Hung YS, Su YJ, Ong YC, Shih HJ. Beta2-microglobulin is a valuable marker and identifies a poor-prognosis subgroup among intermediate-risk patients with diffuse large B cell lymphoma. Clin Exp Med 2023; 23:3759-3766. [PMID: 37086332 DOI: 10.1007/s10238-023-01061-w] [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: 11/15/2022] [Accepted: 03/29/2023] [Indexed: 04/23/2023]
Abstract
Prognosis of diffuse large B cell lymphoma (DLBCL) can be predicted by various factors. The most widely used tool for prediction is the international prognostic index (IPI). β2-microglobulin is a tumor marker commonly used in hematological malignancies. β2-microglobulin is well correlated with outcome of DLBCL. It has been used as an adjunctive tool in some scoring systems for prognostication of DLBCL. In this study, we collected data of patients with diagnosis of DLBCL between 2015 and 2019 in our institute. For each patient, IPI was calculated according to published literature. At diagnosis, serum levels of β2-microglobulin were measured in the clinical laboratory and the results were retrieved from medical records. A total of 516 patients (269 male and 247 female) were enrolled for retrospective analysis. The median age was 64 (range 22-96). The median follow-up period was 32.2 months. The median level of β2-microglobulin was 2319 μg/L (normal range < 2366 μg/L in the clinical laboratory). Level of β2-microglobulin was significantly different between survivors and patients who succumbed to the disease. β2-microglobulin level was correlated with tumor stage, extranodal involvement, B symptoms and IPI, suggesting that it may be a good surrogate marker for disease severity and outcome prediction. We selected the intermediate-risk patients for further analysis. Patients with intermediate-risk IPI and high β2-microglobulin levels have overall survival comparable to patients with high-risk IPI, suggesting an important role of β2-microglobulin in subdivision of DLBCL patients. In conclusion, β2-microglobulin levels correlated with outcome of DLBCL. It may be used independently as a prognostic factor. Subdivision of patients with intermediate-risk IPI may identify a group of high-risk patients, which can be helpful in refining plans of treatment and follow-up.
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Affiliation(s)
- Ning-Chun Chen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan
| | - Hung Chang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan.
- Center of Hemophilia and Coagulation Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Hsiao-Wen Kao
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan
| | - Che-Wei Ou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan
| | - Ming-Chung Kuo
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan
| | - Po-Nan Wang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan
| | - Tung-Liang Lin
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan
| | - Jin-Hou Wu
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan
| | - Yu-Shin Hung
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan
| | - Yi-Jiun Su
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan
| | - Yuen-Chin Ong
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan
| | - Hsuan-Jen Shih
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan
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CAR T-Cell Persistence Correlates with Improved Outcome in Patients with B-Cell Lymphoma. Int J Mol Sci 2023; 24:ijms24065688. [PMID: 36982764 PMCID: PMC10056741 DOI: 10.3390/ijms24065688] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
Chimeric antigen receptor (CAR) T-cell therapy has led to profound and durable tumor responses in a relevant subset of patients with relapsed/refractory (r/r) B-cell lymphomas. Still, some patients show insufficient benefit or relapse after CAR T-cell therapy. We performed a retrospective study to investigate the correlation between CAR T-cell persistence in the peripheral blood (PB) at 6 months, assessed by droplet digital PCR (ddPCR), with CAR T-cell treatment outcome. 92 patients with r/r B-cell lymphomas were treated with CD19-targeting CAR T-cell therapies at our institution between 01/2019–08/2022. Six months post-treatment, 15 (16%) patients had no detectable circulating CAR-T constructs by ddPCR. Patients with CAR T-cell persistence had a significantly higher CAR T-cell peak (5432 vs. 620 copies/ug cfDNA, p = 0.0096), as well as higher incidence of immune effector cell-associated neurotoxicity syndrome (37% vs. 7%, p = 0.0182). After a median follow-up of 8.5 months, 31 (34%) patients relapsed. Lymphoma relapses were less frequent among patients with CAR T-cell persistence (29% vs. 60%, p = 0.0336), and CAR T-cell persistence in the PB at 6 months was associated with longer progression-free survival (PFS) (HR 2.79, 95% CI: 1.09–7.11, p = 0.0319). Moreover, we observed a trend towards improved overall survival (OS) (HR 1.99, 95% CI: 0.68–5.82, p = 0.2092) for these patients. In our cohort of 92 B-cell lymphomas, CAR T-cell persistence at 6 months was associated with lower relapse rates and longer PFS. Moreover, our data confirm that 4-1BB-CAR T-cells have a longer persistence as compared to CD-28-based CAR T-cells.
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Koviazin AK, Filatova LV, Zyuzgin IS, Artemyeva AS, Poliatskin IL, Burda DS, Volchenkov SA, Elkhova SS, Semiglazova TY. The significance of upfront autologous stem cell transplantation for high-intermediate/high-risk stage IV diffuse large B-cell lymphoma. Cancer Rep (Hoboken) 2023; 6:e1786. [PMID: 36855295 PMCID: PMC10075296 DOI: 10.1002/cnr2.1786] [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: 08/31/2022] [Revised: 12/03/2022] [Accepted: 12/31/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is the most common (30%-35%) type of B-cell lymphoma. Only about 60% of all newly diagnosed advanced-stage DLBCL can be completely treated with x6 R-CHOP. High-dose chemotherapy (HDCT) followed by autologous hematopoietic stem cell transplantation in the first remission (upfront auto-HSCT) can serve as an option to improve a prognosis in these patients. AIMS This trial aimed to improve prognosis in DLBCL by upfront auto-HSCT. METHODS AND RESULTS A group of 105 patients: DLBCL NOS, age 18-65, stage IV, IPI ≥2, CR/PR after x6 R-CHOP/DA-EPOCH-R from 2010 to 2019 at NMRC of Oncology named after N.N.Petrov of MoH of Russia was retrospectively analyzed. The HSCT group included patients with upfront HDCT followed by auto-HSCT (n = 35). The control group included patients with non-invasive follow-up after induction (n = 70). Primary endpoint was progression-free survival (PFS). Secondary endpoints were overall survival (OS), response rate and relapse rate. The 3-year OS (p = .013) and 3-year PFS (p = .033) were significantly higher in the HSCT group. The 3-year OS was decreased by the occurrence of relapse (p ≤ .001) and weight loss (B-symptom) (p = .04). DEL was the negative prognostic factor for 3-year PFS in all patients (p = .001) and control group (p = .001). DA-EPOCH-R significantly increased the 3-year PFS (p = .041). CONCLUSION Upfront HDCT followed by auto-HSCT can increase 3-year OS and PFS and improve prognosis in DLBCL NOS, age 18-65, stage IV, IPI ≥2 patients.
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Affiliation(s)
- Aleksei K Koviazin
- Department of Hematology and Chemotherapy with Intensive Care Unit, NMRC of Oncology n.a. N.N.Petrov of MoH of Russia, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation.,Department of Innovative Methods in Therapeutic Oncology and Rehabilitation, NMRC of Oncology n.a. N.N.Petrov of MoH of Russia, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Larisa V Filatova
- Department of Hematology and Chemotherapy with Intensive Care Unit, NMRC of Oncology n.a. N.N.Petrov of MoH of Russia, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation.,Department of Innovative Methods in Therapeutic Oncology and Rehabilitation, NMRC of Oncology n.a. N.N.Petrov of MoH of Russia, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation.,Department of Oncology, Federal State Budgetary Educational Institution of Higher Education "North-Western State Medical University named after I.I. Mechnikov" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Ilia S Zyuzgin
- Department of Hematology and Chemotherapy with Intensive Care Unit, NMRC of Oncology n.a. N.N.Petrov of MoH of Russia, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Anna S Artemyeva
- Laboratory of Tumor Morphology, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Ilia L Poliatskin
- Laboratory of Tumor Morphology, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Darya S Burda
- Laboratory of Tumor Morphology, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Stanislav A Volchenkov
- Department of Hematology and Chemotherapy with Intensive Care Unit, NMRC of Oncology n.a. N.N.Petrov of MoH of Russia, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Svetlana S Elkhova
- Department of Hematology and Chemotherapy with Intensive Care Unit, NMRC of Oncology n.a. N.N.Petrov of MoH of Russia, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Tatiana Yu Semiglazova
- Department of Innovative Methods in Therapeutic Oncology and Rehabilitation, NMRC of Oncology n.a. N.N.Petrov of MoH of Russia, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation.,Department of Oncology, Federal State Budgetary Educational Institution of Higher Education "North-Western State Medical University named after I.I. Mechnikov" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
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Anuar NA, Tey KWF, Ng SC, Teh AKH, Abdul Rahman MHF, Chong BP, Gan GG. Outcomes of high dose therapy and autologous haematopoietic stem cell transplantation for non-hodgkin lymphoma: A retrospective analysis in a resource-limited country. Int J Clin Pract 2021; 75:e13823. [PMID: 33202073 DOI: 10.1111/ijcp.13823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/02/2020] [Indexed: 12/24/2022] Open
Abstract
AIM To retrospectively report the clinical outcomes of non-Hodgkin's Lymphoma (NHL) patients post high dose therapy (HDT) with autologous haematopoietic stem cell transplant (AHSCT) and determine whether upfront transplant, which is a first-line consolidative treatment with induction chemotherapy, would be a feasible modality in a resource-limited country. METHODS The medical records for NHL patients who had undergone HDT followed by AHSCT from October 1997 to November 2016 from two hospitals in Klang Valley, Malaysia were obtained from the medical record database and analysed retrospectively through statistical analysis. RESULTS A total of 148 patients were retrospectively identified post-AHSCT, where the majority of whom had B cell lymphoma (53.4%). Majority of patients (88.5%) were in complete remission before AHSCT. The overall survival (OS) and event-free survival (EFS) at 3 years were 68.9% and 60.8%, respectively. The major cause of death was disease progression at 73.9%, while transplant-related mortality was 15.2%, with a median follow-up period of 179.5 weeks. CONCLUSION Our study illustrates the promising outcomes of HDT with AHSCT in NHL patients in a resource-limited country. We recommend larger studies to be conducted in the future with a longer duration of follow-up to validate our findings.
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Affiliation(s)
- Nur Adila Anuar
- Department of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Kevin Wen Fei Tey
- Department of Pharmacology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Soo Chin Ng
- Department of Haematology, Subang Jaya Medical Centre, Subang Jaya, Malaysia
| | - Alan Kee Hean Teh
- Department of Haematology, Subang Jaya Medical Centre, Subang Jaya, Malaysia
| | | | - Bee Ping Chong
- Department of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Gin Gin Gan
- Department of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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