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Paszkiewicz-Kozik E, Hus I, Palka M, Dębowska M, Końska A, Kotarska M, Tyczyńska A, Joks M, Twardosz M, Giza A, Wąsik-Szczepanek E, Kalicińska E, Wiśniewska A, Morawska M, Lewicka B, Szymański M, Targoński Ł, Romejko-Jarosińska J, Drozd-Sokołowska J, Subocz E, Swoboda R, Długosz-Danecka M, Lech-Maranda E, Walewski J. Early efficacy and safety of obinutuzumab with chemotherapy in previously untreated patients with follicular lymphoma: A real-world retrospective report of the Polish Lymphoma Research Group. ADV CLIN EXP MED 2023; 32:131-136. [PMID: 36603138 DOI: 10.17219/acem/157290] [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] [Received: 08/03/2022] [Revised: 09/14/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The first-line obinutuzumab-based immunochemotherapy improves the outcome of patients with follicular lymphoma (FL) compared with rituximab-based regimens. However, infusion-related reactions occur in almost half of patients during the 1st obinutuzumab administration. OBJECTIVES The study aimed to evaluate the early effectiveness and safety of obinutuzumab-based induction regimens in a real-world setting. MATERIAL AND METHODS Outcomes of patients diagnosed with FL and treated with obinutuzumab between January 2020 and September 2021 were analyzed. RESULTS The study group included 143 treatment-naïve patients with FL. The median age was 52 years (range: 28-89 years); 45.1% of patients had a high-risk disease as assessed using the Follicular Lymphoma International Prognostic Index (FLIPI). Induction chemotherapy included: O-CVP (obinutuzumab, cyclophosphamide, vincristine, prednisolone) in 49.0% of patients, O-CHOP (O-CVP plus doxorubicin) in 28.7% and O-BENDA (obinutuzumab, bendamustine) in 22.4%. Complete response (CR) and partial response (PR) rates were 69.9% and 26.5%, respectively. There was no difference in response rates between different regimens (p = 0.309). Maintenance was started in 115 patients (85.2%). In the 1st cycle, obinutuzumab was administered as a single 1000-milligram infusion in 47.9% of patients, whereas in 52.1%, initial infusions were split over 2 days (100 mg/900 mg). Infusion-related reactions were reported only during the 1st administration of obinutuzumab in 9.1% of patients, with a similar incidence in those receiving the total dose on a single day or split over 2 days (p = 0.458). The most common adverse events were hematological. Five patients died from coronavirus disease 2019 (COVID-19). CONCLUSION The early responses to induction regimens and adverse events profile were similar for every type of induction treatment. The infusion-related reactions were rare and limited to the 1st dose of obinutuzumab.
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Affiliation(s)
- Ewa Paszkiewicz-Kozik
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warszawa, Poland
| | - Iwona Hus
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warszawa, Poland
| | - Monika Palka
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | - Małgorzata Dębowska
- Department of Mathematical Modeling of Physiological Processes, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warszawa, Poland.,Department of Computational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warszawa, Poland
| | - Agnieszka Końska
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warszawa, Poland
| | - Martyna Kotarska
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warszawa, Poland
| | - Agata Tyczyńska
- Department of Hematology and Transplantology, Medical University of Gdańsk, Poland
| | - Monika Joks
- Department of Hematology and Marrow Transplantation, Poznan University of Medical Sciences, Poland
| | - Maja Twardosz
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Agnieszka Giza
- Department of Hematology, Jagiellonian University Medical College, Kraków, Poland
| | - Ewa Wąsik-Szczepanek
- Department of Hematooncology and Bone Marrow Transplantation, Medical University in Lublin, Poland
| | | | - Anna Wiśniewska
- Department of Oncology and Chemotherapy, Nicolas Copernicus State Hospital, Koszalin, Poland
| | - Marta Morawska
- Department of Hematology, St. John's Cancer Center, Lublin, Poland
| | - Barbara Lewicka
- Department of Hematology, Ludwik Rydygier Hospital, Kraków, Poland
| | - Marcin Szymański
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warszawa, Poland
| | - Łukasz Targoński
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warszawa, Poland
| | - Joanna Romejko-Jarosińska
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warszawa, Poland
| | - Joanna Drozd-Sokołowska
- Department of Hematology, Transplantation and Internal Diseases, Medical University of Warsaw, Poland
| | - Edyta Subocz
- Department of Hematology, Warmian-Masurian Cancer Center of the Ministry of the Interior and Administration Hospital, Olsztyn, Polan
| | - Ryszard Swoboda
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Monika Długosz-Danecka
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | - Ewa Lech-Maranda
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warszawa, Poland
| | - Jan Walewski
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warszawa, Poland
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2
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Paszkiewicz-Kozik E, Kluska A, Piątkowska M, Bałabas A, Żeber-Lubecka N, Karczmarski J, Goryca K, Kulecka M, Wojciechowska-Lampka E, Osiadacz W, Romejko-Jarosińska J, Świerkowska M, Paziewska A, Ambrożkiewicz F, Walewski J, Mikula M, Ostrowski J. Genetic associations with lymphomas in Polish patients: A pooled-DNA genome-wide association analysis. Int J Immunogenet 2022; 49:353-363. [PMID: 36036752 DOI: 10.1111/iji.12596] [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] [Received: 05/16/2022] [Revised: 07/26/2022] [Accepted: 08/10/2022] [Indexed: 11/29/2022]
Abstract
Several single nucleotide polymorphisms (SNPs) associated with susceptibility to Hodgkin lymphoma (HL) and diffuse large B-cell lymphoma (DLBCL) have been identified. The aim of this study was to identify susceptibility loci for HL and DLBCL in Polish patients. Altogether, DLBCL (n = 218 and HL patients (n = 224) and healthy individuals (n = 1181) were recruited. Lymphoma diagnosis was based on standard criteria. Genome-wide association study (GWAS) was performed using pooled-DNA samples on llumina Infinium Omni2.5 Exome-8 v1.3, and selected loci were replicated by TaqMan SNP genotyping of individuals. GWAS detected thirteen and seven SNPs associated with DLBCL and HL, respectively. In the replication study, six and seven SNPs reached significance after correction for multiple testing in the DLBCL and HL cohorts, respectively. One and four SNPs associated with DLBCL and HL, respectively, were localized within, and two SNPs-near the major histocompatibility complex (MHC) region. In conclusion, the majority of loci associated with HL and DLBCL aetiology in previous studies have potential roles in immune function. Our pooled-DNA GWAS enabled the identification of several susceptibility loci for DLBCL and HL in the Polish population; some of them were mapped within or adjacent to the MHC, and other associated SNPs were located outside the MHC.
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Affiliation(s)
- Ewa Paszkiewicz-Kozik
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Anna Kluska
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Magdalena Piątkowska
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Aneta Bałabas
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Natalia Żeber-Lubecka
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jakub Karczmarski
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Krzysztof Goryca
- Genomics Core Facility, Centre of New Technologies, University of Warsaw, Warsaw, Poland
| | - Maria Kulecka
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Elżbieta Wojciechowska-Lampka
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Włodzimierz Osiadacz
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Joanna Romejko-Jarosińska
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Monika Świerkowska
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Agnieszka Paziewska
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Filip Ambrożkiewicz
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Jan Walewski
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Michał Mikula
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Jerzy Ostrowski
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
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3
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Paszkiewicz-Kozik E, Michalski W, Taszner M, Mordak-Domagała M, Romejko-Jarosińska J, Knopińska-Posłuszny W, Najda J, Borawska A, Chełstowska M, Świerkowska M, Dąbrowska-Iwanicka A, Malenda A, Druzd-Sitek A, Konecki R, Kumiega B, Osowiecki M, Ostrowska B, Szpila T, Szymański M, Targoński Ł, Domańska-Czyż K, Popławska L, Giebel S, Lange A, Pluta A, Zaucha JM, Rymkiewicz G, Walewski J. Ofatumumab with iphosphamide, etoposide and cytarabine for patients with transplantation-ineligible relapsed and refractory diffuse large B-cell lymphoma. Br J Haematol 2022; 198:73-81. [PMID: 35362096 PMCID: PMC9322457 DOI: 10.1111/bjh.18166] [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: 01/14/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022]
Abstract
The efficacy of salvage treatment of diffuse large B-cell lymphoma (DLBCL) patients who relapse or progress (rrDLBCL) after initial therapy is limited. Efficacy and safety of ofatumumab with iphosphamide, etoposide and cytarabine (O-IVAC) was evaluated in a single-arm study. Dosing was modified for elderly patients. Patients received up to six cycles of treatment. The primary end-point was the overall response rate (ORR). Patients were evaluated every two cycles and then six and 12 months after treatment. Other end-points included progression-free survival (PFS), event-free survival (EFS), overall survival (OS) and safety. Seventy-seven patients received salvage treatment with O-IVAC. The average age was 56.8 years; 39% had an Eastern Cooperative Oncology Group (ECOG) performance status of at least 3; 78% had disease of Ann Arbor stage 3 or 4; 58% received one or more prior salvage therapies. The ORR for O-IVAC was 54.5%. The median duration of study follow-up was 70 months. The median PFS and EFS were 16.3 months each. The median OS was 22.7 months. Age, ECOG performance status and the number of prior therapy lines were independent predictors of survival. Treatment-related mortality was 15.5%. O-IVAC showed a high response rate in a difficult-to-treat population and is an attractive treatment to bridge to potentially curative therapies.
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Affiliation(s)
| | - Wojciech Michalski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Monika Mordak-Domagała
- Lower Silesian Center for Cellular Transplantation with National Bone Marrow Donor Registry, Wroclaw, Poland
| | | | - Wanda Knopińska-Posłuszny
- Maritime Hospital, Gdynia, Poland.,Warmian-Masurian Cancer Center of the Ministry of the Interior and Administration's Hospital, Olsztyn, Poland
| | - Jacek Najda
- Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Anna Borawska
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Monika Świerkowska
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Agata Malenda
- Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | - Robert Konecki
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Beata Kumiega
- Sniadecki Memorial Specialist Hospital, Nowy Sacz, Poland
| | - Michał Osowiecki
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Beata Ostrowska
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Tomasz Szpila
- Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Marcin Szymański
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Łukasz Targoński
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Lidia Popławska
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Sebastian Giebel
- Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Andrzej Lange
- Lower Silesian Center for Cellular Transplantation with National Bone Marrow Donor Registry, Wroclaw, Poland
| | - Andrzej Pluta
- Department of Hematology, Brzozow Oncology Center, Brzozow, Poland
| | - Jan Maciej Zaucha
- Medical University of Gdansk, Gdansk, Poland.,Maritime Hospital, Gdynia, Poland
| | - Grzegorz Rymkiewicz
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Jan Walewski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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4
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Olszewska-Szopa M, Sobas M, Laribi K, Bao Perez L, Drozd-Sokołowska J, Subocz E, Joks M, Zduniak K, Gajewska M, de Nalecz AK, Romejko-Jarosińska J, Kumiega B, Waszczuk-Gajda A, Wróbel T, Czyz A. Primary cutaneous indolent B-cell lymphomas - a retrospective multicenter analysis and a review of literature. Acta Oncol 2021; 60:1361-1368. [PMID: 34346830 DOI: 10.1080/0284186x.2021.1956689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/20/2022]
Abstract
Introduction: Primary cutaneous indolent B-cell lymphomas (PCBCLs) are not well characterized due to their rarity and indolent character.Methods: We retrospectively reviewed the data from 52 patients with primary cutaneous follicular lymphoma (PCFL) (n = 26), marginal zone lymphoma (PCMZL) (n = 25) or undefined PCBCL (n = 1) treated in 10 hematology centers in 1999-2019.Results: Patients characteristics and diagnostic approach: In almost half of the patients, pruritus or pain were present at diagnosis. The lesions were predominantly located on the head and trunk. The disease was present in a form of solitary infiltration or disseminated lesions with a similar frequency.Treatment details and outcomes: Surgery, radiotherapy, rituximab alone or combined with chemotherapy were applied as first-line treatment in 33%, 25%, 21% and 21% of patients, with complete response (CR) achieved by 94%, 83%, 50% and 70% of patients, respectively (p = 0.28). The median duration of response (DoR) was 65 months (95%CI 35-155).Survival: After the median follow-up time of 46 months (range: 3-225), the estimated 5-year overall survival (OS) and progression-free survival (PFS) were 93% and 54%, respectively.Discussion: Clinical presentation was largely consistent with the literature data, however, we observed some differences, including higher predilection to affect upper extremities (25%) and more frequent multifocal appearance in PCFCL (64%) and unifocal in PCMZL (70%).A high proportion of patients with indolent PCBCL achieved CR after the first-line therapy (77%), regardless of treatment mode. We did not find any impact of clinical features on treatment outcomes.Conclusions: All treatment modalities resulted in a high overall response rate. Surgery and/or radiotherapy are the optimal therapeutic options for patients with localized disease. The decision to treat systemically should rather be limited to the generalized form of the disease. High response rate, long duration of remission and excellent long-term survival confirm the truly indolent character of PCFCL and PCMZL.
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Affiliation(s)
- Magdalena Olszewska-Szopa
- Department of Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wrocław Medical University, Wroclaw, Poland
| | - Marta Sobas
- Department of Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wrocław Medical University, Wroclaw, Poland
| | - Kamel Laribi
- Service d'Hématologie, Centre Hospitalier Le Mans, Le Mans, France
| | - Laura Bao Perez
- Division of Hematology, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS – SERGAS), Santiago de Compostela, Spain
| | - Joanna Drozd-Sokołowska
- Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Poland
| | - Edyta Subocz
- Department of Haematology, Military Institute of Medicine, Warsaw, Poland
| | - Monika Joks
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof Zduniak
- Department of Pathology, Wrocław Medical University, Wrocław, Poland
| | | | | | - Joanna Romejko-Jarosińska
- Cytogenetic Department, Centre of Oncology, M. Skłodowska-Curie Memorial Institute, Warszawa, Poland
| | - Beata Kumiega
- Department of Hematology, Specialist District Hospital, Nowy Sacz, Poland
| | - Anna Waszczuk-Gajda
- Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Poland
| | - Tomasz Wróbel
- Department of Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wrocław Medical University, Wroclaw, Poland
| | - Anna Czyz
- Department of Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wrocław Medical University, Wroclaw, Poland
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5
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Drozd-Sokołowska J, Waszczuk-Gajda A, Biecek P, Kobylińska K, Mańko J, Hus I, Szmigielska-Kapłon A, Nowicki M, Romejko-Jarosińska J, Kozioł M, Sędzimirska M, Sachs W, Mądry K, Boguradzki P, Król M, Hus M, Basak G, Dwilewicz-Trojaczek J. Salvage autologous hematopoietic stem cell transplantation for multiple myeloma performed with stem cells procured after previous high dose therapy - a multicenter report by the Polish Myeloma Study Group. Leuk Lymphoma 2021; 62:3226-3234. [PMID: 34396931 DOI: 10.1080/10428194.2021.1950712] [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: 10/20/2022]
Abstract
Salvage autologous hematopoietic stem cell transplantation (auto-HSCT) constitutes a therapeutic option for a group of well-selected patients with relapsed multiple myeloma (MM). However, if an insufficient number of stem cells were harvested and stored before the first auto-HSCT, stem cells need to be remobilized. Patients diagnosed with MM who following relapse after auto-HSCT, had remobilization and afterward, auto-HSCT with remobilized cells were included in this retrospective analysis. Thirty-three patients, 61% males, the median age 61 years, were included. With a median follow-up of 1.8 years, 2-year progression-free survival was 56.2%, non-relapse mortality 4.8%. The 2-year cumulative incidence of t-MDS was 4.9%. Factors important for the outcome were: the quality of response, previous radiotherapy, the time between the first and salvage auto-HSCT. To conclude, salvage auto-HSCT performed with cells procured after the previous auto-HSCT can be efficacious in relapsed MM, especially if a sufficiently long response had been obtained to the first auto-HSCT(s).
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Affiliation(s)
- Joanna Drozd-Sokołowska
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Anna Waszczuk-Gajda
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Przemysław Biecek
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Katarzyna Kobylińska
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Joanna Mańko
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland.,Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Iwona Hus
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.,Department of Clinical Transplantology, Medical University of Lublin, Lublin, Poland
| | | | - Mateusz Nowicki
- Department of Hematology, Copernicus Memorial Hospital in Lodz Comprehensive Cancer Center and Traumatology, Lodz, Poland
| | - Joanna Romejko-Jarosińska
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Magdalena Kozioł
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Mariola Sędzimirska
- Lower Silesian Center for Cellular Transplantation with National Bone Marrow Donor Registry, Wroclaw, Poland
| | - Wojciech Sachs
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Mądry
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Boguradzki
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Małgorzata Król
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Marek Hus
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Grzegorz Basak
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Jadwiga Dwilewicz-Trojaczek
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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6
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Ostrowska B, Szymczyk A, Olszewska-Szopa M, Romejko-Jarosińska J, Domańska-Czyż K, Dąbrowska-Iwanicka A, Tomczak W, Rybski S, Hus M, Wróbel T, Walewski J. Efficacy of siltuximab in the treatment of idiopathic multicentric castleman disease, the first Polish, real-world experience with long-term observation. Leuk Lymphoma 2021; 62:3031-3034. [PMID: 34159888 DOI: 10.1080/10428194.2021.1941926] [Citation(s) in RCA: 1] [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: 12/16/2022]
Affiliation(s)
- Beata Ostrowska
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Agnieszka Szymczyk
- Department of Haematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | | | - Joanna Romejko-Jarosińska
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Katarzyna Domańska-Czyż
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Anna Dąbrowska-Iwanicka
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Waldemar Tomczak
- Department of Haematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Sebastian Rybski
- Mathematical Oncology Unit, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Marek Hus
- Department of Haematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Tomasz Wróbel
- Department of Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Jan Walewski
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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7
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Drozd-Sokołowska J, Waszczuk-Gajda A, Topczewska M, Mańko J, Hus I, Szmigielska-Kapłon A, Nowicki M, Grygoruk-Wiśniowska I, Krawczyk-Kuliś M, Romejko-Jarosińska J, Frączak E, Wróbel T, Piątkowska-Jakubas B, Mądry K, Boguradzki P, Król M, Kozioł M, Hus M, Kopińska A, Dmoszyńska A, Basak GW, Dwilewicz-Trojaczek J. Stem cell mobilization in multiple myeloma patients relapsing after previous autologous hematopoietic stem cell transplantation: A multicenter report by the Polish Myeloma Study Group. J Clin Apher 2021; 36:443-453. [PMID: 33592119 DOI: 10.1002/jca.21885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 12/05/2020] [Accepted: 02/01/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Salvage autologous hematopoietic stem cell transplantation (autoHSCT) may be used to treat relapse of multiple myeloma occurring after previous autoHSCT. When insufficient number of hematopoietic stem cells was stored from the initial harvest, remobilization of stem cells is necessary. PURPOSE The analysis of stem cell remobilization after previous autoHSCT. PATIENTS AND METHODS Fifty-eight patients, 60% males, median 59 years, were included. Median time interval between autoHSCT and remobilization was 42 months. The first remobilization was performed mostly after chemotherapy: cyclophosphamide (33%), cytarabine (43%), and etoposide (19%). RESULTS The first remobilization was successful in 67% patients. About 19% patients required plerixafor rescue, among whom it allowed for successful harvesting in 14%. Use of cyclophosphamide, cytarabine, and etoposide allowed for successful remobilization in 53%, 84%, and 55% patients, respectively. Patients treated with cytarabine had the highest yield of CD34+ cells (median 7.5 × 106 /kg vs 5.8 and 2.4 for etoposide and cyclophosphamide, P = .001). Higher percentage of patients was able to collect ≥2 × 106 CD34+ cells/kg during one leukapheresis after cytarabine (76% vs 21% for cyclophosphamide vs 36% for etoposide, P = .001). Cytarabine use was associated with lower risk of remobilization failure OR = 0.217, P = .02. Toxicity comprised mostly hematological toxicity (thrombocytopenia and neutropenia). One patient succumbed to septic shock. CONCLUSION Remobilization after previous autoHSCT is feasible only in a proportion of patients. Cytarabine is associated with the highest rate of successful mobilization and the highest yield of mobilized CD34+ cells. The toxicity requires careful surveillance of these patients.
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Affiliation(s)
- Joanna Drozd-Sokołowska
- Department of Hematology, Transplantation and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Anna Waszczuk-Gajda
- Department of Hematology, Transplantation and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Topczewska
- Faculty of Computer Science, Bialystok University of Technology, Bialystok, Poland
| | - Joanna Mańko
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland.,Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Iwona Hus
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland.,Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | - Mateusz Nowicki
- Department of Hematology, Copernicus Memorial Hospital in Lodz Comprehensive Cancer Center and Traumatology, Lodz, Poland
| | - Iwona Grygoruk-Wiśniowska
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, Katowice, Poland
| | - Małgorzata Krawczyk-Kuliś
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, Katowice, Poland.,Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Institute-Cancer Center, Gliwice, Poland
| | - Joanna Romejko-Jarosińska
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Ewa Frączak
- Department of Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Tomasz Wróbel
- Department of Hematology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Krzysztof Mądry
- Department of Hematology, Transplantation and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Boguradzki
- Department of Hematology, Transplantation and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Małgorzata Król
- Department of Hematology, Transplantation and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Kozioł
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Marek Hus
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Anna Kopińska
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, Katowice, Poland
| | - Anna Dmoszyńska
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Grzegorz Władysław Basak
- Department of Hematology, Transplantation and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Jadwiga Dwilewicz-Trojaczek
- Department of Hematology, Transplantation and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
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8
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Waszczuk-Gajda A, Drozd-Sokołowska J, Basak GW, Piekarska A, Mensah-Glanowska P, Sadowska-Klasa A, Wierzbowska A, Rzepecki P, Tomaszewska A, Mańko J, Hus M, Adamska M, Romejko-Jarosińska J, Dybko J, Biernat M, Kyrcz-Krzemień S, Sędzimirska M, Winciorek N, Jędrzejczak WW, Styczyński J, Giebel S, Gil L. Infectious Complications in Patients With Multiple Myeloma After High-Dose Chemotherapy Followed by Autologous Stem Cell Transplant: Nationwide Study of the Infectious Complications Study Group of the Polish Adult Leukemia Group. Transplant Proc 2020; 52:2178-2185. [PMID: 32217016 DOI: 10.1016/j.transproceed.2020.02.068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 02/13/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Multiple myeloma (MM) has become a chronic disease in majority of patients, and remission consolidation with autologous hematopoietic stem cell transplant (ASCT) remains the backbone of treatment in transplant-eligible patients. OBJECTIVE The aim of this multicenter cross-sectional nationwide retrospective study was to evaluate the epidemiology, etiology, and outcome of infections in patients with MM undergoing ASCT in 13 Polish transplant centers, carried out on behalf of the Infectious Complications Study Group of the Polish Adult Leukemia Group. METHODS A total number of consecutive 1374 patients with MM treated in Polish adult transplant centers from 2012 to 2014 were followed for infectious complications up to day +100 after ASCT in nationwide study. RESULTS Altogether 490 infection episodes in 336 patients (49% male, aged 21-72 years) were reported, including 145 episodes of neutropenic fever (103 patients) and 34 episodes of clinically documented infections (CDIs) (27 patients). Among microbiologically confirmed infections there were 251 episodes of bacterial infections (180 patients), 42 episodes of fungal infections (38 patients), and 18 episodes of viral infections (17 patients). The overall incidence of infections reached 13.1% for bacterial, 3.6% for fungal, and 1.3% for viral infections. There were 16 cases of infection-related deaths after ASCT (1.2%). The mortality risk factors included multidrug-resistant bacteria etiology (odds ratio [OR], 3.5; P = .033), coexistence of bacterial and fungal infection (OR, 6.3; P = .002), and CDI (OR, 5.5; P = .007). CONCLUSION ASCT in patients with MM was connected with low risk of life-threatening infections. However, multidrug-resistant bacteria bacterial etiology, mixed etiology, and CDI increased the risk of fatal outcome.
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Affiliation(s)
- Anna Waszczuk-Gajda
- Department of Hematology, Oncology, and Internal Medicine, Medical University of Warsaw, Poland.
| | - Joanna Drozd-Sokołowska
- Department of Hematology, Oncology, and Internal Medicine, Medical University of Warsaw, Poland
| | | | | | | | | | | | - Piotr Rzepecki
- Military Institute of Medicine, Department of Hematology, Warsaw, Poland
| | - Agnieszka Tomaszewska
- Department of Hematology, Oncology, and Internal Medicine, Medical University of Warsaw, Poland; Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | - Marek Hus
- Medical University of Lublin, Lublin, Poland
| | | | - Joanna Romejko-Jarosińska
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw Branch, Department of Lymphoid Diseases, Warsaw, Poland
| | | | | | | | - Mariola Sędzimirska
- Lower Silesian Center for Cellular Transplantation and National Bone Marrow Donor Bank, Wroclaw, Poland
| | - Natalia Winciorek
- Lower Silesian Center for Cellular Transplantation and National Bone Marrow Donor Bank, Wroclaw, Poland
| | | | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz
| | - Sebastian Giebel
- Maria Sklodowska-Curie Institute Cancer Center, Gliwice Branch, Gliwice, Poland
| | - Lidia Gil
- Poznan University of Medical Sciences, Poznan, Poland
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9
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Czyż J, Jurczyszyn A, Szudy-Szczyrek A, Koclęga A, Jachalska A, Dzierżak-Mietła M, Puła B, Jamroziak K, Usnarska-Zubkiewicz L, Gil L, Romejko-Jarosińska J, Waszczuk-Gajda A. Autologous stem cell transplantation in the treatment of multiple myeloma with 17p deletion. Pol Arch Intern Med 2020; 130:106-111. [PMID: 31933484 DOI: 10.20452/pamw.15139] [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: 11/23/2022]
Abstract
INTRODUCTION Deletion of chromosome 17p [del(17p)] in patients with multiple myeloma is associated with a poor prognosis. High‑dose chemotherapy followed by autologous stem cell transplantation (ASCT) remains the standard of treatment in this population. OBJECTIVES The aim of the study was to compare the treatment outcomes with high‑dose chemotherapy and ASCT with standard treatment in patients with del(17p). PATIENTS AND METHODS We collected data from 12 Polish centers between 2011 and 2017. The records of 97 patients with p53 deletion were assessed, including 29 individuals treated with ACST and 68 receiving standard treatment alone. RESULTS During the follow‑up, 45 patients died and the overall survival (OS) for the whole group was 33 months (range, 1-66 months), with a median progression‑free survival (PFS) of 13 months (range, 1-46 months). The prognostic factors of OS in a multivariable analysis were calcium levels at diagnosis within the reference range (hazard ratio [HR], 0.24; 95% CI, 0.12-0.48) and at least partial remission achieved after the first‑line treatment (HR, 0.25; 95% CI, 0.12-0.51). Treatment with ASCT was an important factor in improving survival (HR, 3.23; 95% CI, 1.52-6.84). Abnormal kidney function at the time of diagnosis reduced the PFS (HR, 0.46; 95% CI, 0.22-0.94). When the analysis was limited only to patients who could be candidates for ASCT, the survival benefit of the procedure was lost (P = 0.21). CONCLUSIONS Patients with multiple myeloma with del(17p) do not benefit from high‑dose chemotherapy followed by ACST.
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Affiliation(s)
- Jarosław Czyż
- Department of Hematology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland.
| | - Artur Jurczyszyn
- Department of Clinical Hematology, Jagiellonian University Medical College, Kraków, Poland
| | - Aneta Szudy-Szczyrek
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Anna Koclęga
- Department of Bone Marrow Transplantation and Hematology-Oncology, Center of Oncology in Gliwice, Gliwice, Poland
| | - Anna Jachalska
- Department of Hematology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Monika Dzierżak-Mietła
- Department of Bone Marrow Transplantation and Hematology-Oncology, Center of Oncology in Gliwice, Gliwice, Poland
| | - Bartosz Puła
- Institute of Hematology and Transfusion Medicine in Warsaw, Warsaw, Poland
| | | | - Lidia Usnarska-Zubkiewicz
- Chair and Department of Hematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Wrocław, Poland
| | - Lidia Gil
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Science, Poznań, Poland
| | - Joanna Romejko-Jarosińska
- Department of Lymphoma, The Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Anna Waszczuk-Gajda
- Department of Hematology, Oncology and Internal Disease, Medical University of Warsaw, Warsaw, Poland
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10
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Walewski J, Paszkiewicz-Kozik E, Michalski W, Rymkiewicz G, Szpila T, Butrym A, Giza A, Zaucha JM, Kalinka-Warzocha E, Wieczorkiewicz A, Zimowska-Curyło D, Knopińska-Posłuszny W, Tyczyńska A, Romejko-Jarosińska J, Dąbrowska-Iwanicka A, Gruszecka B, Jamrozek-Jedlińska M, Borawska A, Hołda W, Porowska A, Romanowicz A, Hellmann A, Stella-Hołowiecka B, Deptała A, Jurczak W. First-line R-CVP versus R-CHOP induction immunochemotherapy for indolent lymphoma with rituximab maintenance. A multicentre, phase III randomized study by the Polish Lymphoma Research Group PLRG4. Br J Haematol 2019; 188:898-906. [PMID: 31792945 PMCID: PMC7154735 DOI: 10.1111/bjh.16264] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 08/12/2019] [Accepted: 10/01/2019] [Indexed: 12/12/2022]
Abstract
R‐CVP (cyclophosphamide, vincristine, prednisone) and R‐CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone + rituximab) are immunochemotherapy regimens frequently used for remission induction of indolent non‐Hodgkin lymphomas (iNHLs). Rituximab maintenance (RM) significantly improves progression‐free survival (PFS) in patients with complete/partial remission (CR/PR). Here we report the final results of a randomized study comparing R‐CVP to R‐CHOP both followed by RM. Untreated patients in need of systemic therapy with symptomatic and progressive iNHLs including follicular (FL) and marginal zone lymphoma (MZL), mucosa‐associated lymphoid tissue (MALT), small lymphocytic (SLL), and lymphoplasmacytic (LPL) lymphoma were eligible. Patients were randomized to receive R‐CVP or R‐CHOP for eight cycles or until complete response (CR). All patients with CR/PR (partial response) received RM 375 mg/m2 q 2 months for 12 cycles. Primary endpoint was event‐free survival (EFS). Two‐hundred and fifty patients [FL 42%, MZL/MALT 38%, LPL/ Waldenström Macroglobulinaemia (WM) 11%, SLL 9%] were enrolled and randomized (R‐CHOP: 127, R‐CVP: 123). Median age was 56 years (21–85), 44% were male, 90% were in stage III–IV, 43% of FL patients had a Follicular Lymphoma International Prognostic Index (FLIPI) score ≥3, and 33·4% of all patients had an IPI score ≥3. At the end of induction treatment, the CR/PR rate was 43·6/50·9% and 36·3/60·8% in the R‐CHOP and R‐CVP groups (P = 0·218) respectively. After a median follow‐up of 67, 66, and 70 months, five‐year EFS was 61% vs. 56% (not significant), progression‐free survival (PFS) was 71% vs. 69% (not significant) and overall survival (OS) was 84% vs. 89% in the R‐CHOP vs. the R‐CVP arm respectively. Grade III/IV adverse events (65 vs. 22) occurred in 40 (33·1%) and 18 (15·3%) patients, P = 0·001; neutropenia in 16 (11·6%) and 4 (3·4%) patients, P = 0·017; infection in 14 (10·7%) and 3 (2·5%) patients,; P = 0·011; and a second neoplasm in three versus seven patients., in the R‐CHOP and the R‐CVP groups respectively. This multicentre randomized study with >five‐year follow‐up shows similar outcome in patients with indolent lymphoma in need of systemic therapy treated with R‐CVP or R‐CHOP immunochemotherapy and rituximab maintenance in both arms. The minor toxicity of the R‐CVP regimen makes it a reasonable choice for induction treatment, leaving other active agents like doxorubicin or bendamustin for second‐line therapy.
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Affiliation(s)
- Jan Walewski
- Maria Sklodowska-Curie Institute - Oncology Center in Warsaw, Warsaw, Poland
| | | | - Wojciech Michalski
- Maria Sklodowska-Curie Institute - Oncology Center in Warsaw, Warsaw, Poland
| | - Grzegorz Rymkiewicz
- Maria Sklodowska-Curie Institute - Oncology Center in Warsaw, Warsaw, Poland
| | - Tomasz Szpila
- Institute of Hematology and Transfusiology, Warsaw, Poland
| | | | - Agnieszka Giza
- Jagiellonian University Collegium Medicum, Krakow, Poland
| | | | | | | | | | | | | | | | | | | | | | - Anna Borawska
- Maria Sklodowska-Curie Institute - Oncology Center in Warsaw, Warsaw, Poland
| | | | | | | | | | | | - Andrzej Deptała
- Central Clinical Hospital of the MSWiA, Warsaw, Poland.,Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Jurczak
- Maria Sklodowska-Curie Institute - Oncology Center in Warsaw, Warsaw, Poland
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11
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Paszkiewicz-Kozik E, Michalski W, Taszner M, Knopińska-Posłuszny W, Mordak-Domagała M, Najda J, Borawska A, Romejko-Jarosińska J, Chełstowska M, Świerkowska M, Dąbrowska-Iwanicka A, Malenda A, Druzd-Sitek A, Konecki R, Kuniega B, Osowiecki M, Ostrowska B, Szpila T, Domańska-Czyż K, Szymański M, Targoński Ł, Poplawska L, Kotarska M, Giebel S, Lange A, Pluta A, Warzocha K, Zaucha J, Rymkiewicz G, Walewski J. OFATUMUMAB WITH IVAC FOR DLBCL PATIENTS WHO FAILED R-CHOP AND WERE NOT CANDIDATES FOR HIGH-DOSE THERAPY AND ASCT - PHASE 2 TRIAL OF THE POLISH LYMPHOMA RESEARCH GROUP (PLRG-8). Hematol Oncol 2019. [DOI: 10.1002/hon.111_2631] [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: 11/07/2022]
Affiliation(s)
- E. Paszkiewicz-Kozik
- Department of Lymphoid Malignancies; Maria Sklodowska-Curie Institute - Oncology Center; Warszawa Poland
| | - W. Michalski
- Biostatistics Unit; Maria Sklodowska-Curie Institute - Oncology Center; Warsaw Poland
| | - M. Taszner
- Hematology Department; Medical University; Gdansk Poland
| | - W. Knopińska-Posłuszny
- Hematology Department; Independent Public Health Care of the Ministry of the Internal Affairs with the Oncology Centre; Olsztyn Poland
| | - M. Mordak-Domagała
- Hematology Department; Lower Silesia Cell Transplantation Center; Wroclaw Poland
| | - J. Najda
- Hematology Department; Maria Sklodowska-Curie Institute - Oncology Center; Gliwice Poland
| | - A. Borawska
- Department of Lymphoid Malignancies; Maria Sklodowska-Curie Institute - Oncology Center; Warszawa Poland
| | - J. Romejko-Jarosińska
- Department of Lymphoid Malignancies; Maria Sklodowska-Curie Institute - Oncology Center; Warszawa Poland
| | - M. Chełstowska
- Lymphoma Department; Institute of Hematology and Transfusiology; Warszawa Poland
| | - M. Świerkowska
- Department of Lymphoid Malignancies; Maria Sklodowska-Curie Institute - Oncology Center; Warszawa Poland
| | - A. Dąbrowska-Iwanicka
- Department of Lymphoid Malignancies; Maria Sklodowska-Curie Institute - Oncology Center; Warszawa Poland
| | - A. Malenda
- Lymphoma Department; Institute of Hematology and Transfusiology; Warszawa Poland
| | - A. Druzd-Sitek
- Department of Lymphoid Malignancies; Maria Sklodowska-Curie Institute - Oncology Center; Warszawa Poland
| | - R. Konecki
- Department of Lymphoid Malignancies; Maria Sklodowska-Curie Institute - Oncology Center; Warszawa Poland
| | - B. Kuniega
- Hematology Department; Oncology Centre of the Podkarpackie Province; Brzozów Poland
| | - M. Osowiecki
- Department of Lymphoid Malignancies; Maria Sklodowska-Curie Institute - Oncology Center; Warszawa Poland
| | - B. Ostrowska
- Department of Lymphoid Malignancies; Maria Sklodowska-Curie Institute - Oncology Center; Warszawa Poland
| | - T. Szpila
- Lymphoma Department; Institute of Hematology and Transfusiology; Warszawa Poland
| | - K. Domańska-Czyż
- Department of Lymphoid Malignancies; Maria Sklodowska-Curie Institute - Oncology Center; Warszawa Poland
| | - M. Szymański
- Department of Lymphoid Malignancies; Maria Sklodowska-Curie Institute - Oncology Center; Warszawa Poland
| | - Ł. Targoński
- Department of Lymphoid Malignancies; Maria Sklodowska-Curie Institute - Oncology Center; Warszawa Poland
| | - L. Poplawska
- Department of Lymphoid Malignancies; Maria Sklodowska-Curie Institute - Oncology Center; Warszawa Poland
| | - M. Kotarska
- Department of Lymphoid Malignancies; Maria Sklodowska-Curie Institute - Oncology Center; Warszawa Poland
| | - S. Giebel
- Hematology Department; Maria Sklodowska-Curie Institute - Oncology Center; Gliwice Poland
| | - A. Lange
- Hematology Department; Lower Silesia Cell Transplantation Center; Wroclaw Poland
| | - A. Pluta
- Hematology Department; Oncology Centre of the Podkarpackie Province; Brzozów Poland
| | - K. Warzocha
- Lymphoma Department; Institute of Hematology and Transfusiology; Warszawa Poland
| | - J. Zaucha
- Oncology Department; Maritime Hospital; Gdynia Poland
| | - G. Rymkiewicz
- Pathology Department; Maria Sklodowska-Curie Institute - Oncology Center; Warszawa Poland
| | - J. Walewski
- Department of Lymphoid Malignancies; Maria Sklodowska-Curie Institute - Oncology Center; Warszawa Poland
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12
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Długosz-Danecka M, Hus I, Puła B, Jurczyszyn A, Chojnacki T, Blajer-Olszewska B, Drozd-Sokołowska J, Raźny M, Romejko-Jarosińska J, Taszner M, Jurczak W. Pixantrone, etoposide, bendamustine, rituximab (P[R]EBEN) as an effective salvage regimen for relapsed/refractory aggressive non-Hodgkin lymphoma-Polish Lymphoma Research Group real-life analysis. Pharmacol Rep 2019; 71:473-477. [PMID: 31003160 DOI: 10.1016/j.pharep.2019.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/17/2018] [Revised: 01/30/2019] [Accepted: 02/04/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite a significant improvement in treatment outcomes, 30-40% of aggressive non-Hodgkin lymphomas (NHL) patients are refractory or relapse after the first line therapy. Half of them are not eligible to autologous stem cell transplantation (ASCT) due to failure of platinum-based salvage regimens. Pixantrone is conditionally approved in Europe in patients with R/R aggressive NHL failing at least 2 previous lines of therapy. Polish Lymphoma Research Group (PLRG) evaluated the efficacy and tolerability of P[R]EBEN combining pixantrone, etoposide, bendamustine with or without rituximab), a new regimen developed recently by Francesco d'Amore, in real-life experience. METHODS In this retrospective audit, we analyzed the data of consecutive 25 R/R NHL cases, treated with P[R]EBEN regimen in 9 PLRG centers. Safety and efficacy data, including adverse reactions (AE), response rates, progression-free and overall survival (PFS and OS) were collected. RESULTS Overall response rate (ORR) to P[R]EBEN regimen was 68% (40% CR and 28% PR). Most patients responded, relatively early, by second cycle of therapy. P[R]EBEN was effective in 8 out of 15 patients (53%) refractory to previous platinum-based salvage regimens. In 4 patients (16%) stabilization of disease (SD) during therapy was observed and further 4 patients (16%) progressed during the treatment (PD). Response rates were higher in patients, chemosensitive to their prior regimen (ORR - 87.5%, including 50% CR). At the median follow-up of 7.5 months (range 1-16) the median PFS and OS were not reached. Projected PFS and OS at 12 months are 68% and 78% respectively. The P[R]EBEN regimen was well tolerated and most of patients received it as out-patients. AEs grade ≥3 occurred in 17 patients (68%). Most common grade 3-4 AEs were due to hematological toxicity with febrile neutropenia observed in 5 patients (20%). There were no episodes of septic deaths. Six patients (24%) died during treatment and follow-up period, all of them due to lymphoma progression. CONCLUSION Our data suggest good efficiency and tolerability of P[R]EBEN regimen as a rescue therapy in patients with R/R aggressive NHL.
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Affiliation(s)
| | - Iwona Hus
- Department of Clinical Transplantology, Medical University of Lublin, Lublin, Poland.
| | - Bartosz Puła
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warszawa, Poland
| | - Artur Jurczyszyn
- Department of Hematology, Jagiellonian University, Kraków, Poland
| | - Tomasz Chojnacki
- Department of Hematology, Military Institute of Medicine, Warszawa, Poland
| | | | - Joanna Drozd-Sokołowska
- Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Warszawa, Poland
| | - Małgorzata Raźny
- Department of Hematology, Rydygier Memorial Hospital, Kraków, Poland
| | - Joanna Romejko-Jarosińska
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie Centre of Oncology and Institute, Warszawa, Poland
| | - Michał Taszner
- Department of Hematology and Transplantology, Medical University of Gdansk, Gdańsk, Poland
| | - Wojciech Jurczak
- Department of Hematology, Jagiellonian University, Kraków, Poland
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Walewski J, Kraszewska E, Mioduszewska O, Romejko-Jarosińska J, Hellmann A, Czyz J, Hołowiecki J, Kopera M, Grosicki S, Komarnicki M, Rumianowski L, Kuliczkowski K, Wróbel T, Dwilewicz-Trojaczek J, Robak T, Warzocha K, Załuski J, Wójcik E, Dmoszyńska A, Walter-Croneck A. Rituximab (Mabthera, Rituxan) in patients with recurrent indolent lymphoma: evaluation of safety and efficacy in a multicenter study. Med Oncol 2002; 18:141-8. [PMID: 11778760 DOI: 10.1385/mo:18:2:141] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [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: 11/11/2022]
Abstract
The objective of this multiinstitutional study was to evaluate the safety and efficacy of rituximab at standard four weekly doses in patients with recurrent indolent lymphoma. Thirty-eight patients entered into this study, 63% had follicular lymphoma and 61% had an IPI score of 2 or more. Median disease duration was 3 yr, median number of prior treatments was three, and 66% of patients responded to the immediate past treatment with a median remission duration of 3 mo. A total of 158 antibody doses were given, including two patients who received two courses of four infusions each. One patient developed acute respiratory failure after the second dose and required assisted ventilation. There was no immediate relationship to the antibody infusion and no evidence of infection. This complication resolved and the patient successfully completed the full course of the antibody treatment. Another patient discontinued therapy after the second dose owing to intolerable fever and painful erythema. Sixty percent of the first, and 20% of subsequent rituximab infusions were associated with infusion-related reactions including mild fever, chills, and occasional skin eruptions. Complete and partial responses were achieved in 24% and 35% of 34 evaluable patients, respectively, for an overall response rate of 59%. The median time to progression/relapse in responding patients was 16 mo (95% CI, 6.4, 25.6) compared with a median of 3 mo duration of response to the immediate previous therapy in these patients. Longer response duration post rituximab monotherapy than with previous treatment in this series of heavily pretreated patients suggests a major role for the antibody in the therapy of patients with indolent lymphoma.
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Affiliation(s)
- J Walewski
- The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warszawa, Poland.
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Walewski J, Krzyzanowska JB, Kraszewska E, Lampka E, Romejko-Jarosińska J, Miśkiewicz Z, Meder J. CN3OP: an active regimen in patients with relapsed/refractory Hodgkin's lymphoma. Med Oncol 2000; 17:195-202. [PMID: 10962530 DOI: 10.1007/bf02780528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 10/22/2022]
Abstract
Patients with recurrent or refractory Hodgkin's and non-Hodgkin's lymphoma are increasingly being treated with high-dose therapy and hematopoietic cell transplantation. As minimal disease status at the time of transplant has been a repeatedly proven significant prognostic factor for long-term survival, effective initial cytoreduction is an important step in the process. Modern chemotherapy programs for Hodgkin's lymphoma include virtually all active agents and little is left for effective salvage. Mitoxantrone is an active agent in lymphoma that is not generally used in first-line treatment. The aim of this study was to determine toxicity and response rate to CN3OP (fractionated mitoxantrone 6 mg/m2 on days 1, 2, and 3, combined with standard dose cyclophosphamide, vincristine, and prednisone) in 44 patients with relapsed or refractory lymphoma. Most of patients had advanced disease and one or more extranodal sites at relapse. Median response duration to immediate past therapy was four months, and one third of patients had not responded to prior treatment. A median of 4 cycles of CN3OP were given per patient for a total of 173 cycles. Grade III-IV neutropenia occured in 53% of cycles, Grade I-III mucositis in 24%, and Grade I-III infection in 17% of cycles. Of 34 evaluable patients with Hodgkin's lymphoma 12 (35%) achieved complete remission (CR) and 15 (44%) partial remission (PR) for an overall response rate of 79%. Two of five evaluable non-Hodgkin's lymphoma patients responded with PR. Median overall survival and event free survival in the entire group was 29 months and 11 months respectively. At this time 16 patients have died; 12 of lymphoma, two of unknown cause and two of other causes. Complete response to CN3OP correlated with survival. CN3OP is an effective and safe regimen for cytoreduction in Hodgkin's lymphoma patients pretreated with doxorubicin/alkylator/etoposide-containing primary therapies.
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Affiliation(s)
- J Walewski
- Department of Lymphoproliferative Diseases, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, 5 W.K. Roentgen Street, Warszawa 02-781, Poland.
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Walewski J, Romejko-Jarosińska J, Zwoliński J, Falkowski S, Siedlecki P. Tolerability and efficacy of GM-CSF [Leucomax] in patients with small cell lung cancer treated with intensive chemotherapy. Med Oncol 1996; 13:199-205. [PMID: 9152970 DOI: 10.1007/bf02990932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 02/04/2023]
Abstract
The aim of this study was to evaluate tolerability and efficacy of Leucomax (Sandoz/Schering Plough) used for neutropenia in patients with small cell lung cancer (SCLC) treated with etoposide and cisplatin. The potential influence of granulocyte-macrophage colony stimulating factor (GM-CSF) on chemotherapy relative dose intensity (RDI) was also evaluated. The chemotherapy used was the following, cisplatin 50 mg m-2 i.v. 1 and 7 day, etoposide 170 mg m-2 i.v. 3-5 days, q 3-4 weeks. Patients received a median of six cycles (range 2-8) over 4-36 weeks (median: 20). Thirty-two consecutive patients were treated, six were excluded. Eleven patients received GM-CSF 5 micrograms kg-1 s.c. due to absolute neutrophil count (ANC), 1000/mm3 until recovery (ANC > 2000 mm3) or during 7 days, and thereafter prophylactically 24 hours post subsequent chemotherapy cycles for 7 days. Four patients received single GM-CSF course during the terminal disease phase. In 11 patients, there was no neutropenia requiring GM-CSF during the whole treatment course. Toxicity of chemotherapy was high, including thrombocytopenia, neutropenia, anaemia, mucositis, fever and hypotension. GM-CSF toxicity was the following, first dose reaction-one patient, local erythema-two patients, arthralgia-one patient, hypotension, chills, fever requiring GM-CSF discontinuation one patient RDI of cisplatin/etoposide was 0.77/0.62 in GM-CSF group, and 0.90/ 0.80 in patients who didn't receive Leucomax. Overall objective response rate to chemotherapy and complete response rate were 80% (21/26), 26% (7/26) and median survival of all patients was 10 months. Median disease free survival was 8 months. Four patients are alive, two patients lost during progression, 20 died. Administration of GM-CSF did not appear to improve RDI of chemotherapy, overall response rate (RR) nor survival in this phase I/II clinical study. RDI of chemotherapy was reduced in patients receiving GM-CSF due to thrombocytopenia and/or extrahaematologic toxicity of chemotherapy.
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Affiliation(s)
- J Walewski
- Department of Lymphoproliferative Diseases, Centre of Oncology-Maria Sklodowska-Curie Memorial Institute, Warsaw, Poland
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