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Martinsson U, Svärd AM, Witt Nyström P, Embring A, Asklid A, Agrup M, Haugen H, Fröjd C, Engellau J, Nilsson MP, Isacsson U, Kristensen I, Blomstrand M. Complications after proton radiotherapy in children, focusing on severe late complications. A complete Swedish cohort 2008-2019. Acta Oncol 2023; 62:1348-1356. [PMID: 37768736 DOI: 10.1080/0284186x.2023.2260946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Proton radiotherapy (RT) is an attractive tool to deliver local therapy with minimal dose to uninvolved tissue, however, not suitable for all patients. The aim was to explore complications, especially severe late complications (grades 3-4), following proton RT delivered to a complete Swedish cohort of paediatric patients aged <18 years treated 2008-2019. MATERIAL AND METHODS Data was downloaded from a national registry. Complications with a possible causation with RT are reported. Proton treatments until July 2015 was performed with a fixed horizontal 172 MeV beam (The Svedberg Laboratory (TSL), Uppsala) in a sitting position and thereafter with gantry-based pencil-beam scanning technique (Skandion Clinic, Uppsala) in a supine position. RESULTS 219 courses of proton RT (77 at TSL and 142 at Skandion) were delivered to 212 patients (mean age 9.2 years) with various tumour types (CNS tumours 58%, sarcomas 26%, germ cell tumours 7%). Twenty-five patients had severe acute complications (skin, mucous membrane, pharynx/oesophagus, larynx, upper gastrointestinal canal, lower gastrointestinal canal, eyes, ears). Fifteen patients had severe late complications; with increased proportion over time: 4% at 1-year follow-up (FU), 5% at 3-year, 11% at 5-year. Organs affected were skin (1 patient), subcutaneous tissue (4), salivary glands (1), upper GI (1), bone (7), joints (2), CNS (2), PNS (1), eyes (1) and ears (5). Twenty-one of the 28 patients with 10-year FU had at least one late complication grades 1-4 and fourteen of them had more than one (2-5 each). CONCLUSION The most important result of our study is the relatively low proportion of severe late complications, comparable with other proton studies on various tumours. Furthermore, the numbers of late complications are lower than our own data set on a mixed population of photon and proton treated paediatric patients, assuring the safety of using proton therapy also in the clinical practice.
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Affiliation(s)
- Ulla Martinsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Anna-Maja Svärd
- Department of Radiation Sciences, Oncology, Umeå University, Umea, Sweden
| | - Petra Witt Nyström
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Anna Embring
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Asklid
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Måns Agrup
- Department of Oncology, Linköping University, Linköping, Sweden
| | - Hedda Haugen
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Charlotta Fröjd
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jacob Engellau
- Department of Oncology, Clinical Sciences, Lund University, Lund, Sweden
| | - Martin P Nilsson
- Department of Oncology, Clinical Sciences, Lund University, Lund, Sweden
| | - Ulf Isacsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Ingrid Kristensen
- Department of Oncology, Clinical Sciences, Lund University, Lund, Sweden
| | - Malin Blomstrand
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Oncology, Institute of Clinical Sciences, University of Gothenburg, Sweden
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2
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Embring A, Blomstrand M, Asklid A, Nilsson MP, Agrup M, Svärd AM, Fröjd C, Martinsson U, Fagerström Kristensen I, Engellau J. Re-irradiation in Paediatric Tumours of the Central Nervous System: National Guidelines from the Swedish Workgroup of Paediatric Radiotherapy. Clin Oncol (R Coll Radiol) 2023; 35:571-575. [PMID: 37246041 DOI: 10.1016/j.clon.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 05/30/2023]
Abstract
There is a lack of clinical protocols for re-irradiation in paediatric central nervous system (CNS) tumours. To fill this void, the Swedish Workgroup of Paediatric Radiotherapy (SBRTG) compiled national guidelines on re-irradiation in paediatric CNS tumours (diffuse intrinsic pontine glioma, ependymoma, germinoma and medulloblastoma). These have been in clinical practice since 2019 in all paediatric radiotherapy centres in Sweden. Since the implementation, the guidelines have been complemented with a yearly review on clinical outcome and toxicities in all paediatric patients treated according to the guidelines. This article presents the Swedish national guidelines on re-irradiation in paediatric CNS tumours.
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Affiliation(s)
- A Embring
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
| | - M Blomstrand
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Oncology, Institute of Clinical Sciences, University of Gothenburg, Sweden
| | - A Asklid
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - M P Nilsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - M Agrup
- Department of Oncology, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - A-M Svärd
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - C Fröjd
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - U Martinsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - I Fagerström Kristensen
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden; Department of Oncology, Clinical Sciences, Lund University, Lund, Sweden
| | - J Engellau
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
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3
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Mattsson A, Sylvan SE, Asklid A, Wiggh J, Winqvist M, Lundin J, Mansouri L, Rosenquist R, Johansson H, Österborg A, Hansson L. Risk-adapted bendamustine + rituximab is a tolerable treatment alternative for elderly patients with chronic lymphocytic leukaemia: a regional real-world report on 141 consecutive Swedish patients. Br J Haematol 2020; 191:426-432. [PMID: 32779190 PMCID: PMC7689859 DOI: 10.1111/bjh.17032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 11/26/2022]
Abstract
Bendamustine + rituximab (BR) is the current first-line standard-of-care for chronic lymphocytic leukaemia (CLL) in fit patients aged 66-70 years, whereas chlorambucil + CD20 antibody is recommended in older patients with co-morbidities. This retrospective real-world study investigated whether risk-adapted BR was safe and effective in elderly patients. All 141 CLL patients in the Stockholm region (diagnosed from 2007 to 2016, identified from regional registries) who had received BR as first (n = 84) or later line (n = 57) were analysed. Median age was 72 years, 49% had Binet stage C, 40% had Cumulative Illness Rating Scale (CIRS) score ≥ 6, 20% Eastern Cooperative Oncology Group (ECOG) score 2. None had del(17p). Only 15% of patients aged ≥80 years received full-dose bendamustine and 65% of them postponed rituximab until cycle 2. Corresponding numbers in patients 73-79 years were 21% and 36% and in <73 years, 63% and 33%. Overall response rate was 83% (first line) and 67% (later line) (P < 0·022) equally distributed between age subsets. ECOG, immunoglobulin heavy chain variable region (IGHV) mutational status and cytogenetics, but not treatment line and age, were significant factors on progression-free survival (PFS) in multivariate analysis. Infections and neutropenia/thrombocytopenia (≥grade 3) were similar across age subgroups. In summary, BR was well tolerated even in patients ≥80 years, with similar efficacy and safety as in less old patients, provided that carefully adapted dosing was applied.
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MESH Headings
- Age Factors
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bendamustine Hydrochloride/administration & dosage
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Male
- Middle Aged
- Prognosis
- Retrospective Studies
- Rituximab/administration & dosage
- Sweden/epidemiology
- Treatment Outcome
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Affiliation(s)
- Agnes Mattsson
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Department of Internal MedicineSödersjukhusetStockholmSweden
| | - Sandra E. Sylvan
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
| | - Anna Asklid
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Department of OncologyKarolinska University HospitalStockholmSweden
| | - Joel Wiggh
- Department of HematologyKarolinska University HospitalStockholmSweden
| | - Maria Winqvist
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Department of HematologyKarolinska University HospitalStockholmSweden
| | - Jeanette Lundin
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Department of HematologyKarolinska University HospitalStockholmSweden
| | - Larry Mansouri
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - Richard Rosenquist
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - Hemming Johansson
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
| | - Anders Österborg
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Department of HematologyKarolinska University HospitalStockholmSweden
| | - Lotta Hansson
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Department of HematologyKarolinska University HospitalStockholmSweden
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4
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Asklid A, Eketorp Sylvan S, Mattsson A, Winqvist M, Johansson H, Österborg A, Hansson L. A real-world study of first-line therapy in 280 consecutive Swedish patients ≥80 years with newly diagnosed diffuse large B-cell lymphoma: very elderly (≥85 years) do well on curative intended therapy. Leuk Lymphoma 2020; 61:2136-2144. [PMID: 32449636 DOI: 10.1080/10428194.2020.1765233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This real-world study investigated outcome of first-line treatment in elderly patients with diffuse large B-cell lymphoma (DLBCL). All (n = 292) new DLBCL patients ≥80 years diagnosed in the Stockholm region from 2000-2015 were included. Median age was 85 years, most had good performance status and low comorbidity score. CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone) was used in 60/230 patients, R-CHOP in 170/230. Only 12% of patients aged 80-84 years and 6% of ≥85 years received full-dose chemotherapy. Infections (≥ grade III) occurred in 49% and 37% in the two age groups, respectively. Addition of rituximab resulted in a similar and significant improvement in both age subsets regarding complete remission, progression-free (PFS) and overall survival (OS). Rituximab, performance status and stage, but not age, were significantly associated with PFS and OS by multivariate analysis. Strictly consecutive patients ≥85 years from a well-defined geographical region responded to and tolerated R-CHOP equally well as patients aged 80-84 years.
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Affiliation(s)
- Anna Asklid
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Agnes Mattsson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Internal Medicine, Stockholm, Sweden
| | - Maria Winqvist
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Hemming Johansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Österborg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Lotta Hansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
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5
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Sylvan SE, Asklid A, Johansson H, Klintman J, Bjellvi J, Tolvgård S, Kimby E, Norin S, Andersson PO, Karlsson C, Karlsson K, Lauri B, Mattsson M, Sandstedt AB, Strandberg M, Österborg A, Hansson L. First-line therapy in chronic lymphocytic leukemia: a Swedish nation-wide real-world study on 1053 consecutive patients treated between 2007 and 2013. Haematologica 2019; 104:797-804. [PMID: 30467205 PMCID: PMC6442960 DOI: 10.3324/haematol.2018.200204] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/19/2018] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to investigate long-term outcome following first-line therapy in consecutive chronic lymphocytic leukemia (CLL) patients in a well-defined geographic area: Sweden. All patients diagnosed with CLL (2007-2013) (n=3672) were identified from national registries, screening of patient files identified all (100%) treated first line (n=1053) and for those, an in-depth analysis was performed. End points were overall response rate, progression-free survival (PFS), overall survival (OS), and safety. Median age was 71 years; 53% had Rai stage III-IV and 97% had performance status grade 0-2. Fluorescence in situ hybridization (FISH) was performed in 57% of patients: 15% had del(17p). Chlorambucil + prednisone was used in 39% (5% also received rituximab). Fludarabine+cyclophosphamide+rituximab or fludarabine+cyclophosphamide was used in 43% and bendamustine + rituximab in 6%. Overall response rate was 64%; chlorambucil 43%, fludarabine+cyclophosphamide+rituximab 84%, fludarabine+cyclophosphamide 75% and bendamustine + rituximab 75%. Median PFS and OS was 24 and 58 months, respectively, both were significantly associated (multivariate analysis) with type of treatment, del(17p), performance status, gender, age and geographical region (OS only). Chlorambucil-treated patients had a median PFS and OS of only 9 and 33 months, respectively. Chlorambucil usage declined gradually throughout the study period, but one-third of patients still received chlorambucil + rituximab in 2013. Infections ≥grade III were significantly associated with treatment; chlorambucil 19% versus fludarabine+cyclophosphamide+rituximab 30%. Richter transformation occurred in 5.5% of the patients, equally distributed across therapies. This is the largest retrospective, real-world cohort of consecutive first-line treated CLL patients with a complete follow up. In elderly patients, an unmet need for more effective, well-tolerated therapies was identified.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Bendamustine Hydrochloride/administration & dosage
- Chlorambucil/administration & dosage
- Chromosome Deletion
- Chromosomes, Human, Pair 17/genetics
- Chromosomes, Human, Pair 17/metabolism
- Cyclophosphamide/administration & dosage
- Disease-Free Survival
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Male
- Middle Aged
- Prednisolone/administration & dosage
- Registries
- Retrospective Studies
- Rituximab/administration & dosage
- Survival Rate
- Sweden/epidemiology
- Vidarabine/administration & dosage
- Vidarabine/analogs & derivatives
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Affiliation(s)
| | - Anna Asklid
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm
- Department of Oncology, Karolinska University Hospital, Stockholm
| | | | - Jenny Klintman
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund
- Department of Translational Medicine, Lund University
| | - Jenny Bjellvi
- Department of Hematology, Sahlgrenska University Hospital, Gothenburg
| | | | - Eva Kimby
- Department of Internal Medicine Huddinge, Karolinska Institutet, Stockholm
| | - Stefan Norin
- Department of Internal Medicine Huddinge, Karolinska Institutet, Stockholm
| | | | - Claes Karlsson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm
- Department of Hematology, Karolinska University Hospital, Stockholm
| | - Karin Karlsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund
| | - Birgitta Lauri
- Department of Hematology, Sunderby Hospital, Sunderbyn-Luleå
| | | | | | | | - Anders Österborg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm
- Department of Hematology, Karolinska University Hospital, Stockholm
| | - Lotta Hansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm
- Department of Hematology, Karolinska University Hospital, Stockholm
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6
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Winqvist M, Andersson PO, Asklid A, Karlsson K, Karlsson C, Lauri B, Lundin J, Mattsson M, Norin S, Sandstedt A, Rosenquist R, Späth F, Hansson L, Österborg A. Long-term real-world results of ibrutinib therapy in patients with relapsed or refractory chronic lymphocytic leukemia: 30-month follow up of the Swedish compassionate use cohort. Haematologica 2018; 104:e208-e210. [PMID: 30514799 DOI: 10.3324/haematol.2018.198820] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Maria Winqvist
- Department of Hematology, Karolinska University Hospital, Stockholm .,Department of Oncology-Pathology, Karolinska Institutet, Stockholm
| | | | - Anna Asklid
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm
| | | | - Claes Karlsson
- Department of Hematology, Karolinska University Hospital, Stockholm.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm
| | - Birgitta Lauri
- Department of Hematology, Sunderby Hospital, Sunderbyn-Luleå
| | - Jeanette Lundin
- Department of Hematology, Karolinska University Hospital, Stockholm.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm
| | | | - Stefan Norin
- Department of Internal Medicine, Karolinska Institutet, Stockholm
| | | | - Richard Rosenquist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm
| | - Florentin Späth
- Department of Radiation Sciences, Oncology, Umeå University, Sweden
| | - Lotta Hansson
- Department of Hematology, Karolinska University Hospital, Stockholm.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm
| | - Anders Österborg
- Department of Hematology, Karolinska University Hospital, Stockholm.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm
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Hansson L, Asklid A, Diels J, Eketorp-Sylvan S, Repits J, Søltoft F, Jäger U, Österborg A. Ibrutinib versus previous standard of care: an adjusted comparison in patients with relapsed/refractory chronic lymphocytic leukaemia. Ann Hematol 2017; 96:1681-1691. [PMID: 28762081 PMCID: PMC5569664 DOI: 10.1007/s00277-017-3061-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 07/03/2017] [Indexed: 10/26/2022]
Abstract
This study explored the relative efficacy of ibrutinib versus previous standard-of-care treatments in relapsed/refractory patients with chronic lymphocytic leukaemia (CLL), using multivariate regression modelling to adjust for baseline prognostic factors. Individual patient data were collected from an observational Stockholm cohort of consecutive patients (n = 144) diagnosed with CLL between 2002 and 2013 who had received at least second-line treatment. Data were compared with results of the RESONATE clinical trial. A multivariate Cox proportional hazards regression model was used which estimated the hazard ratio (HR) of ibrutinib versus previous standard of care. The adjusted HR of ibrutinib versus the previous standard-of-care cohort was 0.15 (p < 0.0001) for progression-free survival (PFS) and 0.36 (p < 0.0001) for overall survival (OS). A similar difference was observed also when patients treated late in the period (2012-) were compared separately. Multivariate analysis showed that later line of therapy, male gender, older age and poor performance status were significant independent risk factors for worse PFS and OS. Our results suggest that PFS and OS with ibrutinib in the RESONATE study were significantly longer than with previous standard-of-care regimens used in second or later lines in routine healthcare. The approach used, which must be interpreted with caution, compares patient-level data from a clinical trial with outcomes observed in a daily clinical practice and may complement results from randomised trials or provide preliminary wider comparative information until phase 3 data exist.
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Affiliation(s)
- Lotta Hansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden. .,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.
| | - Anna Asklid
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | | | | | - Anders Österborg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
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8
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Winqvist M, Asklid A, Andersson PO, Karlsson K, Karlsson C, Lauri B, Lundin J, Mattsson M, Norin S, Sandstedt A, Hansson L, Österborg A. Real-world results of ibrutinib in patients with relapsed or refractory chronic lymphocytic leukemia: data from 95 consecutive patients treated in a compassionate use program. A study from the Swedish Chronic Lymphocytic Leukemia Group. Haematologica 2016; 101:1573-1580. [PMID: 27198718 PMCID: PMC5479603 DOI: 10.3324/haematol.2016.144576] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/18/2016] [Indexed: 12/22/2022] Open
Abstract
Ibrutinib, a Bruton's tyrosine kinase inhibitor is approved for relapsed/refractory and del(17p)/TP53 mutated chronic lymphocytic leukemia. Discrepancies between clinical trials and routine health-care are commonly observed in oncology. Herein we report real-world results for 95 poor prognosis Swedish patients treated with ibrutinib in a compassionate use program. Ninety-five consecutive patients (93 chronic lymphocytic leukemia, 2 small lymphocytic leukemia) were included in the study between May 2014 and May 2015. The median age was 69 years. 63% had del(17p)/TP53 mutation, 65% had Rai stage III/IV, 28% had lymphadenopathy ≥10cm. Patients received ibrutinib 420 mg once daily until progression. At a median follow-up of 10.2 months, the overall response rate was 84% (consistent among subgroups) and 77% remained progression-free. Progression-free survival and overall survival were significantly shorter in patients with del(17p)/TP53 mutation (P=0.017 and P=0.027, log-rank test); no other factor was significant in Cox proportional regression hazards model. Ibrutinib was well tolerated. Hematomas occurred in 46% of patients without any major bleeding. Seven patients had Richter's transformation. This real-world analysis on consecutive chronic lymphocytic leukemia patients from a well-defined geographical region shows the efficacy and safety of ibrutinib to be similar to that of pivotal trials. Yet, del(17p)/TP53 mutation remains a therapeutic challenge. Since not more than half of our patients would have qualified for the pivotal ibrutinib trial (RESONATE), our study emphasizes that real-world results should be carefully considered in future with regards to new agents and new indications in chronic lymphocytic leukemia.
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MESH Headings
- Adenine/analogs & derivatives
- Aged
- Aged, 80 and over
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Chromosome Aberrations
- Compassionate Use Trials
- Disease Progression
- Drug Resistance, Neoplasm
- Female
- Humans
- Kaplan-Meier Estimate
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Piperidines
- Proportional Hazards Models
- Protein Kinase Inhibitors/administration & dosage
- Protein Kinase Inhibitors/adverse effects
- Protein Kinase Inhibitors/therapeutic use
- Pyrazoles/administration & dosage
- Pyrazoles/adverse effects
- Pyrazoles/therapeutic use
- Pyrimidines/administration & dosage
- Pyrimidines/adverse effects
- Pyrimidines/therapeutic use
- Recurrence
- Retreatment
- Retrospective Studies
- Sweden
- Treatment Outcome
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Affiliation(s)
- Maria Winqvist
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Asklid
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - P O Andersson
- Department of Hematology, South Älvsborg Hospital, Borås, Sweden
| | - Karin Karlsson
- Department of Hematology and Vascular Disorders, Skåne University Hospital, Lund, Sweden
| | - Claes Karlsson
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Birgitta Lauri
- Department of Hematology, Sunderby Hospital, Sunderbyn Luleå, Sweden
| | - Jeanette Lundin
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Mattsson
- Department of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Stefan Norin
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Sandstedt
- Department of Hematology, Linköping University Hospital, Linköping, Sweden
| | - Lotta Hansson
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Österborg
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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Asklid A, Winqvist M, Eketorp Sylvan S, Mattsson A, Björgvinsson E, Søltoft F, Repits J, Diels J, Österborg A, Hansson L. Outcomes of second-line treatment in chronic lymphocytic leukemia - a population-based study from a well defined geographical region between 2003 and 2013. Leuk Lymphoma 2016; 58:1219-1223. [PMID: 27894205 DOI: 10.1080/10428194.2016.1246727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Anna Asklid
- a Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden.,b Department of Oncology , Karolinska University Hospital , Stockholm , Sweden
| | - Maria Winqvist
- a Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden.,d Department of Hematology , Karolinska University Hospital Solna , Stockholm , Sweden
| | | | - Agnes Mattsson
- a Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden.,c Department of Internal Medicine , Södersjukhuset , Stockholm , Sweden
| | - Einar Björgvinsson
- a Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden.,b Department of Oncology , Karolinska University Hospital , Stockholm , Sweden
| | | | | | | | - Anders Österborg
- a Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden.,d Department of Hematology , Karolinska University Hospital Solna , Stockholm , Sweden
| | - Lotta Hansson
- a Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden.,d Department of Hematology , Karolinska University Hospital Solna , Stockholm , Sweden
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