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Storgaard L, Brix-Tange U, Colmorn LB, Ejlertsen B, Greiber IK, Gørløv JS, Hansen DL, Hjortshøj CM, Holm HS, Loft A, Ketabi Z, Kroman N, Leth-Miller D, Macklon KT, Mosgaard B, Nielsen BB, Nielsen HM, Pedersen BW, Rosendavl M, Smedegaard H, Svane IM. New expert advice on cancer in pregnancy. Ugeskr Laeger 2024; 186:V06230347. [PMID: 38327196 DOI: 10.61409/v06230347] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 02/09/2024]
Abstract
Cancer in pregnancy is rare, and most physicians lack knowledge in handling pregnant cancer patients. This review summarises the present knowledge on this condition. In the Netherlands, an Advisory Board on Cancer in Pregnancy was established in 2012. The board supports Dutch physicians' decisions in the management of pregnant patients with cancer. In 2021 the International Advisory Board on Cancer in Pregnancy was established, and in continuation, the Danish Advisory Board on Cancer in Pregnancy (DABCIP) has now been founded. DABCIP consists of 22 members from 13 different medical disciplines.
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Affiliation(s)
- Lone Storgaard
- Afdeling for Graviditet, Fødsel og Barsel, Københavns Universitetshospital - Rigshospitalet
| | - Ulla Brix-Tange
- Afdeling for Kræftbehandling, Københavns Universitetshospital - Rigshospitalet
| | | | - Bent Ejlertsen
- Afdeling for Kræftbehandling, Københavns Universitetshospital - Rigshospitalet
| | - Iben K Greiber
- Afdeling for Graviditet, Fødsel og Barsel, Københavns Universitetshospital - Rigshospitalet
| | | | | | - Christel Ms Hjortshøj
- Børnekardiologisk Afdeling, Afdelingen for Børn og Unge, Københavns Universitetshospital - Rigshospitalet
| | | | - Annika Loft
- Cyclotron og Radiokemi, Københavns Universitetshospital - Rigshospitalet
| | - Zohreh Ketabi
- Dansk Center for Partikelterapi, Aarhus Universitetshospital
| | - Niels Kroman
- Kræftens Bekæmpelse, København
- Afdeling for Brystkirurgi, Københavns Universitetshospital - Herlev og Gentofte Hospital
| | - Dinne Leth-Miller
- Afdeling for Blodsygdomme, Københavns Universitetshospital - Rigshospitalet
| | | | - Berit Mosgaard
- Dansk Center for Partikelterapi, Aarhus Universitetshospital
| | - Birgitte Bruun Nielsen
- Afdeling for Graviditet, Fødsel og Barsel, Københavns Universitetshospital - Rigshospitalet
| | | | | | | | - Heidi Smedegaard
- Afdelingen for Intensiv behandling af nyfødte og mindre børn, Københavns Universitetshospital - Rigshospitalet
| | - Inge Marie Svane
- Center for Cancer Immunterapi, Københavns Universitetshospital - Herlev og Gentofte Hospital
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Clausen MR, Maurer MJ, Ulrichsen SP, Larsen TS, Himmelstrup B, Rønnov-Jessen D, Link BK, Feldman AL, Slager SL, Nowakowski GS, Thompson CA, Pedersen PT, Madsen J, Pedersen RS, Gørløv JS, Cerhan JR, Nørgaard M, D'Amore F. Pretreatment Hemoglobin Adds Prognostic Information To The NCCN-IPI In Patients With Diffuse Large B-Cell Lymphoma Treated With Anthracycline-Containing Chemotherapy. Clin Epidemiol 2019; 11:987-996. [PMID: 31814771 PMCID: PMC6861518 DOI: 10.2147/clep.s219595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 06/15/2019] [Accepted: 09/25/2019] [Indexed: 12/12/2022] Open
Abstract
Background Hemoglobin (Hgb) concentration at diagnosis is associated with outcome in cancer. In a recently reported simplified 3-factor prognostic score in Hodgkin lymphoma, Hgb, along with age and clinical stage, outperformed the classical International Prognostic Score with seven parameters. Methods In the present study, we investigated if pretherapeutic Hgb concentration added prognostic information to the NCCN-IPI in diffuse large B-cell lymphoma. We included patients from the Danish Lymphoma Registry (LYFO; N = 3499) and from the Molecular Epidemiology Resource (MER; N = 1225), Mayo Clinic and University of Iowa. Four sex-specific Hgb groups were defined: below transfusion threshold, from transfusion threshold to below lower limit of normal, from lower limit of normal to the population mean, and above the mean. We used multivariable Cox regression to estimate the hazard rate ratios (HR) and 95% CIs for overall survival (OS) and event-free survival (EFS), adjusting for sex, NCCN-IPI, comorbidity, and rituximab treatment. Results Approximately half of the patients had Hgb levels below the lower limit of normal. Compared to patients with Hgb levels above the mean, an inferior OS was directly correlated with lower pretreatment Hgb within the predefined groups (HR=1.23, HR=1.51, and HR=2.05, respectively). These findings were validated in the MER. Conclusion Based on multivariable analysis, lower pretreatment Hgb, even within the normal range but below the mean, added prognostic information to established indices such as the NCCN-IPI and the Charlson comorbidity index.
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Affiliation(s)
- Michael R Clausen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Matthew J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Thomas S Larsen
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Bodil Himmelstrup
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | | | - Brian K Link
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Susan L Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Jakob Madsen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Mette Nørgaard
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Francesco D'Amore
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
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3
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Arboe B, Olsen MH, Gørløv JS, Duun-Henriksen AK, Dalton SO, Johansen C, de Nully Brown P. Treatment intensity and survival in patients with relapsed or refractory diffuse large B-cell lymphoma in Denmark: a real-life population-based study. Clin Epidemiol 2019; 11:207-216. [PMID: 30881137 PMCID: PMC6407517 DOI: 10.2147/clep.s178003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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] [Indexed: 12/21/2022] Open
Abstract
Purpose High-dose chemotherapy with autologous stem cell transplantation (ASCT) is considered to be the only curative treatment option for patients with refractory or relapsed diffuse large B-cell lymphoma (DLBCL). Due to toxicity, not all patients are eligible for this treatment leading to different treatment intensities. Here, we aim to analyze the impact of treatment intensity on survival in patients previously treated with rituximab and chemotherapy, and, furthermore, to analyze the association between socioeconomic position and treatment intensity, defined as palliation, non-salvage, and salvage regimens. Materials and methods We identified patients with refractory or relapsed DLBCL diagnosed in 2000–2015 in the Danish National Lymphoma Registry (n=1,228). We analyzed the impact of treatment intensity on survival in patients previously treated with rituximab (n=277) using a Cox proportional hazards model. Multinomial regression analyses were performed to identify associations between socioeconomic factors and treatment intensity for the entire cohort. Results In the rituximab era, the 5-year overall survival (OS) was 31% for patients receiving salvage regimens (n=194), and 17% for patients receiving non-salvage regimens (n=83). In the adjusted analysis, HR was 1.88, 95% CI: 0.9–3.9 for patients receiving salvage regimens. Patients living alone were significantly less likely to receive salvage regimens, as were patients with two or more comorbidities. Conclusion We observed a better OS in patients treated with salvage regimens compared with non-salvage regimens; however, the adjusted analysis contradicts this. Furthermore, our results indicate that there is a chance of remission for patients not eligible for ASCT.
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Affiliation(s)
- Bente Arboe
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark, .,Survivorship, The Danish Cancer Society Research Center, Copenhagen, Denmark,
| | - Maja Halgren Olsen
- Survivorship, The Danish Cancer Society Research Center, Copenhagen, Denmark,
| | | | | | - Susanne Oksbjerg Dalton
- Survivorship, The Danish Cancer Society Research Center, Copenhagen, Denmark, .,Department of Clinical Oncology and Palliative Care Units, Zealand University Hospital, Naestved, Denmark
| | - Christoffer Johansen
- Survivorship, The Danish Cancer Society Research Center, Copenhagen, Denmark, .,Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
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Ebbesen MS, Kissow H, Hartmann B, Grell K, Gørløv JS, Kielsen K, Holst JJ, Müller K. Glucagon-Like Peptide-1 Is a Marker of Systemic Inflammation in Patients Treated with High-Dose Chemotherapy and Autologous Stem Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:1085-1091. [PMID: 30731250 DOI: 10.1016/j.bbmt.2019.01.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/31/2019] [Indexed: 12/12/2022]
Abstract
Autologous stem cell transplantation (ASCT) is challenged by side effects that may be propagated by chemotherapy-induced mucositis, resulting in bacterial translocation and systemic inflammation. Because gastrointestinal damage appears as an early event in this cascade of reactions, we hypothesized that markers reflecting damage to the intestinal barrier could serve as early predictive markers of toxicity. Glucagon-like peptide-1 (GLP-1), a well-known regulator of blood glucose, has been found to promote intestinal growth and repair in animal studies. We investigated fasting GLP-1 plasma levels in 66 adults undergoing ASCT for lymphoma and multiple myeloma. GLP-1 increased significantly after chemotherapy, reaching peak levels at day +7 post-transplant (median, 8 pmol/L [interquartile range, 4 to 12] before conditioning versus 10 pmol/L [interquartile range, 6 to 17] at day +7; P = .007). The magnitude of the GLP-1 increase was related to the intensity of conditioning. GLP-1 at the day of transplantation (day 0) was positively associated with peak C-reactive protein (CRP) levels (46 mg/L per GLP-1 doubling, P < .001) and increase in days with fever (32% per GLP-1 doubling, P = .0058). Patients with GLP-1 above the median at day 0 had higher CRP levels from days +3 to +10 post-transplant than patients with lower GLP-1 (P ≤ .041) with peak values of 238 versus 129 mg/L, respectively. This study, which represents the first clinical investigation of fasting GLP-1 in relation to high-dose chemotherapy, provides evidence that GLP-1 plays a role in regulation of mucosal defenses. Fasting GLP-1 levels may serve as an early predictor of systemic inflammation and fever in patients receiving high-dose chemotherapy.
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Affiliation(s)
- Maria Schou Ebbesen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.
| | - Hannelouise Kissow
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; NNF Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Bolette Hartmann
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; NNF Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Kathrine Grell
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark; Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Katrine Kielsen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark; Institute for Inflammation Research, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jens Juul Holst
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; NNF Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Müller
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark; Institute for Inflammation Research, University Hospital Rigshospitalet, Copenhagen, Denmark
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Clausen MR, Ulrichsen SP, Larsen TS, Poulsen CB, Tojaga S, Pedersen PT, Madsen J, Pedersen RS, Josefsson PL, Gørløv JS, Nørgaard M, d'Amore F. Depth of neutrophil nadir after first cycle of R-CHOP predicts outcome in diffuse large B-cell lymphoma - a nationwide population-based cohort study. Leuk Lymphoma 2019; 60:1950-1957. [PMID: 30668181 DOI: 10.1080/10428194.2018.1554863] [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: 10/27/2022]
Abstract
We investigated if survival was predicted by nadir neutrophil counts after the first cycle of R-CHOP in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL). Neutrophil counts (109/L) were categorized in four grades in the nadir time frame. Prognostic indices and comorbidity levels were calculated and used to adjust the Cox regression model. Kaplan-Meier and Cox regression methods were used to estimate and compare survival. We identified 965 patients. Grade 4 neutropenia was present in 432 (45%). Grade 0 patients had a 5-year overall survival of 67%, grade 1-2: 78%, grade 3: 64%, and grade 4: 57%. Compared with grade 0 adjusted hazard ratios (HR) for death were: 0.77 (95% CI 0.49-1.21) for grade 1-2, 1.18 (95% CI 0.82-1.71) for grade 3, and 1.33 (95% CI 1.02-1.73) for grade 4. Grade 4 neutropenia after the 1st cycle of chemotherapy predicted inferior outcome compared with grade 0 and 1-2. Grade 1-2 neutropenia seemed to have superior outcome.
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Affiliation(s)
| | | | | | - Christian B Poulsen
- d Department of Hematology , Zealand University Hospital , Roskilde , Denmark
| | - Selma Tojaga
- e Department of Hematology , Sygehus Lillebaelt , Vejle , Denmark
| | | | - Jakob Madsen
- g Department of Hematology , Aalborg University Hospital , Aalborg , Denmark
| | | | | | | | - Mette Nørgaard
- b Department of Clinical Epidemiology , Aarhus University Hospital , Aarhus , Denmark
| | - Francesco d'Amore
- a Department of Hematology , Aarhus University Hospital , Aarhus , Denmark
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6
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Svalgaard JD, Talkhoncheh MS, Haastrup EK, Munthe-Fog L, Clausen C, Hansen MB, Andersen P, Gørløv JS, Larsson J, Fischer-Nielsen A. Pentaisomaltose, an Alternative to DMSO. Engraftment of Cryopreserved Human CD34 + Cells in Immunodeficient NSG Mice. Cell Transplant 2018; 27:1407-1412. [PMID: 30056762 PMCID: PMC6168988 DOI: 10.1177/0963689718786226] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Indexed: 02/01/2023] Open
Abstract
Hematopoietic stem cell transplantation often involves the cryopreservation of stem cell products. Currently, the standard cryoprotective agent (CPA) is dimethyl sulfoxide (DMSO), which is known to cause concentration-related toxicity and side effects when administered to patients. Based on promising in vitro data from our previous study using pentaisomaltose (a 1 kDa subfraction of Dextran 1) as an alternative to DMSO for cryopreservation of hematopoietic progenitor cells (HPCs) from apheresis products, we proceeded to a preclinical model and compared the two CPAs with respect to engraftment of human hematopoietic stem and progenitor cells (HSPCs) in the immunodeficient NSG mouse model. Human HPCs from apheresis products were cryopreserved with either pentaisomaltose or DMSO, and the following outcomes were measured: (1) the post-thaw recovery of cryopreserved cells and clonogenic potential of CD34+ cells and (2) hematopoietic engraftment in NSG mice. We found that recovery and colony-forming cells data were comparable between pentaisomaltose and DMSO. The engraftment data revealed comparable human CD45+ levels in peripheral blood at 8 weeks and bone marrow at 16 weeks post transplantation. Additionally, the frequencies of CD34+CD38low/negative and myeloid/lymphoid cells in the bone marrow were comparable. We here demonstrated that long-term engrafting HSPCs were well preserved in pentaisomaltose and comparable to cells cryopreserved with DMSO. Although a clinical trial is necessary to translate these results into human use, the present data represent an important step toward the replacement of DMSO with a non-toxic alternative.
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Affiliation(s)
- Jesper Dyrendom Svalgaard
- 1 Department of Clinical Immunology, Cell Therapy Facility, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | | | - Eva Kannik Haastrup
- 1 Department of Clinical Immunology, Cell Therapy Facility, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Lea Munthe-Fog
- 1 Department of Clinical Immunology, Cell Therapy Facility, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | | | - Morten Bagge Hansen
- 1 Department of Clinical Immunology, Cell Therapy Facility, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Pernille Andersen
- 4 Department of Clinical Immunology, Stem Cell Facility, Herlev Hospital, Herlev, Denmark
| | - Jette Sønderskov Gørløv
- 5 Department of Hematology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Jonas Larsson
- 2 Molecular Medicine and Gene Therapy, Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Anne Fischer-Nielsen
- 1 Department of Clinical Immunology, Cell Therapy Facility, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
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Ferreri AJM, Cwynarski K, Pulczynski E, Fox CP, Schorb E, La Rosée P, Binder M, Fabbri A, Torri V, Minacapelli E, Falautano M, Ilariucci F, Ambrosetti A, Roth A, Hemmaway C, Johnson P, Linton KM, Pukrop T, Sønderskov Gørløv J, Balzarotti M, Hess G, Keller U, Stilgenbauer S, Panse J, Tucci A, Orsucci L, Pisani F, Levis A, Krause SW, Schmoll HJ, Hertenstein B, Rummel M, Smith J, Pfreundschuh M, Cabras G, Angrilli F, Ponzoni M, Deckert M, Politi LS, Finke J, Reni M, Cavalli F, Zucca E, Illerhaus G. Whole-brain radiotherapy or autologous stem-cell transplantation as consolidation strategies after high-dose methotrexate-based chemoimmunotherapy in patients with primary CNS lymphoma: results of the second randomisation of the International Extranodal Lymphoma Study Group-32 phase 2 trial. Lancet Haematol 2017; 4:e510-e523. [PMID: 29054815 DOI: 10.1016/s2352-3026(17)30174-6] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 09/07/2017] [Accepted: 09/07/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND The International Extranodal Lymphoma Study Group-32 (IELSG32) trial is an international randomised phase 2 study that addresses two key clinical questions in the treatment of patients with newly diagnosed primary CNS lymphoma. Results of the first randomisation have demonstrated that methotrexate, cytarabine, thiotepa, and rituximab (called the MATRix regimen) is the induction combination associated with significantly better outcome compared with the other induction combinations tested. Here, we report the results of the second randomisation that addresses the efficacy of myeloablative chemotherapy supported by autologous stem-cell transplantation (ASCT), as an alternative to whole-brain radiotherapy (WBRT), as consolidation after high-dose-methotrexate-based chemoimmunotherapy. METHODS HIV-negative patients (aged 18-70 years) with newly diagnosed primary CNS lymphoma and an Eastern Cooperative Oncology Group performance status of 0-3 were randomly assigned to receive four courses of methotrexate 3·5 g/m2 on day 1 plus cytarabine 2 g/m2 twice daily on days 2 and 3 (group A); or the same combination plus two doses of rituximab 375 mg/m2 on days -5 and 0 (group B); or the same methotrexate-cytarabine-rituximab combination plus thiotepa 30 mg/m2 on day 4 (group C), with the three groups repeating treatment every 3 weeks. Patients with responsive or stable disease after induction treatment, with adequate autologous peripheral blood stem-cell collection, and without persistent iatrogenic side-effects, were eligible for the second randomisation between WBRT (photons of 4-10 MeV; five fractions per week; fraction size 180 cGy; started within 4 weeks from the last induction course; group D) and carmustine-thiotepa conditioned ASCT (carmustine 400 mg/m2 on day -6, and thiotepa 5 mg/kg every 12 h on days -5 and -4, followed by reinfusion of autologous peripheral blood stem cells; group E). A permuted block randomised design was adopted for both randomisations, and a computer-generated randomisation list was used within each stratum. No masking after assignment to intervention was adopted. The primary endpoint was 2-year progression-free survival, with induction group and response to induction chemotherapy as stratification parameters. Analyses were done on a modified intention-to-treat basis. This study is registered with ClinicalTrials.gov, number NCT01011920. FINDINGS Between Feb 19, 2010, and Aug 27, 2014, 227 patients were recruited from 53 centres in five countries. 219 of 227 enrolled patients were assessable. Of the 122 patients eligible for the second randomisation, 118 patients were randomly assigned to WBRT or ASCT (59 patients per group) and constitute the study population. WBRT and ASCT were both effective, and achieved the predetermined efficacy threshold of at least 40 progression-free survivors at 2 years among the first 52 patients in both groups D and E. There were no significant differences in 2-year progression-free survival between WBRT and ASCT: 80% (95% CI 70-90) in group D and 69% (59-79) in group E (hazard ratio 1·50, 95% CI 0·83-2·71; p=0·17). Both consolidation therapies were well tolerated. Grade 4 non-haematological toxicity was uncommon; as expected, haematological toxicity was more common in patients treated with ASCT than in those who received WBRT. Two toxic deaths (infections) were recorded, both in patients who received ASCT. INTERPRETATION WBRT and ASCT are both feasible and effective as consolidation therapies after high-dose methotrexate-based chemoimmunotherapy in patients aged 70 years or younger with primary CNS lymphoma. The risks and implications of cognitive impairment after WBRT should be considered at the time of therapeutic decision. FUNDING Agenzia Italiana del Farmaco, Cancer Research UK, Oncosuisse, and Swiss National Science Foundation.
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Affiliation(s)
- Andrés J M Ferreri
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Kate Cwynarski
- Royal Free Hospital/University College London Hospital, London, UK
| | | | - Christopher P Fox
- University Hospitals National Health Service (NHS) Trust, Nottingham, UK
| | | | | | - Mascha Binder
- Uke Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Valter Torri
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | - Monica Falautano
- Department of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fiorella Ilariucci
- Azienda Ospedaliera Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Achille Ambrosetti
- Dipartimento di Medicina, Sezione di Ematologia, Università di Verona, Verona, Italy
| | | | | | - Peter Johnson
- Medical Oncology Unit, Southampton General Hospital, Southampton, UK
| | - Kim M Linton
- The Christie Hospital NHS Foundation Trust, Manchester, UK
| | | | | | | | | | | | | | - Jens Panse
- University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | | | - Lorella Orsucci
- AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Francesco Pisani
- Hematology and Stem Cell Transplantation Unit, Istituto Nazionale dei Tumori Regina Elena, Rome, Italy
| | | | | | | | | | - Mathias Rummel
- Klinikum Der Justus-Liebig-Universität, Giessen, Germany
| | | | | | | | | | - Maurilio Ponzoni
- Ateneo Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Deckert
- Institute of Neuropathology, University Hospital of Cologne, Cologne, Germany
| | - Letterio S Politi
- Unit of Neuroradiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Michele Reni
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Franco Cavalli
- Istituto Oncologico Della Svizzera Italiana, Bellinzona, Switzerland
| | - Emanuele Zucca
- Istituto Oncologico Della Svizzera Italiana, Bellinzona, Switzerland
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8
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Arboe B, Halgren Olsen M, Duun-Henriksen AK, Gørløv JS, Nielsen KF, Thomsen RH, Madsen C, Nielsen SR, Dalton SO, Brown PDN. Prolonged hospitalization, primary refractory disease, performance status and age are prognostic factors for survival in patients with diffuse large B-cell lymphoma and transformed indolent lymphoma undergoing autologous stem cell transplantation. Leuk Lymphoma 2017; 59:1153-1162. [DOI: 10.1080/10428194.2017.1369061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Bente Arboe
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhage, Denmark
- The Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | | | - Jette Sønderskov Gørløv
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhage, Denmark
| | | | - Rasmus Heje Thomsen
- Department of Hematology, Copenhagen University Hospital, Herlev, Copenhagen, Denmark
| | - Charlotte Madsen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Peter de Nully Brown
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhage, Denmark
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9
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Ferreri AJM, Cwynarski K, Pulczynski E, Ponzoni M, Deckert M, Politi LS, Torri V, Fox CP, Rosée PL, Schorb E, Ambrosetti A, Roth A, Hemmaway C, Ferrari A, Linton KM, Rudà R, Binder M, Pukrop T, Balzarotti M, Fabbri A, Johnson P, Gørløv JS, Hess G, Panse J, Pisani F, Tucci A, Stilgenbauer S, Hertenstein B, Keller U, Krause SW, Levis A, Schmoll HJ, Cavalli F, Finke J, Reni M, Zucca E, Illerhaus G. Chemoimmunotherapy with methotrexate, cytarabine, thiotepa, and rituximab (MATRix regimen) in patients with primary CNS lymphoma: results of the first randomisation of the International Extranodal Lymphoma Study Group-32 (IELSG32) phase 2 trial. Lancet Haematol 2016; 3:e217-27. [PMID: 27132696 DOI: 10.1016/s2352-3026(16)00036-3] [Citation(s) in RCA: 364] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 02/24/2016] [Accepted: 03/03/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Standard treatment for patients with primary CNS lymphoma remains to be defined. Active therapies are often associated with increased risk of haematological or neurological toxicity. In this trial, we addressed the tolerability and efficacy of adding rituximab with or without thiotepa to methotrexate-cytarabine combination therapy (the MATRix regimen), followed by a second randomisation comparing consolidation with whole-brain radiotherapy or autologous stem cell transplantation in patients with primary CNS lymphoma. We report the results of the first randomisation in this Article. METHODS For the international randomised phase 2 International Extranodal Lymphoma Study Group-32 (IELSG32) trial, HIV-negative patients (aged 18-70 years) with newly diagnosed primary CNS lymphoma and measurable disease were enrolled from 53 cancer centres in five European countries (Denmark, Germany, Italy, Switzerland, and the UK) and randomly assigned (1:1:1) to receive four courses of methotrexate 3·5 g/m(2) on day 1 plus cytarabine 2 g/m(2) twice daily on days 2 and 3 (group A); or the same combination plus two doses of rituximab 375 mg/m(2) on days -5 and 0 (group B); or the same methotrexate-cytarabine-rituximab combination plus thiotepa 30 mg/m(2) on day 4 (group C), with the three groups repeating treatment every 3 weeks. Patients with responsive or stable disease after the first stage were then randomly allocated between whole-brain radiotherapy and autologous stem cell transplantation. A permuted blocks randomised design (block size four) was used for both randomisations, and a computer-generated randomisation list was used within each stratum to preserve allocation concealment. Randomisation was stratified by IELSG risk score (low vs intermediate vs high). No masking after assignment to intervention was used. The primary endpoint of the first randomisation was the complete remission rate, analysed by modified intention to treat. This study is registered with ClinicalTrials.gov, number NCT01011920. FINDINGS Between Feb 19, 2010, and Aug 27, 2014, 227 eligible patients were recruited. 219 of these 227 enrolled patients were assessable. At median follow-up of 30 months (IQR 22-38), patients treated with rituximab and thiotepa had a complete remission rate of 49% (95% CI 38-60), compared with 23% (14-31) of those treated with methotrexate-cytarabine alone (hazard ratio 0·46, 95% CI 0·28-0·74) and 30% (21-42) of those treated with methotrexate-cytarabine plus rituximab (0·61, 0·40-0·94). Grade 4 haematological toxicity was more frequent in patients treated with methotrexate-cytarabine plus rituximab and thiotepa, but infective complications were similar in the three groups. The most common grade 3-4 adverse events in all three groups were neutropenia, thrombocytopenia, anaemia, and febrile neutropenia or infections. 13 (6%) patients died of toxicity. INTERPRETATION With the limitations of a randomised phase 2 study design, the IELSG32 trial provides a high level of evidence supporting the use of MATRix combination as the new standard chemoimmunotherapy for patients aged up to 70 years with newly diagnosed primary CNS lymphoma and as the control group for future randomised trials. FUNDING Associazione Italiana del Farmaco, Cancer Research UK, Oncosuisse, and Swiss National Foundation.
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Affiliation(s)
- Andrés J M Ferreri
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Kate Cwynarski
- Royal Free Hospital/University College London Hospital, London, UK
| | | | - Maurilio Ponzoni
- Ateneo Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Deckert
- Institute of Neuropathology, University Hospital of Cologne, Cologne, Germany
| | - Letterio S Politi
- Unit of Neuroradiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valter Torri
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | | | | | - Achille Ambrosetti
- Dipartimento di Medicina, Sezione di Ematologia, Università di Verona, Verona, Italy
| | | | | | - Angela Ferrari
- Azienda Ospedaliera Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Kim M Linton
- The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Roberta Rudà
- AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Mascha Binder
- Uke Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Peter Johnson
- Medical Oncology Unit, Southampton General Hospital, Southampton, UK
| | | | | | - Jens Panse
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Francesco Pisani
- Hematology and Stem Cell Transplantation Unit, Istituto Nazionale dei Tumori Regina Elena, Rome, Italy
| | | | | | | | | | | | | | | | - Franco Cavalli
- Istituto Oncologico Della Svizzera Italiana, Bellinzona, Switzerland
| | | | - Michele Reni
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emanuele Zucca
- Istituto Oncologico Della Svizzera Italiana, Bellinzona, Switzerland
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Svalgaard JD, Haastrup EK, Reckzeh K, Holst B, Glovinski PV, Gørløv JS, Hansen MB, Moench KT, Clausen C, Fischer-Nielsen A. Low-molecular-weight carbohydrate Pentaisomaltose may replace dimethyl sulfoxide as a safer cryoprotectant for cryopreservation of peripheral blood stem cells. Transfusion 2016; 56:1088-95. [PMID: 26991781 DOI: 10.1111/trf.13543] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/05/2016] [Accepted: 01/12/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Cryopreserved hematopoietic stem cell products are widely used for certain hematologic malignancies. Dimethyl sulfoxide (DMSO) is the most widely used cryoprotective agent (CPA) today, but due to indications of cellular toxicity, changes of the cellular epigenetic state, and patient-related side effects, there is an increasing demand for DMSO-free alternatives. We therefore investigated whether Pentaisomaltose (PIM), a low-molecular-weight carbohydrate (1 kDa), can be used for cryopreservation of peripheral blood stem cells, more specifically hematopoietic progenitor cell apheresis (HPC(A)) product. STUDY DESIGN AND METHODS We cryopreserved patient or donor HPC(A) products using 10% DMSO or 16% PIM and quantified the recovery of CD34+ cells and CD34+ subpopulations by multicolor flow cytometry. In addition, we compared the frequency of HPCs after DMSO and PIM cryopreservation using the colony-forming cells (CFCs) assay. RESULTS The mean CD34+ cell recovery was 56.3 ± 23.7% (11.4%-97.3%) and 58.2 ± 10.0% (45.7%-76.9%) for 10% DMSO and 16% PIM, respectively. The distribution of CD34+ cell subpopulations was similar when comparing DMSO or PIM as CPA. CFC assay showed mean colony numbers of 70.7 ± 25.4 (range, 37.8-115.5) and 67.7 ± 15.7 (range, 48-86) for 10% DMSO and 16% PIM, respectively. CONCLUSION Our findings demonstrate that PIM cryopreservation of HPC(A) products provides recovery of CD34+ cells, CD34+ subpopulations, and CFCs similar to that of DMSO cryopreservation and therefore may have the potential to be used for cryopreservation of peripheral blood stem cells.
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Affiliation(s)
- Jesper Dyrendom Svalgaard
- Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Eva Kannik Haastrup
- Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Kristian Reckzeh
- The Finsen Laboratory, Biotech Research and Innovation Centre and Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Peter Viktor Glovinski
- Department of Plastic Surgery and Burns, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | | | - Morten Bagge Hansen
- Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Kim Theilgaard Moench
- The Finsen Laboratory, Biotech Research and Innovation Centre and Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Hematology, Skånes University Hospital, Lund, Sweden
| | | | - Anne Fischer-Nielsen
- Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
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Pedersen BW, Clausen MB, Gørløv JS, Langhoff-Roos J, Storgaard L. [Chemotherapy in the second and third trimester of pregnancy is compatible with the delivery of a healthy infant]. Ugeskr Laeger 2015; 177:V12140713. [PMID: 26058439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This case report describes the delay in diagnosis and treatment of a diffuse large B-cell lymphoma in pregnancy of a 27-year-old woman. Chemotherapy was initiated in week 21 of pregnancy - the tumour regressed and the foetus had linear growth. The patient had caesarean section in week 34, and after delivery she received high doses of methotrexate and obtained complete remission. The two-year-old infant had a normal development.
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Bartels FR, Smith NS, Gørløv JS, Grufstedt HK, Nexø C, Kehlet H, Sjøgren P, Kjeldsen L, Høgdal N. Optimized patient-trajectory for patients undergoing treatment with high-dose chemotherapy and autologous stem cell transplantation. Acta Oncol 2015; 54:750-8. [PMID: 25761093 DOI: 10.3109/0284186x.2014.999872] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Before, during and after autologous hematopoietic stem cell transplantation (HD-ASCT) patients suffer from significant loss of physical function, and experience multiple complications during and after hospitalization. Studies regarding safety and feasibility of physical exercise interventions for patients undergoing treatment with HD-ASCT are missing. METHODS Forty patients referred to HD-ASCT treatment, suffering from multiple myeloma, lymphoma or amyloidosis aged 23-70 years were enrolled in a prospective longitudinal study. The study consisted of a home-based exercise program for use in the ambulatory setting and supervised exercise sessions Monday to Friday for 30-40 minutes during admission. Safety of the exercise program and physical tests were assessed by using a weekly questionnaire and report of inadvertent incidences. Adherence to the home-based exercise program was reported by using a patient diary, weekly questionnaire and count of daily attendance in supervised sessions during hospital stay. Data collection was scheduled shortly after diagnosis, admission, discharge and eight weeks after discharge. Success criteria were: no severe adverse events in relation to exercise program and assessments; performance of three days of physical exercises during ambulatory period and hospital stay and 150 minutes of weekly physical activity. RESULTS Of the 25 patients who completed the exercise program during the ambulatory period prior to HD-ASCT a mean weekly attendance to home exercises of 5.3 (± 2.8) days and a median weekly physical activity of 240 (± 153.8) minutes was found. During hospital stay the median attendance was 9 (± 3.9) days of 10 (± 6.9) possible. Two months after discharge the patients reported a median weekly physical activity of 360 (2745.5) minutes. No severe adverse events in relation to the exercise program or assessments were reported. CONCLUSION Based on the enrolled number of patients the physical exercise intervention for patients undergoing HD-ASCT seems promising regarding feasibility and safety.
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Affiliation(s)
- Frederik Reith Bartels
- Department of Occupational Therapy and Physiotherapy, Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark
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