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Chua BJG, Low CE, Yau CE, Tan YH, Chiang J, Chang EWY, Chan JY, Poon EYL, Somasundaram N, Rashid MFBH, Tao M, Lim ST, Yang VS. Recent updates on central nervous system prophylaxis in patients with high-risk diffuse large B-cell lymphoma. Exp Hematol Oncol 2024; 13:1. [PMID: 38173015 PMCID: PMC10765685 DOI: 10.1186/s40164-023-00467-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
The use of central nervous system (CNS) prophylaxis for patients with diffuse large B-cell lymphoma (DLBCL) remains controversial. Although uncommon, CNS relapses are invariably fatal in this otherwise curable disease. Accurate identification of patients at risk and the optimal approach to CNS prophylaxis therefore remains an area of unmet need. The existing literature, largely retrospective in nature, provides mixed conclusions regarding the efficacy of CNS prophylaxis. The utility of CNS prophylaxis has itself been challenged. In this review, we dissect the issues which render the value of CNS prophylaxis uncertain. We first compare international clinical guidelines for CNS prophylaxis. We then interrogate the factors that should be used to identify high-risk patients accurately. We also explore how clinical patterns of CNS relapse have changed in the pre-rituximab and rituximab era. We then discuss the efficacy of CNS-directed approaches, intensification of systemic treatment and other novel approaches in CNS prophylaxis. Improved diagnostics for early detection of CNS relapses and newer therapeutics for CNS prophylaxis are areas of active investigation. In an area where prospective, randomized studies are impracticable and lacking, guidance for the use of CNS prophylaxis will depend on rigorous statistical review of retrospective data.
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Affiliation(s)
- Bernard Ji Guang Chua
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Chen Ee Low
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Chun En Yau
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Ya Hwee Tan
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Jianbang Chiang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Esther Wei Yin Chang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Duke-NUS Medical School, Oncology Academic Clinical Program, 8 College Road, Singapore, 169857, Singapore
| | - Eileen Yi Ling Poon
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Nagavalli Somasundaram
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Duke-NUS Medical School, Oncology Academic Clinical Program, 8 College Road, Singapore, 169857, Singapore
| | - Mohamed Farid Bin Harunal Rashid
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Duke-NUS Medical School, Oncology Academic Clinical Program, 8 College Road, Singapore, 169857, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Duke-NUS Medical School, Oncology Academic Clinical Program, 8 College Road, Singapore, 169857, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Duke-NUS Medical School, Oncology Academic Clinical Program, 8 College Road, Singapore, 169857, Singapore
| | - Valerie Shiwen Yang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Duke-NUS Medical School, Oncology Academic Clinical Program, 8 College Road, Singapore, 169857, Singapore.
- Translational Precision Oncology Lab, Institute of Molecular and Cell Biology (IMCB), 61 Biopolis Dr Proteos, Singapore, 138673, A*STAR, Singapore.
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2
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Chang EWY, Yang VS, Ong SY, Kang HX, Lim BY, de Mel S, Ng EKY, Poon ML, Tan YH, Chiang J, Poon E, Somasundaram N, Farid M, Tang T, Tao M, Khoo LP, Cheng CL, Huang D, Ong CK, Lim ST, Chan JY. Clinical features and prognostic outcomes of angioimmunoblastic T cell lymphoma in an Asian multicenter study. Leuk Lymphoma 2023; 64:1782-1791. [PMID: 37477443 DOI: 10.1080/10428194.2023.2235043] [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: 05/05/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023]
Abstract
In our Asian multicenter retrospective study, we investigated the clinical prognostic factors affecting the outcomes of AITL patients and identified a novel prognostic index relevant in the Asian context. In our 174-patient cohort, the median PFS and OS was 1.8 years and 5.6 years respectively. Age > 60, bone marrow involvement, total white cell count >12 × 109/L and raised serum lactate dehydrogenase were associated with poorer PFS and OS in multivariate analyses. This allowed for a prognostic index (AITL-PI) differentiating patients into low (0-1 factors, n = 64), moderate (2 factors, n = 59) and high-risk (3-4 factors, n = 49) subgroups with 5-year OS of 84.0%, 44.0% and 28.0% respectively (p < 0.0001). POD24 proved to be strongly prognostic (5-year OS 24% vs 89%, p < 0.0001). Exploratory gene expression studies were performed and disparate immune cell profiles and cell signaling signatures were seen in the low risk group as compared to the intermediate and high risk groups.
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Affiliation(s)
- Esther Wei Yin Chang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Valerie Shiwen Yang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
- Institute of Molecular and Cell Biology, Singapore, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Shin Yeu Ong
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | | | - Boon Yee Lim
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore, Singapore
| | - Sanjay de Mel
- Department of Haematology, National University Cancer Institute, Singapore, Singapore
| | - Esther Ka Yan Ng
- Department of Haematology, National University Cancer Institute, Singapore, Singapore
| | - Michelle Limei Poon
- Department of Haematology, National University Cancer Institute, Singapore, Singapore
| | - Ya Hwee Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
| | - Jianbang Chiang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
| | - Eileen Poon
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Nagavalli Somasundaram
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Tiffany Tang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Lay Poh Khoo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Chee Leong Cheng
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Dachuan Huang
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore, Singapore
| | - Choon Kiat Ong
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore, Singapore
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Tan JY, Qiu TY, Chiang J, Tan YH, Yang VS, Chang EWY, Poon E, Somasundaram N, Farid M, Tao M, Lim ST, Chan JY. Burkitt lymphoma - no impact of HIV status on outcomes with rituximab-based chemoimmunotherapy. Leuk Lymphoma 2023; 64:586-596. [PMID: 35188049 DOI: 10.1080/10428194.2022.2027402] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We analyzed the prognostic factors for treatment outcomes amongst 34 patients with adult Burkitt lymphoma (BL) who received rituximab with standard first-line chemotherapy. Seven patients had human immunodeficiency virus (HIV)-associated BL. Overall, we observed a complete remission (CR) rate of 91.2%, and 10-year progression-free survival (PFS) and overall survival (OS) was 84.8 and 88.2%, respectively. In patients with concomitant HIV, the prognosis was not different with 10-year PFS of 100% and OS of 88.2%. The majority (71.4%) of HIV-associated BL patients received dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab) and had excellent outcomes with 100% CR and no relapses. Central nervous system (CNS) disease, bone marrow involvement and elevated serum lactate dehydrogenase (LDH) levels more than 3 times upper limit of normal (ULN) were associated with poorer survival outcomes. Patients with refractory disease, whilst uncommon (n = 4), had dismal outcomes. Patients with adult BL, including HIV-related cases, harbor generally good prognosis in the modern era.
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Affiliation(s)
- Jing Yuan Tan
- Singhealth Internal Medicine Residency, Singapore General Hospital, Singapore
| | - Tian Yu Qiu
- Singhealth Internal Medicine Residency, Singapore General Hospital, Singapore
| | - Jianbang Chiang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
| | - Ya Hwee Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
| | - Valerie Shiwen Yang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
- Institute of Molecular and Cell Biology, Singapore
| | - Esther Wei Yin Chang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
| | - Eileen Poon
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
| | - Nagavalli Somasundaram
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
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4
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Teo YN, Teo YH, Khoo LP, Yin Chang EW, Tan YH, Chiang J, Yang VS, Poon E, Somasundaram N, Farid M, Tao M, Lim ST, Chan JY. MO30-5 Clinicopathological factors affecting prognosis in marginal zone lymphoma in an Asian tertiary cancer centre. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.05.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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5
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Teo YH, Teo YN, Khoo LP, Chang EWY, Tan YH, Chiang J, Yang VS, Poon E, Somasundaram N, Farid M, Tao M, Lim ST, Chan JY. Clinicopathological factors affecting prognosis in marginal zone lymphoma in Asian patients: a cohort study. Leuk Lymphoma 2022; 63:2723-2726. [DOI: 10.1080/10428194.2022.2086242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Yao Hao Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yao Neng Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lay Poh Khoo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Esther Wei Yin Chang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
| | - Ya Hwee Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
| | - Jianbang Chiang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
| | - Valerie Shiwen Yang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
- Institute of Molecular and Cell Biology, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Eileen Poon
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
| | - Nagavalli Somasundaram
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
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6
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Lo YT, Lim VY, Ng M, Tan YH, Chiang J, Chang EWY, Chan J, Poon EYL, Somasundaram N, Harunal Rashid MFR, Tao M, Thye LS, Yang VS. A prognostic model for overall survival in primary central nervous system lymphoma using post-steroid neutrophil-lymphocyte ratio. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e14049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14049 Background: Ratios of differential blood counts (hematological indices, HI) had been identified as prognostic variables in various cancers. In primary central nervous system lymphomas (PCNSL), higher baseline neutrophil-lymphocyte ratio (NLR) in particular was found to portend a worse overall survival. However, it was often observed that differential counts shift drastically following steroid administration. Moreover, steroids are an important part of the arsenal against PCNSL due to its potent lymphotoxic effects. We showed that the effect of steroids on differential blood cell counts and HI could be an early biomarker for subsequent progression-free (PFS) and overall survival (OS). Methods: This study retrospectively identified all adult patients who received a brain biopsy from 2008 to 2019 and had histologically confirmed PCNSL, and included only those who received chemoimmunotherapy, with documented use of corticosteroids prior to treatment induction. Different blood cell counts and HI were calculated at three time-points: baseline (pre-steroid), pre-chemoimmunotherapy (post-steroid) and post-chemoimmunotherapy. Tumor progression and survival data were collected and analyzed through Kaplan-Meier estimates and Cox regression. We then utilized selected variables found to be significant on Kaplan-Meier analysis to generate a decision-tree prognostic model, the NNI-NCCS score. Results: A total of 75 patients who received chemoimmunotherapy were included in the final analysis. For NLR, OS was longer with higher pre-chemoimmunotherapy (post-steroid) NLR (dichotomized at NLR≥4.0, HR 0.42, 95% CI: 0.21-0.83, p = 0.01) only. For platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR), OS was better for lower post-chemoimmunotherapy PLR (dichotomized at PLR≥241, HR 2.27, 95% CI: 1.00 to 5.18, p = 0.05) and lower pre-chemoimmunotherapy (post-steroid) LMR (dichotomized at LMR ≥25.7, HR 2.17, 95% CI: 1.10 to 4.31, p = 0.03) respectively only. Decision-tree model using age ≤70, post-steroid NLR > 4.0, and pre-steroid (baseline) NLR < 2.5 divided patients into three risk categories – low, medium, high – and achieved good accuracy (area-under-curve of 0.78), with good calibration (Brier score: 0.16) for predicting 2-year overall survival. Conclusions: We found that post-steroid NLR, when considered together with baseline NLR, has prognostic value, and incorporation into a prognostic model allowed accurate and well-calibrated stratification into three risk groups.
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Affiliation(s)
- Yu Tung Lo
- National Neuroscience Institute, Singapore, Singapore
| | - Vivian Yujing Lim
- Institute of Molecular and Cell Biology (IMCB), Singapore, Singapore
| | - Melissa Ng
- Singapore Immunology Network (SIgN), Singapore, Singapore
| | | | | | | | - Jason Chan
- National Cancer Centre Singapore, Singapore, Singapore
| | | | | | | | - Miriam Tao
- National Cancer Centre Singapore, Singapore, Singapore
| | - Lim Soon Thye
- National Cancer Centre Singapore and Duke-NUS Medical School, Singapore, Singapore
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7
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Lo YT, Lim VY, Ng M, Tan YH, Chiang J, Chang EWY, Chan JY, Poon EYL, Somasundaram N, Bin Harunal Rashid MF, Tao M, Lim ST, Yang VS. A Prognostic Model Using Post-Steroid Neutrophil-Lymphocyte Ratio Predicts Overall Survival in Primary Central Nervous System Lymphoma. Cancers (Basel) 2022; 14:cancers14071818. [PMID: 35406590 PMCID: PMC8997514 DOI: 10.3390/cancers14071818] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Ratios of differential blood counts (hematological indices, HIs) had been identified as prognostic variables in various cancers. In primary central nervous system lymphomas (PCNSLs), higher baseline neutrophil-lymphocyte ratio (NLR) in particular was found to portend a worse overall survival. However, it was often observed that differential counts shift drastically following steroid administration. Moreover, steroids are an important part of the arsenal against PCNSL due to its potent lymphotoxic effects. We showed that the effect of steroids on differential blood cell counts and HIs could be an early biomarker for subsequent progression-free (PFS) and overall survival (OS). Methods: This study retrospectively identified all adult patients who received a brain biopsy from 2008 to 2019 and had histologically confirmed PCNSL, and included only those who received chemoimmunotherapy, with documented use of corticosteroids prior to treatment induction. Different blood cell counts and HIs were calculated at three time-points: baseline (pre steroid), pre chemoimmunotherapy (post steroid) and post chemoimmunotherapy. Tumor progression and survival data were collected and analyzed through Kaplan−Meier estimates and Cox regression. We then utilized selected variables found to be significant on Kaplan−Meier analysis to generate a decision-tree prognostic model, the NNI-NCCS score. Results: A total of 75 patients who received chemoimmunotherapy were included in the final analysis. For NLR, OS was longer with higher pre-chemoimmunotherapy (post-steroid) NLR (dichotomized at NLR ≥ 4.0, HR 0.42, 95% CI: 0.21−0.83, p = 0.01) only. For platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR), OS was better for lower post-chemoimmunotherapy PLR (dichotomized at PLR ≥ 241, HR 2.27, 95% CI: 1.00 to 5.18, p = 0.05) and lower pre-chemoimmunotherapy (post-steroid) LMR (dichotomized at LMR ≥25.7, HR 2.17, 95% CI: 1.10 to 4.31, p = 0.03), respectively, only. The decision-tree model using age ≤70, post-steroid NLR >4.0, and pre-steroid (baseline) NLR <2.5 and the division of patients into three risk profiles—low, medium, and high—achieved good accuracy (area-under-curve of 0.78), with good calibration (Brier score: 0.16) for predicting 2-year overall survival. Conclusion: We found that post-steroid NLR, when considered together with baseline NLR, has prognostic value, and incorporation into a prognostic model allowed for accurate and well-calibrated stratification into three risk groups.
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Affiliation(s)
- Yu Tung Lo
- Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore;
- Department of Neurosurgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Vivian Yujing Lim
- Translational Precision Oncology Lab, Institute of Molecular and Cell Biology (IMCB), A*STAR, 61 Biopolis Dr, Proteos, Singapore 138673, Singapore;
| | - Melissa Ng
- Singapore Immunology Network (SIgN), A*STAR, 8A Biomedical Grove, Immunos, Singapore 138648, Singapore;
| | - Ya Hwee Tan
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore; (Y.H.T.); (J.C.); (E.W.Y.C.); (J.Y.C.); (E.Y.L.P.); (N.S.); (M.F.B.H.R.); (M.T.); (S.T.L.)
| | - Jianbang Chiang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore; (Y.H.T.); (J.C.); (E.W.Y.C.); (J.Y.C.); (E.Y.L.P.); (N.S.); (M.F.B.H.R.); (M.T.); (S.T.L.)
| | - Esther Wei Yin Chang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore; (Y.H.T.); (J.C.); (E.W.Y.C.); (J.Y.C.); (E.Y.L.P.); (N.S.); (M.F.B.H.R.); (M.T.); (S.T.L.)
| | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore; (Y.H.T.); (J.C.); (E.W.Y.C.); (J.Y.C.); (E.Y.L.P.); (N.S.); (M.F.B.H.R.); (M.T.); (S.T.L.)
- Oncology Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Eileen Yi Ling Poon
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore; (Y.H.T.); (J.C.); (E.W.Y.C.); (J.Y.C.); (E.Y.L.P.); (N.S.); (M.F.B.H.R.); (M.T.); (S.T.L.)
| | - Nagavalli Somasundaram
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore; (Y.H.T.); (J.C.); (E.W.Y.C.); (J.Y.C.); (E.Y.L.P.); (N.S.); (M.F.B.H.R.); (M.T.); (S.T.L.)
- Oncology Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Mohamad Farid Bin Harunal Rashid
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore; (Y.H.T.); (J.C.); (E.W.Y.C.); (J.Y.C.); (E.Y.L.P.); (N.S.); (M.F.B.H.R.); (M.T.); (S.T.L.)
- Oncology Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore; (Y.H.T.); (J.C.); (E.W.Y.C.); (J.Y.C.); (E.Y.L.P.); (N.S.); (M.F.B.H.R.); (M.T.); (S.T.L.)
- Oncology Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore; (Y.H.T.); (J.C.); (E.W.Y.C.); (J.Y.C.); (E.Y.L.P.); (N.S.); (M.F.B.H.R.); (M.T.); (S.T.L.)
- Oncology Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Valerie Shiwen Yang
- Translational Precision Oncology Lab, Institute of Molecular and Cell Biology (IMCB), A*STAR, 61 Biopolis Dr, Proteos, Singapore 138673, Singapore;
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore; (Y.H.T.); (J.C.); (E.W.Y.C.); (J.Y.C.); (E.Y.L.P.); (N.S.); (M.F.B.H.R.); (M.T.); (S.T.L.)
- Oncology Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
- Correspondence:
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8
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Tan JY, Qiu TY, Chiang J, Tan YH, Yang VS, Chang EWY, Poon E, Somasundaram N, Farid M, Tao M, Lim ST, Chan JY. Treatment Outcomes and Survival Patterns of Asian Patients With Relapsed/Refractory Mantle Cell Lymphoma. J Hematol 2021; 10:187-195. [PMID: 34527115 PMCID: PMC8425802 DOI: 10.14740/jh890] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/10/2021] [Indexed: 11/11/2022] Open
Abstract
Background Mantle cell lymphoma (MCL) is widely considered an incurable malignancy even with current therapies and relapsed/refractory (R/R) disease to primary treatment remains common. With improved treatment guidelines and the advent of novel agents, patients are increasingly being treated with more lines of regimens. However, outcomes after each line of treatment remain poorly characterized, especially in the Asian population. In this paper, we described the survival outcomes in a group of R/R MCL patients. Methods We retrospectively studied 35 patients with R/R MCL between 1998 and 2020 at the National Cancer Centre Singapore. Patients were followed longitudinally throughout their disease course. Overall survival (OS) and progression-free survival (PFS) were determined by the Kaplan-Meier method. Results The median OS and PFS from diagnosis were 105 and 40 months, respectively. After first relapse, the median OS and PFS were 52 and 19 months, post-second relapse 32 and 8 months, and post-third relapse 12 and 6 months, respectively. Patients older than 65 years at first relapse had shorter survival (median OS: 22 vs. 55 months, P = 0.0417; median PFS: 9 vs. 29 months, P = 0.001). Early treatment failure after first line therapy was also associated with worse survival outcomes (median OS: 13 vs. 55 months, P < 0.001; median PFS: 9 vs. 26 months, P < 0.001). Conclusion With each relapse, survival outcomes for patients with MCL are worse. Novel treatment and contemporary outcomes of R/R MCL are encouraging and support the need for continued research in this area.
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Affiliation(s)
- Jing Yuan Tan
- Singhealth Internal Medicine Residency, Singapore General Hospital, Singapore.,These authors contributed equally to this article
| | - Tian Yu Qiu
- Singhealth Internal Medicine Residency, Singapore General Hospital, Singapore.,These authors contributed equally to this article
| | - Jianbang Chiang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore
| | - Ya Hwee Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore
| | - Valerie Shiwen Yang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore.,Institute of Molecular and Cell Biology, Singapore
| | - Esther Wei Yin Chang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore
| | - Eileen Poon
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore
| | - Nagavalli Somasundaram
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore.,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore.,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore.,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore.,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore.,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
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9
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Yang X, Khoo LP, Chang EWY, Yang VS, Poon E, Somasundaram N, Farid M, Tang TPL, Tao M, Lim ST, Chan JY. Treatment patterns and outcomes of older patients with mantle cell lymphoma in an Asian population. BMC Cancer 2021; 21:566. [PMID: 34001056 PMCID: PMC8130422 DOI: 10.1186/s12885-021-08326-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 05/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background Significant progress has been made in the treatment outcomes of mantle cell lymphoma (MCL) since the introduction of cytarabine and rituximab in modern regimens. However, older patients may not readily tolerate these agents nor derive benefit. We investigated the impact of age on treatment patterns and clinical outcomes of MCL patients in an Asian population. Methods A retrospective study was conducted on patients (n = 66) diagnosed with MCL at the National Cancer Centre Singapore between 1998 and 2018. The median follow-up duration was 40 months. Survival analyses were performed using the Kaplan-Meier method and multivariate Cox proportional models. Results The median age of the cohort was 59 years (range, 26–84), with a male predominance (73%). The majority (86%) had advanced stage 3–4 disease at diagnosis. Compared with younger patients, older patients aged ≥60 years (n = 32; 48.5%) presented more frequently with B-symptoms (75% vs 38%, p = 0.0028), anaemia (75% vs 35%, p = 0.0013), and carried higher prognostic risk scores (sMIPI high risk 84% vs 56%, p = 0.016). Non-cytarabine-based induction chemotherapy was more commonly administered in older patients (76% vs 32%, p = 0.0012). The 5-year overall survival (OS) and progression-free survival (PFS) was 68 and 25% respectively. In a multivariable model, older age (HR 3.42, 95%CI 1.48–7.92, p = 0.004) and anemia (HR 2.56, 95%CI 1.10–5.96, p = 0.029) were independently associated with poorer OS while older age (HR 2.24, 95%CI 1.21–4.14, p = 0.010) and hypoalbuminemia (HR 2.20, 95%CI 1.17–4.13, p = 0.014) were independently associated with poorer PFS. In an exploratory analysis, maintenance rituximab following induction chemotherapy improved PFS in younger patients, with median PFS of 131 months and 45 months with or without maintenance therapy respectively (HR 0.39, 95%CI 0.16–0.93, p = 0.035). In contrast, no survival benefit was observed in older patients. Conclusions We demonstrated in our analysis that older patients with MCL may harbor adverse clinical features and may not derive benefit from maintenance rituximab, highlighting the need for further research in this area of need. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08326-1.
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Affiliation(s)
- Xinyi Yang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Lay Poh Khoo
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore City, 169610, Singapore
| | - Esther Wei Yin Chang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore City, 169610, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore City, Singapore
| | - Valerie Shiwen Yang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore City, 169610, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore City, Singapore.,Institute of Molecular and Cell Biology, Singapore City, Singapore
| | - Eileen Poon
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore City, 169610, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore City, Singapore.,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore City, Singapore
| | - Nagavalli Somasundaram
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore City, 169610, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore City, Singapore.,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore City, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore City, 169610, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore City, Singapore.,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore City, Singapore
| | - Tiffany Pooi Ling Tang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore City, 169610, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore City, Singapore.,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore City, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore City, 169610, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore City, Singapore.,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore City, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore City, 169610, Singapore. .,SingHealth Duke-NUS Blood Cancer Centre, Singapore City, Singapore. .,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore City, Singapore.
| | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore City, 169610, Singapore. .,SingHealth Duke-NUS Blood Cancer Centre, Singapore City, Singapore. .,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore City, Singapore. .,Cancer Science Institute of Singapore, National University of Singapore, Singapore City, Singapore.
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10
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Tan LLY, Hong J, Goh WL, Chang EWY, Yang VS, Poon E, Somasundaram N, Farid M, Chan ASY, Chan JY. Clinical features and survival outcomes of ocular melanoma in a multi-ethnic Asian cohort. Sci Rep 2020; 10:16367. [PMID: 33004998 PMCID: PMC7529790 DOI: 10.1038/s41598-020-73534-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/15/2020] [Indexed: 12/31/2022] Open
Abstract
Ocular melanomas are uncommon cancers in Southeast Asia unlike in the West. We conducted a retrospective review of patients (n = 44) with histologically-proven ocular melanoma within a multi-ethnic Asian cohort from Singapore. Clinicopathological features and relapse patterns were examined, and survival outcomes of interest included recurrence-free survival (RFS) and overall survival (OS). Survival analysis was performed using the Kaplan–Meier method and multivariable Cox proportional regression. The study cohort included 18 male and 26 female patients, with a median age of 52 years (range 8–78). Median follow-up was 154 months. For uveal melanomas (n = 29), the 5-year RFS and OS was 56.8% and 76.6%, respectively; whilst for conjunctival melanomas (n = 15), the 5-year RFS and OS was 30.1% and 68.8%, respectively. Fifteen patients (38.5%) eventually developed metastasis, following which the median survival was only 17 months. Multivariate analysis demonstrated that higher T stage was a significant independent predictor for both OS (HR 8.69, 95% CI 1.03 to 73.09, p = 0.047) and RFS (HR 11.62, 95% CI 2.45 to 55.00, p = 0.002). Smoking history was independently predictive of better RFS (HR 0.08, 95% CI 0.01 to 0.78, p = 0.030). In conclusion, our study demonstrates the poor ocular melanoma outcomes in Southeast Asians, highlighting the necessity for urgent research in this area of unmet clinical need.
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Affiliation(s)
- Laura Ling Ying Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jiancheng Hong
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Wei Lin Goh
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Esther Wei Yin Chang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Valerie Shiwen Yang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore.,Institute of Molecular and Cell Biology, Singapore, Singapore.,Duke-NUS Medical School, Oncology Academic Clinical Program, Singapore, Singapore
| | - Eileen Poon
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Nagavalli Somasundaram
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore.,Duke-NUS Medical School, Oncology Academic Clinical Program, Singapore, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore.,Duke-NUS Medical School, Oncology Academic Clinical Program, Singapore, Singapore
| | - Anita Sook Yee Chan
- Translational Ophthalmic Pathology Platform, Singapore Eye Research Institute, 20 College Road Discovery Tower, Level 6, The Academia, Singapore, 169856, Singapore. .,Ocular Inflammation and Immunology Department, Singapore National Eye Centre, Singapore, Singapore. .,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
| | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore. .,Duke-NUS Medical School, Oncology Academic Clinical Program, Singapore, Singapore. .,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.
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11
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Yap DRY, Tan GF, Chang EWY, Yang VS, Poon EYL, Somasundaram N, Farid M, Tang T, Tao M, Lim ST, Chan JY. Clinical Features of Plasmablastic Lymphoma: Case Series From an Asian Tertiary Cancer Center and Literature Review. J Hematol 2020; 9:71-78. [PMID: 32855755 PMCID: PMC7430862 DOI: 10.14740/jh672] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/18/2020] [Indexed: 12/16/2022] Open
Abstract
Background Plasmablastic lymphoma (PBL) is an aggressive subtype of mature B-cell non-Hodgkin lymphoma. Given its rarity, there remains a lack of clinicopathological data to guide its management, particularly on Asian patients. Methods We conducted a retrospective chart review of 10 patients diagnosed with PBL at the National Cancer Centre Singapore and performed a literature review of similar studies on Asian cohorts. Results Most patients were male (n = 9), with median age at diagnosis of 55 years (range, 33 - 91 years). Seven (70%) patients were considered to be immunocompromised. In the overall cohort, the median overall survival (OS) was 19.4 months with 5-year survival estimates given at 60% and 36% for OS and progression-free survival (PFS), respectively. At diagnosis, patients with HIV/AIDS (n = 5) were younger compared to others (median, 43 vs. 61 years; P = 0.0278), had greater number of nodal site involvement (median, 6 vs. 0; P = 0.0333), and higher international prognostic index (IPI) scores (P = 0.034 for trend). Amongst different chemotherapy used, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin (EPOCH)-based regimens (n = 6) elicited prominent complete response rates (83%) and led to durable responses even in the setting of advanced stage, high-risk IPI score and immunodeficiency. Conclusions In conclusion, our study describes the features of PBL in an Asian cohort and highlights disease features unique to HIV-associated PBL.
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Affiliation(s)
- Daniel Ren Yi Yap
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Grace Fangmin Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Esther Wei Yin Chang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Valerie Shiwen Yang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Eileen Yi Ling Poon
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
| | - Nagavalli Somasundaram
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Tiffany Tang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
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12
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Fang YY, Lee QJ, Chang EWY, Wong YC. Local infiltration analgesia in primary total knee arthroplasty. Hong Kong Med J 2019; 25:279-86. [PMID: 31395787 DOI: 10.12809/hkmj187756] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Postoperative pain in total knee arthroplasty (TKA) can hinder rehabilitation and cause morbidity. Local infiltration analgesia (LIA), comprising an anaesthetic drug, non-steroidal anti-inflammatory drug, and adrenaline, has been introduced to reduce pain and systemic side-effects. This study evaluated the efficacy of LIA in TKA with respect to morphine consumption and postoperative pain score. METHODS This single-centre retrospective cohort study recruited patients with knee osteoarthritis who were scheduled for primary TKA during the period from January 2017 to December 2017. Patients with chronic inflammatory joint disease, contra-indications for LIA, or dementia were excluded. Patients in the LIA group were administered single-dose LIA intra-operatively, while those in the control group were not. Primary outcomes were postoperative pain score, morphine demand, and morphine consumption; secondary outcomes were range of motion, quadriceps power, and postoperative length of stay. RESULTS In total, 136 patients were recruited (68 per group). Total postoperative morphine demand and consumption, as well as pain scores from postoperative day (POD) 1 to POD 4, were lower in the LIA group than in the control group. The range of motion from POD 1 to POD 4 and quadriceps power on POD 1 were higher in the LIA group than in the control group. Quadriceps power from POD 2 to POD 4 and postoperative length of stay were not significantly different between groups. CONCLUSIONS Intra-operative single-dose LIA can effectively reduce postoperative pain, morphine demand, and morphine consumption. Therefore, the use of LIA is recommended during TKA.
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Affiliation(s)
- Y Y Fang
- Department of Orthopaedics and Traumatology, Princess Margaret Hospital, Laichikok, Hong Kong
| | - Q J Lee
- Department of Orthopaedics and Traumatology, Yan Chai Hospital, Tsuen Wan, Hong Kong
| | - E W Y Chang
- Department of Orthopaedics and Traumatology, Yan Chai Hospital, Tsuen Wan, Hong Kong
| | - Y C Wong
- Department of Orthopaedics and Traumatology, Yan Chai Hospital, Tsuen Wan, Hong Kong
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13
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Chang EWY, Tai DWM, Koo SL, Ng MCH, Yeong JPS, Zhai WW, Newell E, Chow PKH, Lim KH, Gogna A, Tong AKT, Huang HL, Loke KSH, Ng DCE, Hennedige TP, Thng CH, Choo SP. A phase II open-label, single-centre, non-randomized trial of Y90 transarterial radioembolization in combination with nivolumab in Asian patients with intermediate stage hepatocellular carcinoma: An immunological study of radioembolization in combination with anti-PD1 therapy in HCC. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.tps542] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS542 Background: In recent years, Yttrium-90 (Y90) trans-arterial radioembolization (TARE) has emerged as a therapeutic option for intermediate stage hepatocellular carcinoma (HCC). Cancer immunotherapy targeting tumour immune evasion has shown remarkable successes in various cancers. Nivolumab, an immune checkpoint inhibitor of programmed death 1 (PD1), has demonstrated encouraging activity in advanced stage HCC. Similarly, chronic hepatitis B virus (HBV) infection, a strong risk factor for HCC, is characterized by immune escape mechanisms. We hypothesize that TARE will stimulate tumor and/or HBV specific T cell responses that can be boosted using nivolumab. We thus propose an open label phase 2 trial investigating the combination of TARE with nivolumab in BCLC intermediate stage HCC. Methods: Eligible patients (pts) have ECOG performance status ≤ 2, Child-Pugh A score, intermediate stage HCC planned for TARE according to institutional practice with adequate organ function. Pts will be treated with TARE followed by nivolumab 240mg, 21 days after TARE and every 2 weeks thereafter. Pre- and on-treatment tumor biopsies will be taken. Primary end-point is response rate (RR) of combinational TARE and nivolumab. Key secondary end points are: progression free survival, overall survival, safety and quality of life using FACT-HEP score and EORTC QLQ-C30. Exploratory objectives are to evaluate how tumor PD L-1 expression, HCC mutational burden and blood lymphocyte activation/phenotypic profiles correlate with tumor response. Where possible, serial changes in antigen-specific T cell responses to HBV and/or tumour antigens will also be assessed. This study aims to enroll 40 pts as calculated using the Simon two-stage optimal design with 80% power and one sided significance level of 0.05. This will assess whether the addition of nivolumab improves the RR of TARE at 8 weeks from 21% to 41%. Patient accrual was initiated in December 2016 and as of September 2017, 9 pts have been treated. Clinical trial information: 03033446.
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Affiliation(s)
| | | | - Si-Lin Koo
- National Cancer Center, Singapore, Singapore
| | | | | | - Wei Wei Zhai
- Genome Institute of Singapore, Singapore, Singapore
| | - Evan Newell
- Singapore Immunology Network, Singapore, Singapore
| | | | - Kiat Hon Lim
- Singapore General Hospital, Singapore, Singapore
| | | | | | | | | | | | | | | | - Su Pin Choo
- National Cancer Center Singapore, Singapore, Singapore
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14
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Chang EWY, Loong AM, Wong WP, Chew SF, Wilson JM, Ip YK. Changes in tissue free amino acid contents, branchial Na+/K+-ATPase activity and bimodal breathing pattern in the freshwater climbing perch,Anabas testudineus (Bloch), during seawater acclimation. ACTA ACUST UNITED AC 2007; 307:708-23. [DOI: 10.1002/jez.a.424] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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