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Saifi O, Rule WG, Lester SC, Laack NN, Breen W, Rosenthal A, Ansell SM, Habermann TM, Villasboas Bisneto J, Iqbal M, Alhaj Moustafa M, Tun H, Kharfan-Dabaja M, Peterson JL, Hoppe BS. The Role of Radiation Therapy in the Management of Gray Zone Lymphoma. Int J Radiat Oncol Biol Phys 2023; 117:e484-e485. [PMID: 37785532 DOI: 10.1016/j.ijrobp.2023.06.1711] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Gray zone lymphoma (GZL) is a relatively rare disease predominantly affecting young adults with purportedly poor outcomes with current treatment approaches. The role of radiation therapy (RT) in the management of GZL is not well established. This is the largest study to report on the outcomes of GZL patients treated with and without RT. MATERIALS/METHODS A retrospective review of 30 patients with GZL treated across 3 institutions from 2009 to 2021 was performed. Event-free survival (EFS) was defined from initiation of frontline chemotherapy (CHT) to disease progression/relapse, initiation of salvage therapy, or death. Local control (LC) was defined from RT start date to in-field recurrence. RESULTS The median age was 32 (range: 18-86) years, and 16 (53%) patients had early stage (I-II) disease. Bulky mediastinal disease was present in 63% of patients, and the median tumor diameter was 10 (range: 1.5-18) cm. Patients received ABVD (20%), RCHOP (33%), or REPOCH (47%) as frontline CHT. Among 25 patients with interim PET/CT scan, there were 6 rapid early responders and 14 slow early responders (SER), with 2-year EFS of 33% and 24%, respectively (p = 0.13). After the completion of CHT, 15 (50%) patients achieved complete response (CR) and 10 (33%) achieved partial response (PR), with 2-year EFS of 46% and 10%, respectively (p = 0.004). RT was given to 9 patients in CR (n = 3) or in PR (n = 6). The median RT dose was 36 (30.6-48.6) Gy, at 1.8-2 Gy/fraction. Those receiving RT had bulkier disease at diagnosis (p = 0.049) and lower rates of CR following CHT (p = 0.03). After RT, 3/6 (50%) PR patients converted to CR. At a median follow-up of 4 years, the 2-year EFS was 26% for all patients, 33% for RT and 23% for noRT (p = 0.44). Among patients who did not receive upfront RT and experienced progression (n = 17), 16 (94%) relapsed in pre-existing sites. The 5-year OS was 80% for all patients, 88% for RT and 78% for no RT (p = 0.63). Patients who achieved PR to CHT and received RT had better 2-year EFS (17% vs 0%, p = 0.007) compared to patients who did not receive RT. Similarly, patients with SER who received RT had superior 2-year EFS (33% vs 13%, p = 0.038). Patients with bulky mediastinal disease had a 2-year EFS of 43% with RT and 11% without RT (p = 0.08). After 1st line treatment, 22 (73%) patients relapsed and 18 were successfully salvaged with a sustained CR. The most common salvage regimen involved high dose CHT followed by hematopoietic cell transplantation (HCT) (n = 15). RT was given for 7 patients in the relapsed/refractory setting (consolidative peri-HCT n = 4; definitive salvage n = 3) and 5 (71%) achieved a sustained CR. Among the 16 patients who received RT in the upfront (n = 9) or salvage (n = 7) setting, 3 patients experienced in-field recurrence translating to 2-year LC of 79%. CONCLUSION GZL patients have high risk of relapse and maximal upfront combined modality therapy should be considered. RT provides good local control and improves EFS particularly for SER, PR, and bulky mediastinal disease.
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Affiliation(s)
- O Saifi
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - W G Rule
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - S C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - N N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - W Breen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - A Rosenthal
- Division of Hematology, Mayo Clinic, Phoenix, AZ
| | - S M Ansell
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - M Iqbal
- Division of Hematology, Mayo Clinic, Jacksonville, FL
| | | | - H Tun
- Division of Hematology, Mayo Clinic, Jacksonville, FL
| | | | - J L Peterson
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - B S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
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2
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Krull J, Wenzl K, Manske MK, Hopper MA, Larson MC, Sarangi V, Barman P, Serres MR, Khan S, Novak AJ, Maurer MJ, Yang Z, Rimsza L, Link BK, Habermann TM, Ansell SM, King RL, Cerhan JR, Novak JP. SOMATIC ALTERATIONS IN FOLLICULAR LYMPHOMA ASSOCIATE WITH UNIQUE TUMOR‐CELL TRANCRIPTIONAL STATES AND TUMOR‐IMMUNE MICROENVIRONMENTS. Hematol Oncol 2021. [DOI: 10.1002/hon.41_2879] [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: 11/07/2022]
Affiliation(s)
- J. Krull
- Mayo Clinic, Hematology Rochester Minnesota USA
| | - K. Wenzl
- Mayo Clinic, Hematology Rochester Minnesota USA
| | | | | | - M. C. Larson
- Mayo Clinic, Health Science Research Rochester Minnesota USA
| | - V. Sarangi
- Mayo Clinic, Health Science Research Rochester Minnesota USA
| | - P. Barman
- Mayo Clinic, Health Science Research Rochester Minnesota USA
| | | | - S. Khan
- Mayo Clinic, Hematology Rochester Minnesota USA
| | - A. J. Novak
- Mayo Clinic, Hematology Rochester Minnesota USA
| | - M. J. Maurer
- Mayo Clinic, Health Science Research Rochester Minnesota USA
| | - Z. Yang
- Mayo Clinic, Hematology Rochester Minnesota USA
| | - L. Rimsza
- Mayo Clinic Laboratory Medicine and Pathology Phoenix Arizona USA
| | - B. K. Link
- University of Iowa Hematology Iowa City Iowa USA
| | | | | | - R. L. King
- Mayo Clinic, Hematopathology Rochester Minnesota USA
| | - J. R. Cerhan
- Mayo Clinic, Health Science Research Rochester Minnesota USA
| | - J. P. Novak
- Mayo Clinic, Health Science Research Rochester Minnesota USA
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3
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Desai S, Laplant B, Macon W, Young J, King R, Wang Y, Inwards D, Micallef I, Johnston PB, Porrata LF, Ansell SM, Habermann TM, Witzig TE, Nowakowski GS. INTERIM PET/CT PREDICTS OUTCOMES OF DIFFUSE LARGE B‐CELL LYMPHOMA (DLBCL) TREATED WITH FRONTLINE LENALIDOMIDE/RCHOP (R2CHOP): LONG‐TERM ANALYSIS OF MC078E. Hematol Oncol 2021. [DOI: 10.1002/hon.83_2880] [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: 11/08/2022]
Affiliation(s)
- S. Desai
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - B. Laplant
- Mayo Clinic Department of Quantitative Health Sciences Rochester Minnesota USA
| | - W. Macon
- Mayo Clinic Department of Laboratory Medicine and Pathology Rochester Minnesota USA
| | - J. Young
- Mayo Clinic Division of Nuclear Medicine Department of Radiology Rochester Minnesota USA
| | - R. King
- Mayo Clinic Department of Laboratory Medicine and Pathology Rochester Minnesota USA
| | - Y. Wang
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - D. Inwards
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - I. Micallef
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - P. B. Johnston
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - L. F. Porrata
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - S. M. Ansell
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - T. M. Habermann
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - T. E. Witzig
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
| | - G. S. Nowakowski
- Mayo Clinic Division of Hematology Department of Medicine Rochester Minnesota USA
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4
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Maurer MJ, Habermann TM, Shi Q, Schmitz N, Cunningham D, Pfreundschuh M, Seymour JF, Jaeger U, Haioun C, Tilly H, Ghesquieres H, Merli F, Ziepert M, Herbrecht R, Flament J, Fu T, Flowers CR, Coiffier B. Progression-free survival at 24 months (PFS24) and subsequent outcome for patients with diffuse large B-cell lymphoma (DLBCL) enrolled on randomized clinical trials. Ann Oncol 2019; 29:1822-1827. [PMID: 29897404 DOI: 10.1093/annonc/mdy203] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Patients with diffuse large B-cell lymphoma treated with first-line anthracycline-based immunochemotherapy and remaining in remission at 2 years have excellent outcomes. This study assessed overall survival (OS) stratified by progression-free survival (PFS) at 24 months (PFS24) using individual patient data from patients with DLBCL enrolled in multi-center, international randomized clinical trials as part of the Surrogate Endpoint for Aggressive Lymphoma (SEAL) Collaboration. Patients and methods PFS24 was defined as being alive and PFS24 after study entry. OS from PFS24 was defined as time from identified PFS24 status until death due to any cause. OS was compared with each patient's age-, sex-, and country-matched general population using expected survival and standardized mortality ratios (SMRs). Results A total of 5853 patients enrolled in trials in the SEAL database received rituximab as part of induction therapy and were included in this analysis. The median age was 62 years (range 18-92), and 56% were greater than 60 years of age. At a median follow-up of 4.4 years, 1337 patients (23%) had disease progression, 1489 (25%) had died, and 5101 had sufficient follow-up to evaluate PFS24. A total of 1423 assessable patients failed to achieve PFS24 with a median OS of 7.2 months (95% CI 6.8-8.1) after progression; 5-year OS after progression was 19% and SMR was 32.1 (95% CI 30.0-34.4). A total of 3678 patients achieved PFS24; SMR after achieving PFS24 was 1.22 (95% CI 1.09-1.37). The observed OS versus expected OS at 3, 5, and 7 years after achieving PFS24 was 93.1% versus 94.4%, 87.6% versus 89.5%, and 80.0% versus 83.7%, respectively. Conclusion Patients treated with rituximab containing anthracycline-based immunochemotherapy on clinical trials who are alive without progression at 24 months from the onset of initial therapy have excellent outcomes with survival that is marginally lower but clinically indistinguishable from the age-, sex-, and country-matched background population for 7 years after achieving PFS24.
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Affiliation(s)
- M J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA.
| | | | - Q Shi
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | - N Schmitz
- Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Hospital St. Georg, Hamburg, Germany
| | - D Cunningham
- Department of Medicine, The Royal Marsden Hospital, Surrey, UK
| | - M Pfreundschuh
- Internal Medicine I, University of the Saarland, Homberg, Germany
| | - J F Seymour
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - U Jaeger
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - C Haioun
- Lymphoid Malignancies Unit, AP-HP Hôpital Henri Mondor, Créteil, France
| | - H Tilly
- Henri Becquerel Centre, University of Rouen, Rouen, France
| | - H Ghesquieres
- Department of Hematology, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - F Merli
- Hematology, Azienda Ospedaliera Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - M Ziepert
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - R Herbrecht
- Department of Oncology and Hematology, Hôpital de Hautepierre, Strasbourg, France
| | - J Flament
- Celgene Corporation, Boudry, Switzerland
| | - T Fu
- Celgene Corporation, Summit
| | - C R Flowers
- Department of Bone Marrow and Stem Cell Transplantation, Winship Cancer Institute of Emory University, Atlanta, USA
| | - B Coiffier
- Department of Hematology, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
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5
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Maurer MJ, Habermann TM. Reply to the letter to the editor 'Progression-free survival at 24 months (PFS24) and subsequent outcome for patients with diffuse large B-cell lymphoma (DLBCL) in the real-world setting' by van der Galiën et al. Ann Oncol 2019; 30:153. [PMID: 30395156 DOI: 10.1093/annonc/mdy492] [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: 11/14/2022] Open
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Witzig TE, LaPlant B, Habermann TM, McPhail E, Inwards DJ, Micallef IN, Colgan JP, Nowakowski GS, Ansell SM, Johnston PB. High rate of event-free survival at 24 months with everolimus/RCHOP for untreated diffuse large B-cell lymphoma: updated results from NCCTG N1085 (Alliance). Blood Cancer J 2017. [PMID: 28649983 PMCID: PMC5520404 DOI: 10.1038/bcj.2017.57] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- T E Witzig
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - B LaPlant
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - T M Habermann
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - E McPhail
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - D J Inwards
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - I N Micallef
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - J P Colgan
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - G S Nowakowski
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - S M Ansell
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
| | - P B Johnston
- Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA
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7
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Sfeir JG, Drake MT, LaPlant BR, Maurer MJ, Link BK, Berndt TJ, Shanafelt TD, Cerhan JR, Habermann TM, Feldman AL, Witzig T. Validation of a vitamin D replacement strategy in vitamin D-insufficient patients with lymphoma or chronic lymphocytic leukemia. Blood Cancer J 2017; 7:e526. [PMID: 28157213 PMCID: PMC5386343 DOI: 10.1038/bcj.2017.9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- J G Sfeir
- Division of Endocrinology, Diabetes, Metabolism and Nutrition Department of Internal Medicine Mayo Clinic, Rochester, MN, USA
| | - M T Drake
- Division of Endocrinology, Diabetes, Metabolism and Nutrition Department of Internal Medicine Mayo Clinic, Rochester, MN, USA
| | - B R LaPlant
- Division of Biomedical Statistics and Informatics Mayo Clinic, Rochester, MN, USA
| | - M J Maurer
- Division of Biomedical Statistics and Informatics Mayo Clinic, Rochester, MN, USA
| | - B K Link
- Holden Comprehensive Cancer Center University of Iowa, Iowa City, IA, USA
| | - T J Berndt
- Mayo Clinic Health Science Research, Rochester, MN, USA
| | - T D Shanafelt
- Mayo Clinic Cancer Center Mayo Clinic, Rochester, MN, USA
| | - J R Cerhan
- Mayo Clinic Health Science Research, Rochester, MN, USA
| | - T M Habermann
- Mayo Clinic Cancer Center Mayo Clinic, Rochester, MN, USA
| | - A L Feldman
- Department of Laboratory Medicine and Pathology Mayo Clinic, Rochester, MN, USA
| | - T Witzig
- Mayo Clinic Cancer Center Mayo Clinic, Rochester, MN, USA
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8
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Novak AJ, Asmann YW, Maurer MJ, Wang C, Slager SL, Hodge LS, Manske M, Price-Troska T, Yang ZZ, Zimmermann MT, Nowakowski GS, Ansell SM, Witzig TE, McPhail E, Ketterling R, Feldman AL, Dogan A, Link BK, Habermann TM, Cerhan JR. Whole-exome analysis reveals novel somatic genomic alterations associated with outcome in immunochemotherapy-treated diffuse large B-cell lymphoma. Blood Cancer J 2015; 5:e346. [PMID: 26314988 PMCID: PMC4558593 DOI: 10.1038/bcj.2015.69] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/21/2015] [Indexed: 01/14/2023] Open
Abstract
Lack of remission or early relapse remains a major clinical issue in diffuse large B-cell lymphoma (DLBCL), with 30% of patients failing standard of care. Although clinical factors and molecular signatures can partially predict DLBCL outcome, additional information is needed to identify high-risk patients, particularly biologic factors that might ultimately be amenable to intervention. Using whole-exome sequencing data from 51 newly diagnosed and immunochemotherapy-treated DLBCL patients, we evaluated the association of somatic genomic alterations with patient outcome, defined as failure to achieve event-free survival at 24 months after diagnosis (EFS24). We identified 16 genes with mutations, 374 with copy number gains and 151 with copy number losses that were associated with failure to achieve EFS24 (P<0.05). Except for FOXO1 and CIITA, known driver mutations did not correlate with EFS24. Gene losses were localized to 6q21-6q24.2, and gains to 3q13.12-3q29, 11q23.1-11q23.3 and 19q13.12-19q13.43. Globally, the number of gains was highly associated with poor outcome (P=7.4 × 10−12) and when combined with FOXO1 mutations identified 77% of cases that failed to achieve EFS24. One gene (SLC22A16) at 6q21, a doxorubicin transporter, was lost in 54% of EFS24 failures and our findings suggest it functions as a doxorubicin transporter in DLBCL cells.
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Affiliation(s)
- A J Novak
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Y W Asmann
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - M J Maurer
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - C Wang
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - S L Slager
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - L S Hodge
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Manske
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Z-Z Yang
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M T Zimmermann
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - S M Ansell
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - T E Witzig
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - E McPhail
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - R Ketterling
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - A L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - A Dogan
- Departments of Pathology and Laboratory Medicine, Hematopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - B K Link
- Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - T M Habermann
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - J R Cerhan
- Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
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Asmann YW, Maurer MJ, Wang C, Sarangi V, Ansell SM, Feldman AL, Nowakowski GS, Manske M, Price-Troska T, Yang ZZ, Slager SL, Habermann TM, Cerhan JR, Novak AJ. Genetic diversity of newly diagnosed follicular lymphoma. Blood Cancer J 2014; 4:e256. [PMID: 25360902 PMCID: PMC4220653 DOI: 10.1038/bcj.2014.80] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Y W Asmann
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - M J Maurer
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - C Wang
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - V Sarangi
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - S M Ansell
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - M Manske
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Z-Z Yang
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S L Slager
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - T M Habermann
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - J R Cerhan
- Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - A J Novak
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
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Cozen W, Timofeeva MN, Li D, Diepstra A, Hazelett D, Delahaye-Sourdeix M, Edlund CK, Franke L, Rostgaard K, Van Den Berg DJ, Cortessis VK, Smedby KE, Glaser SL, Westra HJ, Robison LL, Mack TM, Ghesquieres H, Hwang AE, Nieters A, de Sanjose S, Lightfoot T, Becker N, Maynadie M, Foretova L, Roman E, Benavente Y, Rand KA, Nathwani BN, Glimelius B, Staines A, Boffetta P, Link BK, Kiemeney L, Ansell SM, Bhatia S, Strong LC, Galan P, Vatten L, Habermann TM, Duell EJ, Lake A, Veenstra RN, Visser L, Liu Y, Urayama KY, Montgomery D, Gaborieau V, Weiss LM, Byrnes G, Lathrop M, Cocco P, Best T, Skol AD, Adami HO, Melbye M, Cerhan JR, Gallagher A, Taylor GM, Slager SL, Brennan P, Coetzee GA, Conti DV, Onel K, Jarrett RF, Hjalgrim H, van den Berg A, McKay JD. A meta-analysis of Hodgkin lymphoma reveals 19p13.3 TCF3 as a novel susceptibility locus. Nat Commun 2014; 5:3856. [PMID: 24920014 PMCID: PMC4055950 DOI: 10.1038/ncomms4856] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 04/11/2014] [Indexed: 12/20/2022] Open
Abstract
Recent genome-wide association studies (GWAS) of Hodgkin lymphoma (HL) have identified associations with genetic variation at both HLA and non-HLA loci; however, much of heritable HL susceptibility remains unexplained. Here we perform a meta-analysis of three HL GWAS totaling 1,816 cases and 7,877 controls followed by replication in an independent set of 1,281 cases and 3,218 controls to find novel risk loci. We identify a novel variant at 19p13.3 associated with HL (rs1860661; odds ratio (OR)=0.81, 95% confidence interval (95% CI) = 0.76-0.86, P(combined) = 3.5 × 10(-10)), located in intron 2 of TCF3 (also known as E2A), a regulator of B- and T-cell lineage commitment known to be involved in HL pathogenesis. This meta-analysis also notes associations between previously published loci at 2p16, 5q31, 6p31, 8q24 and 10p14 and HL subtypes. We conclude that our data suggest a link between the 19p13.3 locus, including TCF3, and HL risk.
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Affiliation(s)
- W Cozen
- 1] USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90089-9175, USA [2]
| | - M N Timofeeva
- 1] International Agency for Research on Cancer (IARC), 69372 Lyon, France [2] Institute of Genetics and Molecular Medicine, University of Edinburgh, EH4 2XU Edinburgh, UK [3]
| | | | - A Diepstra
- 1] University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands [2]
| | - D Hazelett
- 1] USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90089-9175, USA [2]
| | - M Delahaye-Sourdeix
- 1] International Agency for Research on Cancer (IARC), 69372 Lyon, France [2]
| | - C K Edlund
- USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90089-9175, USA
| | - L Franke
- University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands
| | - K Rostgaard
- Statens Serum Institut, DK-2300 Copenhagen, Denmark
| | - D J Van Den Berg
- USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90089-9175, USA
| | - V K Cortessis
- USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90089-9175, USA
| | - K E Smedby
- Karolinska Institutet and Karolinska University Hospital, S-221 00 Stockholm, Sweden
| | - S L Glaser
- Cancer Prevention Institute of California, Fremont, California 94538, USA
| | - H-J Westra
- University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands
| | - L L Robison
- St Jude Children's Hospital, Cordova, Tennessee 38105, USA
| | - T M Mack
- USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90089-9175, USA
| | - H Ghesquieres
- Centre Léon Bérard, UMR CNRS 5239-Université Lyon 1, 69008 Lyon, France
| | - A E Hwang
- USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90089-9175, USA
| | - A Nieters
- University Medical Centre Freiburg, D-79085 Freiburg, Germany
| | - S de Sanjose
- IDIBELL Institut Català d'Oncologia, 8907 Barcelona, Spain
| | | | - N Becker
- German Cancer Research Centre, D-69120 Heidelberg, Germany
| | - M Maynadie
- CHU de Dijon, EA 4184, University of Burgundy, 21070 Dijon, France
| | - L Foretova
- Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic
| | - E Roman
- University of York, YO10 5DD York, UK
| | - Y Benavente
- IDIBELL Institut Català d'Oncologia, 8907 Barcelona, Spain
| | - K A Rand
- USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90089-9175, USA
| | - B N Nathwani
- City of Hope National Medical Center, Duarte, California 91010, USA
| | | | - A Staines
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - P Boffetta
- Icahn School of Medicine at Mount Sinai, New York City, New York 10029-6574, USA
| | - B K Link
- University of Iowa College of Medicine, Iowa City, Iowa 52242, USA
| | - L Kiemeney
- Radboud University Nijmegen Medical Centre, 6500HB Nijmegen, The Netherlands
| | - S M Ansell
- Mayo Clinic, Rochester, Minnesota 55905, USA
| | - S Bhatia
- City of Hope National Medical Center, Duarte, California 91010, USA
| | - L C Strong
- MD Anderson Cancer Center, University of Texas, Houston, Texas 77030, USA
| | - P Galan
- INSERM U557 (UMR Inserm; INRA; CNAM, Université Paris 13), 93017 Paris, France
| | - L Vatten
- Norwegian University of Science and Technology, NO-7491 Trondheim, Norway
| | | | - E J Duell
- IDIBELL Institut Català d'Oncologia, 8907 Barcelona, Spain
| | - A Lake
- MRC University of Glasgow Centre for Virus Research, Garscube Estate, University of Glasgow, G12 8QQ Glasgow, Scotland, UK
| | - R N Veenstra
- University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands
| | - L Visser
- University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands
| | - Y Liu
- University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands
| | - K Y Urayama
- Department of Human Genetics and Disease Diversity, Tokyo Medical and Dental University, Tokyo 104-0044, Japan
| | - D Montgomery
- MRC University of Glasgow Centre for Virus Research, Garscube Estate, University of Glasgow, G12 8QQ Glasgow, Scotland, UK
| | - V Gaborieau
- International Agency for Research on Cancer (IARC), 69372 Lyon, France
| | - L M Weiss
- Clarient Pathology Services, Aliso Viejo, California 92656, USA
| | - G Byrnes
- International Agency for Research on Cancer (IARC), 69372 Lyon, France
| | - M Lathrop
- Genome Quebec, Montreal, Canada H3A 0G1
| | - P Cocco
- Institute of Occupational Health, University of Cagliari, Monserrato, 09042 Cagliari, Italy
| | - T Best
- The University of Chicago, Chicago, Illinois 60637-5415, USA
| | - A D Skol
- The University of Chicago, Chicago, Illinois 60637-5415, USA
| | - H-O Adami
- 1] Karolinska Institutet and Karolinska University Hospital, S-221 00 Stockholm, Sweden [2] Harvard University School of Public Health, Boston, Massachusetts 02115, USA
| | - M Melbye
- Statens Serum Institut, DK-2300 Copenhagen, Denmark
| | - J R Cerhan
- Mayo Clinic, Rochester, Minnesota 55905, USA
| | - A Gallagher
- MRC University of Glasgow Centre for Virus Research, Garscube Estate, University of Glasgow, G12 8QQ Glasgow, Scotland, UK
| | - G M Taylor
- School of Cancer Sciences, University of Manchester, St Mary's Hospital, M13 0JH Manchester, UK
| | - S L Slager
- Mayo Clinic, Rochester, Minnesota 55905, USA
| | - P Brennan
- International Agency for Research on Cancer (IARC), 69372 Lyon, France
| | - G A Coetzee
- USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90089-9175, USA
| | - D V Conti
- USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90089-9175, USA
| | - K Onel
- 1] The University of Chicago, Chicago, Illinois 60637-5415, USA [2]
| | - R F Jarrett
- 1] MRC University of Glasgow Centre for Virus Research, Garscube Estate, University of Glasgow, G12 8QQ Glasgow, Scotland, UK [2]
| | - H Hjalgrim
- 1] Statens Serum Institut, DK-2300 Copenhagen, Denmark [2]
| | - A van den Berg
- 1] University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands [2]
| | - J D McKay
- 1] International Agency for Research on Cancer (IARC), 69372 Lyon, France [2]
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11
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Hong F, Habermann TM, Gordon LI, Hochster H, Gascoyne RD, Morrison VA, Fisher RI, Bartlett NL, Stiff PJ, Cheson BD, Crump M, Horning SJ, Kahl BS. The role of body mass index in survival outcome for lymphoma patients: US intergroup experience. Ann Oncol 2014; 25:669-674. [PMID: 24567515 PMCID: PMC4433526 DOI: 10.1093/annonc/mdt594] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 12/17/2013] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The role of body mass index (BMI) in survival outcomes is controversial among lymphoma patients. We evaluated the association between BMI at study entry and failure-free survival (FFS) and overall survival (OS) in three phase III clinical trials, among patients with diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL) and Hodgkin's lymphoma (HL). PATIENTS AND METHODS A total of 537, 730 and 282 patients with DLBCL, HL and FL were included in the analysis. Baseline patient and clinical characteristics, treatment received and clinical outcomes were compared across BMI categories. RESULTS Among patients with DLBCL, HL and FL, the median age was 70, 33 and 56; 29%, 29% and 37% were obese and 38%, 27% and 37% were overweight, respectively. Age was significantly different among BMI groups in all three studies. Higher BMI groups tended to have more favorable prognosis factors at study entry among DLBCL and HL patients. BMI was not associated with clinical outcome with P-values of 0.89, 0.30 and 0.40 for FFS, and 0.64, 0.67 and 0.09 for OS, for patients with DLBCL, HL and FL, respectively. The association remains non-significant after adjusting for other clinical factors in the Cox model. A subset analysis of males with DLBCL treated on R-CHOP revealed no differences in FFS (P = 0.48) or OS (P = 0.58). CONCLUSION BMI was not significantly associated with clinical outcomes among patients with DLBCL, HD or FL, in three prospective phase III clinical trials. The findings contradict some previous reports of similar investigations. Further work is required to understand the observed discrepancies.
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Affiliation(s)
- F Hong
- Dana Farber Cancer Institute, Boston, MA.
| | | | | | | | - R D Gascoyne
- British Columbia Cancer Agency, Vancouver, Canada
| | - V A Morrison
- University of Minnesota, VA Medical Center, Minneapolis, MN
| | - R I Fisher
- Fox Chase Cancer Center, Philadelphia, PA
| | | | | | - B D Cheson
- Georgetown University Hospital, Washington, DC, USA
| | - M Crump
- Princess Margaret Hospital, Toronto, Ontario, Canada
| | | | - B S Kahl
- University of Wisconsin, Madison, WI, USA
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12
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Evens AM, Choquet S, Kroll-Desrosiers AR, Jagadeesh D, Smith SM, Morschhauser F, Leblond V, Roy R, Barton B, Gordon LI, Gandhi MK, Dierickx D, Schiff D, Habermann TM, Trappe R. Primary CNS posttransplant lymphoproliferative disease (PTLD): an international report of 84 cases in the modern era. Am J Transplant 2013; 13:1512-22. [PMID: 23721553 DOI: 10.1111/ajt.12211] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 01/28/2013] [Accepted: 01/31/2013] [Indexed: 01/25/2023]
Abstract
We performed a multicenter, International analysis of solid organ transplant (SOT)-related primary central nervous system (PCNS) posttransplant lymphoproliferative disease (PTLD). Among 84 PCNS PTLD patients, median time of SOT-to-PTLD was 54 months, 79% had kidney SOT, histology was monomorphic in 83% and tumor was EBV+ in 94%. Further, 33% had deep brain involvement, 10% had CSF involvement, while none had ocular disease. Immunosuppression was reduced in 93%; additional first-line therapy included high-dose methotrexate (48%), high-dose cytarabine (33%), brain radiation (24%) and/or rituximab (44%). The overall response rate was 60%, while treatment-related mortality was 13%. With 42-month median follow-up, three-year progression-free survival (PFS) and overall survival (OS) were 32% and 43%, respectively. There was a trend on univariable analysis for improved PFS for patients who received rituximab and/or high-dose cytarabine. On multivariable Cox regression, poor performance status predicted inferior PFS (HR 2.61, 95% CI 1.32-5.17, p = 0.006), while increased LDH portended inferior OS (HR 4.16, 95% CI 1.29-13.46, p = 0.02). Moreover, lack of response to first-line therapy was the most dominant prognostic factor on multivariable analysis (HR 8.70, 95% CI 2.56-29.57, p = 0.0005). Altogether, PCNS PTLD appears to represent a distinct clinicopathologic entity within the PTLD spectrum that is associated with renal SOT, occurs late, is monomorphic and retains EBV positivity.
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Affiliation(s)
- A M Evens
- Division of Hematology/Oncology, The University of Massachusetts Medical School, Worcester, MA, USA.
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13
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Vaidya R, Habermann TM, Donohue JH, Ristow KM, Maurer MJ, Macon WR, Colgan JP, Inwards DJ, Ansell SM, Porrata LF, Micallef IN, Johnston PB, Markovic SN, Thompson CA, Nowakowski GS, Witzig TE. Bowel perforation in intestinal lymphoma: incidence and clinical features. Ann Oncol 2013; 24:2439-43. [PMID: 23704194 DOI: 10.1093/annonc/mdt188] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [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: 12/14/2022] Open
Abstract
BACKGROUND Perforation is a serious life-threatening complication of lymphomas involving the gastrointestinal (GI) tract. Although some perforations occur as the initial presentation of GI lymphoma, others occur after initiation of chemotherapy. To define the location and timing of perforation, a single-center study was carried out of all patients with GI lymphoma. PATIENTS AND METHODS Between 1975 and 2012, 1062 patients were identified with biopsy-proven GI involvement with lymphoma. A retrospective chart review was undertaken to identify patients with gut perforation and to determine their clinicopathologic features. RESULTS Nine percent (92 of 1062) of patients developed a perforation, of which 55% (51 of 92) occurred after chemotherapy. The median day of perforation after initiation of chemotherapy was 46 days (mean, 83 days; range, 2-298) and 44% of perforations occurred within the first 4 weeks of treatment. Diffuse large B-cell lymphoma (DLBCL) was the most common lymphoma associated with perforation (59%, 55 of 92). Compared with indolent B-cell lymphomas, the risk of perforation was higher with aggressive B-cell lymphomas (hazard ratio, HR = 6.31, P < 0.0001) or T-cell/other types (HR = 12.40, P < 0.0001). The small intestine was the most common site of perforation (59%). CONCLUSION Perforation remains a significant complication of GI lymphomas and is more frequently associated with aggressive than indolent lymphomas. Supported in part by University of Iowa/Mayo Clinic SPORE CA97274 and the Predolin Foundation.
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Affiliation(s)
- R Vaidya
- Department of Internal Medicine, Division of Hematology, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN 55905, USA
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14
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Eggers SDZ, Pittock SJ, Shepard NT, Habermann TM, Neff BA, Klebig RR. Positional periodic alternating vertical nystagmus with PCA-Tr antibodies in Hodgkin lymphoma. Neurology 2012; 78:1800-2. [PMID: 22592362 DOI: 10.1212/wnl.0b013e3182583085] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S D Z Eggers
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA.
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15
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Nowakowski GS, LaPlant B, Habermann TM, Rivera CE, Macon WR, Inwards DJ, Micallef IN, Johnston PB, Porrata LF, Ansell SM, Klebig RR, Reeder CB, Witzig TE. Lenalidomide can be safely combined with R-CHOP (R2CHOP) in the initial chemotherapy for aggressive B-cell lymphomas: phase I study. Leukemia 2011; 25:1877-81. [PMID: 21720383 DOI: 10.1038/leu.2011.165] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Lenalidomide was shown to have significant single-agent activity in relapsed aggressive non-Hodgkin's lymphoma (NHL). We conducted a phase I trial to establish the maximum tolerated dose of lenalidomide that could be combined with R-CHOP (rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone). Eligible patients were adults with newly diagnosed, untreated CD20 positive diffuse large cell or follicular grade III NHL. Patients received oral lenalidomide on days 1-10 with standard dose R-CHOP every 21 days. All patients received pegfilgrastim on day 2 of the cycle and aspirin prophylaxis. The lenalidomide dose levels tested were 15, 20 and 25 mg. A total of 24 patients were enrolled. The median age was 65 (35-82) years and 54% were over 60 years. Three patients received 15 mg, 3 received 20 mg and 18 received 25 mg of lenalidomide. No dose limiting toxicity was found, and 25 mg on days 1-10 is the recommended dose for phase II. The incidence of grade IV neutropenia and thrombocytopenia was 67% and 21%, respectively. Febrile neutropenia was rare (4%) and there were no toxic deaths. The overall response rate was 100% with a complete response rate of 77%. Lenalidomide at the dose of 25 mg/day administered on days 1 to 10 of 21-day cycle can be safely combined with R-CHOP in the initial chemotherapy of aggressive B-cell lymphoma.
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Affiliation(s)
- G S Nowakowski
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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16
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Wilcox RA, Ristow K, Habermann TM, Inwards DJ, Micallef INM, Johnston PB, Colgan JP, Nowakowski GS, Ansell SM, Witzig TE, Markovic SN, Porrata L. The absolute monocyte and lymphocyte prognostic score predicts survival and identifies high-risk patients in diffuse large-B-cell lymphoma. Leukemia 2011; 25:1502-9. [PMID: 21606957 DOI: 10.1038/leu.2011.112] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite the use of modern immunochemotherapy regimens, almost 50% of patients with diffuse large-B-cell lymphoma will relapse. Current prognostic models, including the International Prognostic Index, incorporate patient and tumor characteristics. In contrast, recent observations show that variables related to host adaptive immunity and the tumor microenvironment are significant prognostic variables in non-Hodgkin lymphoma. Therefore, we retrospectively examined the absolute monocyte and lymphocyte counts as prognostic variables in a cohort of 366 diffuse large-B-cell lymphoma patients who were treated between 1993 and 2007 and followed at a single institution. The absolute monocyte and lymphocyte counts in univariate analysis predicted progression-free and overall survival when analyzed as continuous and dichotomized variables. On multivariate analysis performed with factors included in the IPI, the absolute monocyte and lymphocyte counts remained independent predictors of progression-free and overall survival. Therefore, the absolute monocyte and lymphocyte counts were combined to generate a prognostic score that identified patients with an especially poor overall survival. This prognostic score was independent of the IPI and added to its ability to identify high-risk patients.
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Affiliation(s)
- R A Wilcox
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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17
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Kasamon YL, Jacene HA, Swinnen LJ, Popplewell L, Link BK, Habermann TM, Herman JM, Jones RJ, Ambinder RF. Multicenter phase II study of rituximab-ABVD in classic Hodgkin lymphoma (cHL). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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18
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Thompson CA, Maurer MJ, Allmer C, Slager SL, Yost KJ, Macon WR, Ansell SM, Inwards DJ, Habermann TM, Link BK, Cerhan JR. Quality of life (QOL) as a predictor of survival in aggressive non-Hodgkin lymphoma (NHL). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Nowakowski GS, Reeder CB, LaPlant B, Habermann TM, Rivera C, Macon WR, Inwards DJ, Micallef INM, Johnston PB, Porrata LF, Ansell SM, Witzig TE. Combination of lenalidomide with R-CHOP (R2CHOP) as an initial therapy for aggressive B-cell lymphomas: A phase I/II study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Witzig TE, Reeder CB, LaPlant BR, Gupta M, Johnston PB, Micallef IN, Porrata LF, Ansell SM, Colgan JP, Jacobsen ED, Ghobrial IM, Habermann TM. A phase II trial of the oral mTOR inhibitor everolimus in relapsed aggressive lymphoma. Leukemia 2010; 25:341-7. [PMID: 21135857 PMCID: PMC3049870 DOI: 10.1038/leu.2010.226] [Citation(s) in RCA: 257] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The phosphatidylinositol 3-kinase signal transduction pathway members are often activated in tumor samples from patients with non-Hodgkin's lymphoma (NHL). Everolimus is an oral agent that targets the raptor mammalian target of rapamycin (mTORC1). The goal of this trial was to learn the antitumor activity and toxicity of single-agent everolimus in patients with relapsed/refractory aggressive NHL. Patients received everolimus 10 mg PO daily. Response was assessed after two and six cycles, and then every three cycles until progression. A total of 77 patients with a median age of 70 years were enrolled. Patients had received a median of three previous therapies and 32% had undergone previous transplant. The overall response rate (ORR) was 30% (95% confidence interval: 20-41%), with 20 patients achieving a partial remission and 3 a complete remission unconfirmed. The ORR in diffuse large B cell was 30% (14/47), 32% (6/19) in mantle cell and 38% (3/8) in follicular grade 3. The median duration of response was 5.7 months. Grade 3 or 4 anemia, neutropenia and thrombocytopenia occurred in 14, 18 and 38% of patients, respectively. Everolimus has single-agent activity in relapsed/refractory aggressive NHL and provides proof-of-concept that targeting the mTOR pathway is clinically relevant.
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Affiliation(s)
- T E Witzig
- Division of Hematology, Department of Medicine, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN 55905, USA.
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21
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Porrata LF, Ristow K, Inwards DJ, Ansell SM, Micallef IN, Johnston PB, Habermann TM, Witzig TE, Colgan J, Markovic S. Use of lymphopenia assessed during routine follow-up after immunochemotherapy (R-CHOP) to predict relapse in patients with diffuse large B-cell lymphoma (DLBCL). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e18516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Issa N, Amer H, Dean PG, Kremers WK, Kudva YC, Rostambeigi N, Cosio FG, Larson TS, Habermann TM, Stegall MD, Griffin MD. Posttransplant lymphoproliferative disorder following pancreas transplantation. Am J Transplant 2009; 9:1894-902. [PMID: 19519812 DOI: 10.1111/j.1600-6143.2009.02691.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The incidence, risk factors and impact on patient and graft survival were evaluated for posttransplant lymphoproliferative disorder (PTLD) among 212 pancreas transplant recipients. Thirteen (6.1%) developed PTLD during 71 +/- 27 months follow-up. Cumulative incidences of PTLD at 1, 3, 5 and 10 years posttransplant were 4.2%, 5.3%, 6.0% and 7.0%, respectively. Incidence of PTLD was lower for recipients of simultaneous pancreas kidney compared to pancreas after kidney transplant or pancreas transplant alone, though not significantly so. Recipient Epstein-Barr virus (EBV) seronegativity and number of doses of depleting antibody therapy administered at transplant were associated with increased risk of PTLD, while recipient age, gender, transplant type, cytomegalovirus mismatch maintenance immunosuppression type and treated acute rejection were not. All 13 cases underwent immunosuppression reduction, and 10 received anti-CD20 monoclonal antibody. During follow-up, 10/13 (77%) responded to treatment with complete remission, while 3 (23%) died as a result of PTLD. Patient and graft survivals did not differ for recipients with and without PTLD. The strong association of PTLD with EBV-seronegativity requires considering this risk factor when evaluating and monitoring pancreas transplant recipients. With reduction of immunosuppression and anti-CD20 therapy, survival for pancreas transplant recipients with PTLD was substantially better than previously reported.
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Affiliation(s)
- N Issa
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, MN, USA
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23
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Kumar N, Sandroni P, Steensma DP, Luthra HS, Habermann TM. POLYRADICULOPATHY DUE TO METHOTREXATE-INDUCED EBV-ASSOCIATED LYMPHOPROLIFERATIVE DISORDER. Neurology 2008; 71:1644-5. [DOI: 10.1212/01.wnl.0000334757.16882.37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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24
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Wang SS, Maurer MJ, Morton LM, Habermann TM, Davis S, Cozen W, Lynch CF, Severson RK, Rothman N, Chanock SJ, Hartge P, Cerhan JR. Polymorphisms in DNA repair and one-carbon metabolism genes and overall survival in diffuse large B-cell lymphoma and follicular lymphoma. Leukemia 2008; 23:596-602. [PMID: 18830263 PMCID: PMC3066015 DOI: 10.1038/leu.2008.240] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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25
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Habermann TM, Witzig TE, Lossos IS, Vose JM, Wiernik PH, Weiss L, Ervin-Haynes A, Pietronigro D, Zeldis JB, Czuczman M. Safety of lenalidomide monotherapy in patients with relapsed or refractory aggressive non-Hodgkin’s lymphom. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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26
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Thomas A, Gingrich R, Smith BJ, Jacobus LS, Habermann TM, Link BK. FDG-PET as predictor of outcome in diffuse large B-cell lymphoma (DLBCL): First analysis of “indeterminate” reports. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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27
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Porrata LF, Ristow K, Witzig TE, Tuinistra N, Habermann TM, Inwards DJ, Ansell SM, Micallef IN, Johnston PB, Markovic SN. Absolute lymphocyte count predicts therapeutic efficacy and survival at the time of radioimmunotherapy in patients with relapsed follicular lymphomas. Leukemia 2007; 21:2554-6. [PMID: 17581607 DOI: 10.1038/sj.leu.2404819] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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28
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Morrison VA, Weller EA, Habermann TM, Cassileth PA, Cohn JB, Gascoyne RD, Woda B, Fisher RI, Peterson BA, Horning SJ. Maintenance rituximab (MR) compared to observation (OBS) after R-CHOP or CHOP in older patients (pts) with diffuse large B-cell lymphoma (DLBCL): An Intergroup E4494/C9793 update. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8011 Background: Maintenance therapy is generally not used in treatment of DLBCL. However, older pts are a unique group in which to study this approach, due to poorer outcome. Methods: As part of intergroup trial E4494/C9793, 415 pts >= 60 years (yr) of age with DLBCL who responded to induction therapy with CHOP or R-CHOP were randomized to MR (rituximab, 375 mg/m2 weekly {wk} X 4 every 6 months for 2 yr) starting 4 wk after the last chemotherapy (n=207) or observation (OBS, n=208) in a prospective 2 × 2 randomized trial design (J Clin Oncol 2006;24:3121). Impact of MR on failure-free survival (FFS) was the primary objective, and impact on time to failure (TTF) and overall survival (OS) were secondary objectives. All p-values are two-sided. Results: Results are presented for 352 centrally reviewed evaluable pts, with a median follow-up after maintenance randomization of 5.5 yr. All results were similar for the intent-to-treat population. Baseline characteristics and response to induction therapy are balanced among the CHOP/R-CHOP pts. At 6 yr, FFS was 46% for those pt who received MR and 36% for the OBS cohort (p=0.005, hazard rate {HR} 0.64); 6-yr OS was 62% for MR and 64% for OBS (p=0.83, HR 0.96). Outcome was also examined in the four treatment subgroups. The 6-yr FFS were: CHOP+MR 44%, CHOP+OBS 35%, R-CHOP+MR 47%, and R- CHOP+OBS 40%. No differences in 6-yr OS were observed according to maintenance randomization following CHOP (57% MR vs 55% OBS) or R-CHOP (67% MR and 72% OBS). Median TTF after maintenance randomization following CHOP+MR was 5.2 yr vs 1.6 yr for CHOP-OBS (p=0.0004), and following R-CHOP+MR was 5.6 yr vs 5.4 yr with R-CHOP-OBS (p=0.50). Proportionately more of the treatment failures occurred within 2 yr after CHOP+OBS (85%) compared to CHOP+MR (61%), p=0.01. In contrast, the proportion of failures within 2 yr was similar for R- CHOP+OBS (47%) and R-CHOP+MR (53%), p=NS. Conclusions: MR after CHOP, but not after R-CHOP, significantly prolongs TTF, but fails to prolong OS, possibly due to a delayed pattern of relapse and/or the efficacy of rituximab in the salvage setting. As 6-yr FFS declined to <50% among R-CHOP responders, with or without MR, there is a need for more effective treatment strategies in older DLBCL pts. No significant financial relationships to disclose.
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Affiliation(s)
- V. A. Morrison
- VA Medcl Ctr, Minneapolis, MN; ECOG Statistical Center, Boston, MA; Mayo Clinic, Rochester, MN; University of Miami, Miami, FL; Albert Einstein Medical Center, Philadelphia, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; University of Massachusetts, Worcester, MA; University of Rochester, Rochester, NY; University of Minnesota, Minneapolis, MN; Stanford University Medical Center, Stanford, CA
| | - E. A. Weller
- VA Medcl Ctr, Minneapolis, MN; ECOG Statistical Center, Boston, MA; Mayo Clinic, Rochester, MN; University of Miami, Miami, FL; Albert Einstein Medical Center, Philadelphia, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; University of Massachusetts, Worcester, MA; University of Rochester, Rochester, NY; University of Minnesota, Minneapolis, MN; Stanford University Medical Center, Stanford, CA
| | - T. M. Habermann
- VA Medcl Ctr, Minneapolis, MN; ECOG Statistical Center, Boston, MA; Mayo Clinic, Rochester, MN; University of Miami, Miami, FL; Albert Einstein Medical Center, Philadelphia, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; University of Massachusetts, Worcester, MA; University of Rochester, Rochester, NY; University of Minnesota, Minneapolis, MN; Stanford University Medical Center, Stanford, CA
| | - P. A. Cassileth
- VA Medcl Ctr, Minneapolis, MN; ECOG Statistical Center, Boston, MA; Mayo Clinic, Rochester, MN; University of Miami, Miami, FL; Albert Einstein Medical Center, Philadelphia, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; University of Massachusetts, Worcester, MA; University of Rochester, Rochester, NY; University of Minnesota, Minneapolis, MN; Stanford University Medical Center, Stanford, CA
| | - J. B. Cohn
- VA Medcl Ctr, Minneapolis, MN; ECOG Statistical Center, Boston, MA; Mayo Clinic, Rochester, MN; University of Miami, Miami, FL; Albert Einstein Medical Center, Philadelphia, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; University of Massachusetts, Worcester, MA; University of Rochester, Rochester, NY; University of Minnesota, Minneapolis, MN; Stanford University Medical Center, Stanford, CA
| | - R. D. Gascoyne
- VA Medcl Ctr, Minneapolis, MN; ECOG Statistical Center, Boston, MA; Mayo Clinic, Rochester, MN; University of Miami, Miami, FL; Albert Einstein Medical Center, Philadelphia, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; University of Massachusetts, Worcester, MA; University of Rochester, Rochester, NY; University of Minnesota, Minneapolis, MN; Stanford University Medical Center, Stanford, CA
| | - B. Woda
- VA Medcl Ctr, Minneapolis, MN; ECOG Statistical Center, Boston, MA; Mayo Clinic, Rochester, MN; University of Miami, Miami, FL; Albert Einstein Medical Center, Philadelphia, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; University of Massachusetts, Worcester, MA; University of Rochester, Rochester, NY; University of Minnesota, Minneapolis, MN; Stanford University Medical Center, Stanford, CA
| | - R. I. Fisher
- VA Medcl Ctr, Minneapolis, MN; ECOG Statistical Center, Boston, MA; Mayo Clinic, Rochester, MN; University of Miami, Miami, FL; Albert Einstein Medical Center, Philadelphia, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; University of Massachusetts, Worcester, MA; University of Rochester, Rochester, NY; University of Minnesota, Minneapolis, MN; Stanford University Medical Center, Stanford, CA
| | - B. A. Peterson
- VA Medcl Ctr, Minneapolis, MN; ECOG Statistical Center, Boston, MA; Mayo Clinic, Rochester, MN; University of Miami, Miami, FL; Albert Einstein Medical Center, Philadelphia, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; University of Massachusetts, Worcester, MA; University of Rochester, Rochester, NY; University of Minnesota, Minneapolis, MN; Stanford University Medical Center, Stanford, CA
| | - S. J. Horning
- VA Medcl Ctr, Minneapolis, MN; ECOG Statistical Center, Boston, MA; Mayo Clinic, Rochester, MN; University of Miami, Miami, FL; Albert Einstein Medical Center, Philadelphia, PA; British Columbia Cancer Agency, Vancouver, BC, Canada; University of Massachusetts, Worcester, MA; University of Rochester, Rochester, NY; University of Minnesota, Minneapolis, MN; Stanford University Medical Center, Stanford, CA
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Aurora V, Li S, Horning SJ, Variakojis D, Nelson BP, Krajewska M, Habermann TM, Fisher RI, Gascoyne RD, Winter JN. Prognostic significance of p53/p21 expression in DLBCL treated with CHOP or R-CHOP: A correlative study of E4494. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8038 Background: P21 is a downstream effector protein of p53 that induces cell cycle arrest by inhibiting cyclin/cyclin dependent kinase (cdK) complexes. In this prospective correlative study, we investigated the prognostic significance of p21, p53, Bcl-6, and Bcl-2 in diffuse large B cell lymphoma (DLBCL) in the context of E4494, a randomized trial comparing conventional CHOP to rituximab(R)-CHOP induction, and maintenance R (MR) to observation for responding patients. Methods: Protein expression was quantified by immunohistochemical (IHC) staining of 198 DLBCL paraffin-embedded biopsy specimens and scored by an expert panel of hematopathologists. Results: No differences in the distribution of patient characteristics were detected between p21+ and p21- cases and between p53+ and p53- cases as well as across treatment arms. Among all study patients, there were no differences in clinical outcomes between p21+ and p21- cases. However, when analyzed by induction arm (removing the effect of MR), R-CHOP patients had marginally better FFS (p=0.06) if p21+; among CHOP-treated patients, p21 status had no effect on outcome. For R-CHOP patients but NOT CHOP patients, p21+ was an independent, favorable prognostic factor after adjusting for Bcl-6, IPI and Bcl-2 in multivariate analysis (FFS relative risk 0.3; p=0.003; OS relative risk 0.4; p=0.02). P21+ patients treated with R-CHOP had higher %FFS at 5 years compared to p21+ patients treated with CHOP (61 ± 7% vs. 24 ± 7%; p=0.007) but p21- R-CHOP and CHOP patients had similar FFS (37 ± 7% vs. 35 ± 7%; p=0.64). P53 staining (+ scored as either >20% or 50%) did not predict for FFS or OS in uni- or multivariate analyses. The p53+/p21- phenotype, a possible surrogate for mutated p53, was not prognostic. Further, no significant correlation was seen between p53 and p21 expression by IHC. Conclusions: These data suggest that p21 expression by IHC predicts for favorable outcome in older DLBCL patients treated with R-CHOP but not in those treated with CHOP. Furthermore, p21+ identifies patients who benefit from the addition of rituximab to CHOP. Complex interactions between p53, p21, and Bcl-6, as well as other unknown pathways, may account for this treatment-related effect and should be further investigated. [Table: see text]
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Affiliation(s)
- V. Aurora
- Northwestern University, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Stanford University, Palo Alto, CA; Burnham Institute for Medical Research, La Jolla, CA; Mayo Clinic College of Medicine, Rochester, MN; University of Rochester, Rochester, NY; British Columbia Cancer Agency, Vancouver, BC, Canada
| | - S. Li
- Northwestern University, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Stanford University, Palo Alto, CA; Burnham Institute for Medical Research, La Jolla, CA; Mayo Clinic College of Medicine, Rochester, MN; University of Rochester, Rochester, NY; British Columbia Cancer Agency, Vancouver, BC, Canada
| | - S. J. Horning
- Northwestern University, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Stanford University, Palo Alto, CA; Burnham Institute for Medical Research, La Jolla, CA; Mayo Clinic College of Medicine, Rochester, MN; University of Rochester, Rochester, NY; British Columbia Cancer Agency, Vancouver, BC, Canada
| | - D. Variakojis
- Northwestern University, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Stanford University, Palo Alto, CA; Burnham Institute for Medical Research, La Jolla, CA; Mayo Clinic College of Medicine, Rochester, MN; University of Rochester, Rochester, NY; British Columbia Cancer Agency, Vancouver, BC, Canada
| | - B. P. Nelson
- Northwestern University, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Stanford University, Palo Alto, CA; Burnham Institute for Medical Research, La Jolla, CA; Mayo Clinic College of Medicine, Rochester, MN; University of Rochester, Rochester, NY; British Columbia Cancer Agency, Vancouver, BC, Canada
| | - M. Krajewska
- Northwestern University, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Stanford University, Palo Alto, CA; Burnham Institute for Medical Research, La Jolla, CA; Mayo Clinic College of Medicine, Rochester, MN; University of Rochester, Rochester, NY; British Columbia Cancer Agency, Vancouver, BC, Canada
| | - T. M. Habermann
- Northwestern University, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Stanford University, Palo Alto, CA; Burnham Institute for Medical Research, La Jolla, CA; Mayo Clinic College of Medicine, Rochester, MN; University of Rochester, Rochester, NY; British Columbia Cancer Agency, Vancouver, BC, Canada
| | - R. I. Fisher
- Northwestern University, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Stanford University, Palo Alto, CA; Burnham Institute for Medical Research, La Jolla, CA; Mayo Clinic College of Medicine, Rochester, MN; University of Rochester, Rochester, NY; British Columbia Cancer Agency, Vancouver, BC, Canada
| | - R. D. Gascoyne
- Northwestern University, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Stanford University, Palo Alto, CA; Burnham Institute for Medical Research, La Jolla, CA; Mayo Clinic College of Medicine, Rochester, MN; University of Rochester, Rochester, NY; British Columbia Cancer Agency, Vancouver, BC, Canada
| | - J. N. Winter
- Northwestern University, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Stanford University, Palo Alto, CA; Burnham Institute for Medical Research, La Jolla, CA; Mayo Clinic College of Medicine, Rochester, MN; University of Rochester, Rochester, NY; British Columbia Cancer Agency, Vancouver, BC, Canada
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Johnston PB, Ansell SM, Colgan JP, Habermann TM, Inwards DJ, Markovic SN, Micallef IN, Porrata LF, LaPlant BR, Geyer SM, Witzig TE. Phase II trial of the oral mTOR inhibitor everolimus (RAD001) for patients with relapsed or refractory lymphoma. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8055 Background: mTOR inhibition with intravenous temsirolimus (Wyeth Pharmaceuticals) has been associated with responses in mantle cell lymphoma (J Clin Oncol 23;5347, 2005) as well as other lymphomas (Blood 108 (11) 2483; 2006). This phase II study tested the oral mTOR inhibitor everolimus (RAD001, Novartis Pharmaceuticals) in three simultaneous two-stage phase II lymphoma studies - aggressive (group 1), indolent (group 2), or uncommon (group 3). The goals were to learn the toxicity profile and to assess the anti-tumor response. Planned interim analysis for groups 1 and 3 have been completed and are the subject of this report. Methods: Patients (pts) received 10 mg PO daily for each 28 day cycle (up to 12) and restaged after 2, 6, and 12 cycles. The primary endpoint is the confirmed response rate, including CR, CRu or PR. 12 pts were enrolled in stage 1 of each study. At least 1 success in 12 is required to proceed to stage 2, to a total of 37 pts. Overall, the treatment will be considered promising if 4 or more successes are observed in all 37 pts in each group. Results: The median age of the 12 pts in group 1 was 68.5 yrs (range: 53–80), with a median of 3 (range, 1–15) prior therapies. Four pts had a prior stem cell transplant (SCT). Pts completed a median of 7 (range, 1–12) cycles of therapy. 6 confirmed responses have been achieved (1 CR, 5 PR), meeting the overall criteria for promising results in this study. Common grade 3 adverse events (AEs) include thrombocytopenia (3 pts) and anemia (2 pts). For group 3, the median age was 49 yrs (range, 27–78), with a median of 7 (range, 1–13) prior therapies and 6 pts had a prior SCT. Pts have completed a median of 6.5 cycles (range, 1–11). 5 confirmed responses have been achieved (5 PR), meeting the criteria for this regimen to be considered promising. Of these 5 patients, 3 had HD, 1 T-cell NHL, and 1 had macroglobulinemia. Common grade 3 AEs include anemia (3 pts) and thrombocytopenia (2 pts). No grade 4 AEs were reported. Conclusions: Oral everolimus has activity in a spectrum of lymphomas with acceptable toxicity. The responses observed in both group 1 and group 3 met the criteria to continue accrual. These results provide the rationale for additional studies with this novel class of agents and to integrate mTOR inhibitors into salvage treatment regimens. No significant financial relationships to disclose.
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Hochster HS, Weller E, Gascoyne RD, Ryan T, Habermann TM, Gordon LI, Frankel SR, Horning SJ. Cyclophosphamide and fludarabine (CF) in advanced indolent lymphoma: Results from the ECOG/CALGB intergroup E1496 trial. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8004 Background: To determine optimal induction and the role of maintenance, the E1496 study randomized patients (pts) to induction CVP (cyclophosphamide, vincristine, prednisone) versus CF (cyclophosphamide 1 G/m2 d1, fludarabine 20 mg/m2 d1–5 every 28 d) for 2 cycles beyond best response (maximum 8). Responding and stable pts were secondarily randomized to MR (375 mg/m2 weekly × 4 every 6 months for 2 years [yr]) or observation (OBS). Methods: Due to early deaths the CF arm was closed to accrual with 115 pts randomized to CF and 119 pts to CVP (thereafter all pts were assigned to CVP prior to maintenance randomization). The results presented here compare the outcome of CF patients with the subset of E1496 pts randomized to CVP (CVPR). Results: Median follow-up on pts randomized to induction is 6.5 yr. Toxic deaths occurred in 8 (7%) CF pts during induction and 4 additional deaths (1 OBS, 3 MR) occurred among the 69 (6%) CF pts randomized to MR or OBS. Causes of death were infection (9), liver failure (2), CNS gliosis (1). CF pts received a median of 5 cycles compared to 7 cycles for CVPR. The CR rate was 51% vs 22% (p=0.00001) and the PR rate was 35% vs 55% for CF vs. CVPR, respectively. Four-yr PFS for CF vs. CVPR was 49% vs 45% (p=0.19) and OS was 66% vs. 81% (p=0.12), respectively. Of 45 CF deaths, 23 (51%) occurred without lymphoma progression compared to 5 (13%) of 38 CVPR deaths (p=0.0004). More than 90% of CF patients randomized to maintenance achieved protocol-defined minimal residual disease compared with 64% CVPR pts. Maintenance therapy had no impact on 2 yr PFS for the 67 evaluable randomized CF pts, which was 74% for MR vs. 73% for OBS (p=0.19). In contrast, 2 yr PFS was 73% for MR and 42% for OBS in randomized CVPR pts (p=0.004). Survival at 2 yr for MR vs OBS was: CF 79% vs 91% (p=0.19) compared with CVP 98% vs 93% (p=0.21). Conclusions: Induction with CF results in higher CR and miminal residual disease rates than CVP. However, gains in remission quality with CF (in the dose and schedule used here) were offset by early and late deaths in the absence of progressive lymphoma. In E1496, the benefit of MR was influenced by the induction chemotherapy. [Table: see text]
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Affiliation(s)
- H. S. Hochster
- NYU Cancer Institute, New York, NY; Dana-Farber Cancer Institute, Boston, MA; British Columbia Cancer Agency, Vancouver, BC, Canada; Mayo Clinic College of Medicine, Rochester, MN; Northwestern University, Chicago, IL; University of Maryland, Baltimore, MD; Stanford University, Stanford, CA
| | - E. Weller
- NYU Cancer Institute, New York, NY; Dana-Farber Cancer Institute, Boston, MA; British Columbia Cancer Agency, Vancouver, BC, Canada; Mayo Clinic College of Medicine, Rochester, MN; Northwestern University, Chicago, IL; University of Maryland, Baltimore, MD; Stanford University, Stanford, CA
| | - R. D. Gascoyne
- NYU Cancer Institute, New York, NY; Dana-Farber Cancer Institute, Boston, MA; British Columbia Cancer Agency, Vancouver, BC, Canada; Mayo Clinic College of Medicine, Rochester, MN; Northwestern University, Chicago, IL; University of Maryland, Baltimore, MD; Stanford University, Stanford, CA
| | - T. Ryan
- NYU Cancer Institute, New York, NY; Dana-Farber Cancer Institute, Boston, MA; British Columbia Cancer Agency, Vancouver, BC, Canada; Mayo Clinic College of Medicine, Rochester, MN; Northwestern University, Chicago, IL; University of Maryland, Baltimore, MD; Stanford University, Stanford, CA
| | - T. M. Habermann
- NYU Cancer Institute, New York, NY; Dana-Farber Cancer Institute, Boston, MA; British Columbia Cancer Agency, Vancouver, BC, Canada; Mayo Clinic College of Medicine, Rochester, MN; Northwestern University, Chicago, IL; University of Maryland, Baltimore, MD; Stanford University, Stanford, CA
| | - L. I. Gordon
- NYU Cancer Institute, New York, NY; Dana-Farber Cancer Institute, Boston, MA; British Columbia Cancer Agency, Vancouver, BC, Canada; Mayo Clinic College of Medicine, Rochester, MN; Northwestern University, Chicago, IL; University of Maryland, Baltimore, MD; Stanford University, Stanford, CA
| | - S. R. Frankel
- NYU Cancer Institute, New York, NY; Dana-Farber Cancer Institute, Boston, MA; British Columbia Cancer Agency, Vancouver, BC, Canada; Mayo Clinic College of Medicine, Rochester, MN; Northwestern University, Chicago, IL; University of Maryland, Baltimore, MD; Stanford University, Stanford, CA
| | - S. J. Horning
- NYU Cancer Institute, New York, NY; Dana-Farber Cancer Institute, Boston, MA; British Columbia Cancer Agency, Vancouver, BC, Canada; Mayo Clinic College of Medicine, Rochester, MN; Northwestern University, Chicago, IL; University of Maryland, Baltimore, MD; Stanford University, Stanford, CA
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Kremers WK, Devarbhavi HC, Wiesner RH, Krom RAF, Macon WR, Habermann TM. Post-transplant lymphoproliferative disorders following liver transplantation: incidence, risk factors and survival. Am J Transplant 2006. [PMID: 16611339 DOI: 10.1111/j.1600-6143.2006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This study investigates retrospectively the incidence, risk factors and mortality of post-transplant lymphoproliferative disorders (PTLD) in adult orthotopic liver transplant (OLT) recipients. Among 1206 OLT recipients at a single institution, 37 developed a PTLD. The incidence of PTLD was highest during the first 18 months and relatively constant thereafter with cumulative incidence of 1.1% at 18 months and 4.7% at 15 years. The risk of PTLD was approximately 10% to 15% of the risk of death without PTLD. During the first 4 years following OLT, PTLD were predominantly related to EBV, while afterward most PTLD were EBV negative. Significant risk factors for PTLD in OLT recipients were transplantation for acute fulminant hepatitis during the first 18 months following OLT (HR=2.6, p=0.007), and rejection therapy with high-dose steroids (HR=4.5, p=0.049) and OKT3 (HR=3.9, p=0.016) during the previous year. Therapy with high-dose steroids or OKT3 (HR=3.6, p=0.0071) were also significant risk factors for PTLD-associated mortality. OLT recipients remain at risk for PTLD years after transplantation. The strong association of PTLD with rejection therapy and the worse post-PTLD prognosis among recipients of rejection therapy indicate the need to balance the risk of immunosuppression against the risk of PTLD following rejection treatment.
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Affiliation(s)
- W K Kremers
- The William J. von Liebig Transplant Center, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Behl D, Markovic SN, Witzig TE, Colgan JP, Habermann TM, Inwards DJ, Ansell SM, Micallef IN, Johnston PB, Porrata LF. Absolute lymphocyte count prior to rituximab therapy predicts time to progression in patients with follicular grade 1 lymphoma. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7586 Background: The immunologic mechanisms of action of rituximab have been described as complement mediated lysis, vaccine like effect, antibody-dependent cellular cytotoxicity (ADCC) and the cellular microenvironment. We hypothesized that in the treatment of follicular grade 1 lymphoma (FL), the presence of a stronger host immune status prior to rituximab therapy would result in a prolonged time to progression (TTP). As a surrogate marker for immune status, we evaluated the absolute lymphocyte count (ALC) prior to rituximab treatment. Methods: Between 1996 and 2002, 1,104 consecutive FL patients were evaluated at Mayo Clinic Rochester. Of these patients, we retrospectively analyzed a group of all FL patients who received rituximab (375 mg/m2 once a week for four weeks) alone at any time during their lymphoma treatment at the Mayo Clinic (n=79). The primary end-point was to assess the impact of ALC just prior to rituximab therapy on TTP for FL. Results: The median age of the cohort was 56.6 years (range: 25–98 years). The median follow-up was 12.5 months (range: 1–76 months). An ALC count of ≥ 890 cells/μL prior to rituximab therapy predicted a longer TTP compared with an ALC < 890 cells/μl (25 months versus 8 months, respectively, p < 0.0124). A higher complete response rate was observed in the ALC ≥ 890 cells/μL group compared with the ALC < 890 cells/μL group [15/40 (38%) vs 5/39 (13%), p < 0.035]. The groups were balanced regarding the Follicular Lymphoma International Prognostic Index (FLIPI) (p = 0.794). Multivariate analysis demonstrated ALC ≥ 890 cells/μL prior to rituximab therapy as an independent prognostic factor for TTP when compared to hemoglobin, LDH, and Ann Arbor stage. The ALC was independent of the FLIPI in multivariate analysis. Conclusions: This data supports the hypothesis that a higher lymphocyte count, as a marker of the immune status of the patient, predicts for a longer TTP following rituximab therapy. No significant financial relationships to disclose.
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Wiernik PH, Lossos IS, Justice G, Zeldis JB, Takeshita K, Pietronigro D, Habermann TM, Witzig TE. Preliminary results from two phase II studies of lenalidomide monotherapy in relapsed/refractory non-Hodgkin’s Lymphoma. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.17569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
17569 Background: Lenalidomide is an immunomodulatory drug of the IMiD class that has activity in multiple myeloma, myelodysplastic syndromes and chronic lymphocytic leukemia. We report preliminary results of two Phase II studies assessing the safety and efficacy of lenalidomide monotherapy in subjects with relapsed/refractory indolent or aggressive non-Hodgkin’s lymphoma (NHL). Methods: Subjects with indolent (study NHL-001) or aggressive (study NHL-002) relapsed/refractory NHL following ≥ 1 prior treatment regimen with measurable disease are eligible. Subjects receive 25 mg lenalidomide orally once daily on Days 1–21 every 28 days and continue therapy for 52 weeks as tolerated until disease progression. Response and progression are evaluated using cross sectional imaging by the NCI criteria. Results: 10 subjects (2 indolent (I), 8 aggressive (A)) of a planned 80 (40 in each study) have enrolled thus far. Median age is 66 (45–80) and 7 subjects are female. Indolent histology is follicular center lymphoma grade 1, 2 (n = 2) and aggressive histology diffuse large cell lymphoma (n = 7) and follicular center lymphoma grade 3 (n = 1). Median time from diagnosis to lenalidomide monotherapy is 2.9 years (1.1–10) and median number of prior treatment regimens per subject is 3 (1–6). Median duration of follow-up is 2 months. Of eight subjects (2 I, 6 A) evaluable for response at two months, three demonstrated a decrease in their tumor burden by 72% (I), 68% (A) and 52% (A), two subjects (2 A) exhibited stable disease and three subjects (1 I, 2 A) had disease progression. Six of the ten subjects (2 I, 4 A) demonstrated no Grade 3 or 4 adverse events. Grade 3 or 4 hematological adverse events (neutropenia, thrombocytopenia) occurred in four subjects including one febrile neutropenia and one of these four subjects also exhibited Grade 3 cellulitis. No tumor flare or tumor lysis has been observed to date. Conclusions: Preliminary data of lenalidomide monotherapy in relapsed and refractory NHL are encouraging. [Table: see text]
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Affiliation(s)
- P. H. Wiernik
- New York Medical College, Bronx, NY; University of MIami, Miami, FL; Pacific Coast Hematology/Oncology Medical Group, Fountain Valley, CA; Celgene Corporation, Summit, NJ; Mayo Clinic College of Medicine, Rochester, MN
| | - I. S. Lossos
- New York Medical College, Bronx, NY; University of MIami, Miami, FL; Pacific Coast Hematology/Oncology Medical Group, Fountain Valley, CA; Celgene Corporation, Summit, NJ; Mayo Clinic College of Medicine, Rochester, MN
| | - G. Justice
- New York Medical College, Bronx, NY; University of MIami, Miami, FL; Pacific Coast Hematology/Oncology Medical Group, Fountain Valley, CA; Celgene Corporation, Summit, NJ; Mayo Clinic College of Medicine, Rochester, MN
| | - J. B. Zeldis
- New York Medical College, Bronx, NY; University of MIami, Miami, FL; Pacific Coast Hematology/Oncology Medical Group, Fountain Valley, CA; Celgene Corporation, Summit, NJ; Mayo Clinic College of Medicine, Rochester, MN
| | - K. Takeshita
- New York Medical College, Bronx, NY; University of MIami, Miami, FL; Pacific Coast Hematology/Oncology Medical Group, Fountain Valley, CA; Celgene Corporation, Summit, NJ; Mayo Clinic College of Medicine, Rochester, MN
| | - D. Pietronigro
- New York Medical College, Bronx, NY; University of MIami, Miami, FL; Pacific Coast Hematology/Oncology Medical Group, Fountain Valley, CA; Celgene Corporation, Summit, NJ; Mayo Clinic College of Medicine, Rochester, MN
| | - T. M. Habermann
- New York Medical College, Bronx, NY; University of MIami, Miami, FL; Pacific Coast Hematology/Oncology Medical Group, Fountain Valley, CA; Celgene Corporation, Summit, NJ; Mayo Clinic College of Medicine, Rochester, MN
| | - T. E. Witzig
- New York Medical College, Bronx, NY; University of MIami, Miami, FL; Pacific Coast Hematology/Oncology Medical Group, Fountain Valley, CA; Celgene Corporation, Summit, NJ; Mayo Clinic College of Medicine, Rochester, MN
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Thompson CA, Cerhan JR, Laplant BR, Maurer MJ, Clark MM, Sloan JA, Rummans TA, Thomas RJ, Habermann TM. Body mass index (BMI) and physical activity in long-term lymphoma survivors: A pilot study. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.17511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
17511 Background: There is no published data regarding BMI changes in survivors of adult lymphoma. Methods: In October of 2004, we mailed a 23-page survey to 95 randomly selected patients from a population of 2,485 of patients from the Mayo Tumor Registry who had survived lymphoma from 5 to 20 years. 56 completed the survey for a 68% participation rate. Body mass index (BMI) was calculated using clinical height and weight in the medical record at the time of diagnosis and self-reported weight in the survey response. Physical activity was self-reported. Based on their pattern of response, patients were categorized into a stage of change of current exercise (precontemplation, contemplation, preparation, action, or maintenance). Mood disturbance (depression, anxiety, and distress) and quality of life (QOL) were self-reported using the CES-D, POMS, STAI, FACT-G, and LASA questionnaires. Scores were transformed to a scale of 0–100 (higher score meaning higher functioning) to allow comparisons with a difference of 10 points considered significant. Results: The median age at completion of the questionnaire was 62 years (range: 25–85). The median time since diagnosis was 11 years (range: 6–20). Regular fitness, defined as a stage of change for exercise of action or maintenance, was reported by 48% of the respondents. The median BMI at diagnosis was 25.6 and the median at time of questionnaire was 27.0, which is a statistically significant change. Change in BMI, BMI at diagnosis, and BMI at time of questionnaire had no correlation with level of physical activity. Obese patients had a mean score of 72 points on the LASA, which was significantly lower than normal and underweight patients (mean 86) and overweight patients (mean 84). Conclusions: A small, but significant increase in body mass index was noted in long-term lymphoma survivors from the time of diagnosis to long-term follow-up. Patients who were obese at time of diagnosis may have lower quality of life down-the-road, as measured by the LASA years following treatment. This data represents the first information about body mass index in survivors of adult lymphoma. Further larger studies are needed to confirm these preliminary data and to evaluate other aspects of health behavior in long-term survivors of lymphoma. No significant financial relationships to disclose.
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Kremers WK, Devarbhavi HC, Wiesner RH, Krom RAF, Macon WR, Habermann TM. Post-transplant lymphoproliferative disorders following liver transplantation: incidence, risk factors and survival. Am J Transplant 2006; 6:1017-24. [PMID: 16611339 DOI: 10.1111/j.1600-6143.2006.01294.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [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: 01/25/2023]
Abstract
This study investigates retrospectively the incidence, risk factors and mortality of post-transplant lymphoproliferative disorders (PTLD) in adult orthotopic liver transplant (OLT) recipients. Among 1206 OLT recipients at a single institution, 37 developed a PTLD. The incidence of PTLD was highest during the first 18 months and relatively constant thereafter with cumulative incidence of 1.1% at 18 months and 4.7% at 15 years. The risk of PTLD was approximately 10% to 15% of the risk of death without PTLD. During the first 4 years following OLT, PTLD were predominantly related to EBV, while afterward most PTLD were EBV negative. Significant risk factors for PTLD in OLT recipients were transplantation for acute fulminant hepatitis during the first 18 months following OLT (HR=2.6, p=0.007), and rejection therapy with high-dose steroids (HR=4.5, p=0.049) and OKT3 (HR=3.9, p=0.016) during the previous year. Therapy with high-dose steroids or OKT3 (HR=3.6, p=0.0071) were also significant risk factors for PTLD-associated mortality. OLT recipients remain at risk for PTLD years after transplantation. The strong association of PTLD with rejection therapy and the worse post-PTLD prognosis among recipients of rejection therapy indicate the need to balance the risk of immunosuppression against the risk of PTLD following rejection treatment.
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Affiliation(s)
- W K Kremers
- The William J. von Liebig Transplant Center, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Ansell SM, Ristow KM, Inwards DJ, Micallef INM, Porrata LF, Habermann TM, Johnston PB, Litzow MR. Rituximab administration as part of initial therapy may be associated with a poorer outcome in young patients subsequently treated with stem cell transplantation for relapsed chemosensitive large B-cell lymphoma. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6665] [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: 11/20/2022] Open
Affiliation(s)
- S. M. Ansell
- Mayo Clinic, Rochester, MN; Mayo Clinic, Rochester, MN
| | - K. M. Ristow
- Mayo Clinic, Rochester, MN; Mayo Clinic, Rochester, MN
| | - D. J. Inwards
- Mayo Clinic, Rochester, MN; Mayo Clinic, Rochester, MN
| | | | - L. F. Porrata
- Mayo Clinic, Rochester, MN; Mayo Clinic, Rochester, MN
| | | | | | - M. R. Litzow
- Mayo Clinic, Rochester, MN; Mayo Clinic, Rochester, MN
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Colocci N, Weller E, Hochster HS, Gascoyne R, Kumm B, Ryan T, Habermann TM, Frankel SR, Horning SJ. Prognostic significance of the follicular lymphoma international prognostic index (FLIPI) in the E1496 trial of chemotherapy with or without maintenance rituximab. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- N. Colocci
- Stanford Univ Medcl Ctr, Stanford, CA; DFCI, Boston, CA; NYU Sch of Medicine, New York, NY; British Cancer Control Agency, Vancouver, BC, Canada; ECOG, Boston, MA; Mayo Clinic, Rochester, MN; Univ of Maryland, Baltimore, MD
| | - E. Weller
- Stanford Univ Medcl Ctr, Stanford, CA; DFCI, Boston, CA; NYU Sch of Medicine, New York, NY; British Cancer Control Agency, Vancouver, BC, Canada; ECOG, Boston, MA; Mayo Clinic, Rochester, MN; Univ of Maryland, Baltimore, MD
| | - H. S. Hochster
- Stanford Univ Medcl Ctr, Stanford, CA; DFCI, Boston, CA; NYU Sch of Medicine, New York, NY; British Cancer Control Agency, Vancouver, BC, Canada; ECOG, Boston, MA; Mayo Clinic, Rochester, MN; Univ of Maryland, Baltimore, MD
| | - R. Gascoyne
- Stanford Univ Medcl Ctr, Stanford, CA; DFCI, Boston, CA; NYU Sch of Medicine, New York, NY; British Cancer Control Agency, Vancouver, BC, Canada; ECOG, Boston, MA; Mayo Clinic, Rochester, MN; Univ of Maryland, Baltimore, MD
| | - B. Kumm
- Stanford Univ Medcl Ctr, Stanford, CA; DFCI, Boston, CA; NYU Sch of Medicine, New York, NY; British Cancer Control Agency, Vancouver, BC, Canada; ECOG, Boston, MA; Mayo Clinic, Rochester, MN; Univ of Maryland, Baltimore, MD
| | - T. Ryan
- Stanford Univ Medcl Ctr, Stanford, CA; DFCI, Boston, CA; NYU Sch of Medicine, New York, NY; British Cancer Control Agency, Vancouver, BC, Canada; ECOG, Boston, MA; Mayo Clinic, Rochester, MN; Univ of Maryland, Baltimore, MD
| | - T. M. Habermann
- Stanford Univ Medcl Ctr, Stanford, CA; DFCI, Boston, CA; NYU Sch of Medicine, New York, NY; British Cancer Control Agency, Vancouver, BC, Canada; ECOG, Boston, MA; Mayo Clinic, Rochester, MN; Univ of Maryland, Baltimore, MD
| | - S. R. Frankel
- Stanford Univ Medcl Ctr, Stanford, CA; DFCI, Boston, CA; NYU Sch of Medicine, New York, NY; British Cancer Control Agency, Vancouver, BC, Canada; ECOG, Boston, MA; Mayo Clinic, Rochester, MN; Univ of Maryland, Baltimore, MD
| | - S. J. Horning
- Stanford Univ Medcl Ctr, Stanford, CA; DFCI, Boston, CA; NYU Sch of Medicine, New York, NY; British Cancer Control Agency, Vancouver, BC, Canada; ECOG, Boston, MA; Mayo Clinic, Rochester, MN; Univ of Maryland, Baltimore, MD
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Micallef IN, Kahl BS, Gayko U, Cesano A, Ansell SM, Geyer S, Inwards DJ, Maurer MJ, Horning S, Habermann TM. Initial results of a pilot study of epratuzumab and rituximab in combination with CHOP chemotherapy (ER-CHOP) in previously untreated patients with diffuse large B-cell lymphoma (DLBCL). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- I. N. Micallef
- Mayo Clinic College of Medicine, Rochester, MN; University of Wisconsin, Madison, WI; Amgen Corporation, Thousand Oaks, CA; Stanford University, Palo Alto, CA
| | - B. S. Kahl
- Mayo Clinic College of Medicine, Rochester, MN; University of Wisconsin, Madison, WI; Amgen Corporation, Thousand Oaks, CA; Stanford University, Palo Alto, CA
| | - U. Gayko
- Mayo Clinic College of Medicine, Rochester, MN; University of Wisconsin, Madison, WI; Amgen Corporation, Thousand Oaks, CA; Stanford University, Palo Alto, CA
| | - A. Cesano
- Mayo Clinic College of Medicine, Rochester, MN; University of Wisconsin, Madison, WI; Amgen Corporation, Thousand Oaks, CA; Stanford University, Palo Alto, CA
| | - S. M. Ansell
- Mayo Clinic College of Medicine, Rochester, MN; University of Wisconsin, Madison, WI; Amgen Corporation, Thousand Oaks, CA; Stanford University, Palo Alto, CA
| | - S. Geyer
- Mayo Clinic College of Medicine, Rochester, MN; University of Wisconsin, Madison, WI; Amgen Corporation, Thousand Oaks, CA; Stanford University, Palo Alto, CA
| | - D. J. Inwards
- Mayo Clinic College of Medicine, Rochester, MN; University of Wisconsin, Madison, WI; Amgen Corporation, Thousand Oaks, CA; Stanford University, Palo Alto, CA
| | - M. J. Maurer
- Mayo Clinic College of Medicine, Rochester, MN; University of Wisconsin, Madison, WI; Amgen Corporation, Thousand Oaks, CA; Stanford University, Palo Alto, CA
| | - S. Horning
- Mayo Clinic College of Medicine, Rochester, MN; University of Wisconsin, Madison, WI; Amgen Corporation, Thousand Oaks, CA; Stanford University, Palo Alto, CA
| | - T. M. Habermann
- Mayo Clinic College of Medicine, Rochester, MN; University of Wisconsin, Madison, WI; Amgen Corporation, Thousand Oaks, CA; Stanford University, Palo Alto, CA
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Hochster HS, Weller E, Ryan T, Habermann TM, Gascoyne R, Frankel SR, Horning SJ. Results of E1496: A phase III trial of CVP with or without maintenance rituximab in advanced indolent lymphoma (NHL). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6502] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- H. S. Hochster
- NYU School of Medicine, New York, NY; DFCI, Boston, MA; Mayo Clinic, Rochester, MN; British Cancer Control Agency, Vancouver, BC, Canada; University of Maryland, Baltimore, MD; Stanford School of Medicine, Stanford, CA
| | - E. Weller
- NYU School of Medicine, New York, NY; DFCI, Boston, MA; Mayo Clinic, Rochester, MN; British Cancer Control Agency, Vancouver, BC, Canada; University of Maryland, Baltimore, MD; Stanford School of Medicine, Stanford, CA
| | - T. Ryan
- NYU School of Medicine, New York, NY; DFCI, Boston, MA; Mayo Clinic, Rochester, MN; British Cancer Control Agency, Vancouver, BC, Canada; University of Maryland, Baltimore, MD; Stanford School of Medicine, Stanford, CA
| | - T. M. Habermann
- NYU School of Medicine, New York, NY; DFCI, Boston, MA; Mayo Clinic, Rochester, MN; British Cancer Control Agency, Vancouver, BC, Canada; University of Maryland, Baltimore, MD; Stanford School of Medicine, Stanford, CA
| | - R. Gascoyne
- NYU School of Medicine, New York, NY; DFCI, Boston, MA; Mayo Clinic, Rochester, MN; British Cancer Control Agency, Vancouver, BC, Canada; University of Maryland, Baltimore, MD; Stanford School of Medicine, Stanford, CA
| | - S. R. Frankel
- NYU School of Medicine, New York, NY; DFCI, Boston, MA; Mayo Clinic, Rochester, MN; British Cancer Control Agency, Vancouver, BC, Canada; University of Maryland, Baltimore, MD; Stanford School of Medicine, Stanford, CA
| | - S. J. Horning
- NYU School of Medicine, New York, NY; DFCI, Boston, MA; Mayo Clinic, Rochester, MN; British Cancer Control Agency, Vancouver, BC, Canada; University of Maryland, Baltimore, MD; Stanford School of Medicine, Stanford, CA
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Yoong Y, Kurtin PJ, Allmer C, Geyer S, Habermann TM, Nagorney DM, Witzig TE. Efficacy of splenectomy for patients with mantle cell non-Hodgkin's lymphoma. Leuk Lymphoma 2001; 42:1235-41. [PMID: 11911404 DOI: 10.3109/10428190109097748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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
The purpose of this study was to define the role of splenectomy in patients (pts) with mantle cell lymphoma (MCL) with regard to improving cytopenias and symptoms of splenomegaly. 26 pts with MCL underwent splenectomy between January 1987 and October 1999 and were followed prospectively for hematologic response and operative morbidity and mortality. A positive response was defined at 1 month of follow-up as: a hemoglobin of > or = 1.0 g/dl in a pt with a preoperative value < 11.0 g/dl; or a platelet count of > or = 100 x 10(9)/L in a pt with a preoperative value < 100 x 10(9)/L. A positive hematologic response was achieved in 69.2% of pts with preoperative anemia, 90% with thrombocytopenia, and 50% with both anemia and thrombocytopenia. The peri- and post-operative morbidity were 3.8 and 19.2%, respectively, the operative mortality was 0%. The median duration of hospitalization was six days. Four (15.4%) pts have not required chemotherapy after splenectomy. Three of these four were previously untreated and they have maintained stable disease for eight years after splenectomy without chemotherapy. Eight additional pts did not require chemotherapy for > 13 months after splenectomy. These results suggest that splenectomy may provide durable remission in selected pts with refractory cytopenias or symptoms related to splenomegaly in pts with MCL. There is a subset of pts that have prolonged disease stabilization without the requirement for immediate chemotherapy after splenectomy.
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Affiliation(s)
- Y Yoong
- Division of Internal Medicine and Hematology, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
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Kanelli S, Ansell SM, Habermann TM, Inwards DJ, Tuinstra N, Witzig TE. Rituximab toxicity in patients with peripheral blood malignant B-cell lymphocytosis. Leuk Lymphoma 2001; 42:1329-37. [PMID: 11911416 DOI: 10.3109/10428190109097760] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [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] [Indexed: 11/13/2022]
Abstract
Infusion related adverse events (AE) with day 1 rituximab in patients with B-cell non-Hodgkin's lymphoma (NHL) are common. The purpose of this study was to evaluate the AE occurring in patients with malignant B-cell lymphocytosis who received rituximab. Patients with a > or = 3 x 10(9)/L absolute lymphocyte count (ALC) receiving rituximab from 1998 to 1999 or participating in a phase I study of rituximab and interleukin-12 were reviewed. The AE occurring on the day of rituximab, the treatment provided (including hospitalization), and the subsequent ALC responses were recorded. Twenty-seven patients were identified; 14 had NHL, one Waldenstrom's macroglobulinemia, and 12 patients had chronic lymphocytic leukemia. The baseline median ALC was 9.58 x 10(9)/L (mean, 49.31; range, 3.56-380.95). All patients received rituximab as an outpatient. There were only two AE > or = grade 3. One patient was hospitalized for 1 day for i.v. fluids to treat an increase in creatinine that occurred with tumor lysis. A second patient developed a pulmonary syndrome five days after day 1 rituximab and required mechanical ventilation, but had no long-term lung toxicity. This study demonstrates that patients with high numbers of circulating blood B-lymphocytes can usually safely receive rituximab as outpatients. Patients who experience a rapid drop in ALC should be monitored closely for tumor lysis and the pulmonary syndrome.
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Affiliation(s)
- S Kanelli
- Faculty of Medicine, Charles University, Hradec Kralove, Czech Republic
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Habermann TM, Ziemer RE, Beck CS. Images and reflections from Mayo Clinic heritage. Mayo Clin Proc 2001; 76:1062. [PMID: 11605692 DOI: 10.4065/76.10.1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- T M Habermann
- Mayo Graduate School of Medicine and the Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA
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Hogan WJ, Edwards WD, Macon WR, Habermann TM. Fulminant hepatic failure secondary to adenovirus following fludarabine-based chemotherapy for non-Hodgkin's lymphoma. Leuk Lymphoma 2001; 42:1145-50. [PMID: 11697635 DOI: 10.3109/10428190109097738] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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
Self-limited adenoviral infections are very common with the majority of infections resolving rapidly. Fatal complications may occur in severely immunocompromised patients. We describe a case of fulminant hepatic failure due to adenovirus in a 54-year-old man treated with fludarabine and cyclophosphamide for non-Hodgkin's lymphoma. There are no previous reports of this complication in conjunction with purine nucleoside therapy.
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Affiliation(s)
- W J Hogan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Habermann TM, Ziemer RE, Beck CS. Images and reflections from Mayo Clinic heritage. Mayo Clin Proc 2001; 76:768. [PMID: 11499812 DOI: 10.1016/s0025-6196(11)63217-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- T M Habermann
- Mayo Graduate School of Medicine and Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA
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Habermann TM, Ziemer RE, Beck CS. Images and reflections from Mayo Clinic heritage. Mayo Clin Proc 2001; 76:632. [PMID: 11393502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- T M Habermann
- Mayo Graduate School of Medicine, Mayo Clinic, Rochester, Minn 55905, USA
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Abstract
BACKGROUND AND PURPOSE Orbital non-Hodgkin's lymphomas (NHL) have traditionally been treated with radiation. Forty-eight patients presenting with orbital NHL were treated with radiation and were evaluated for local control, overall survival, cause-specific survival, and complications. MATERIALS AND METHODS Forty-five patients had low-grade and 3 patients had intermediate-grade histologic findings. Orbit-only disease occurred in 22 patients, the conjunctiva in 16, both in five, and lacrimal gland only in five. Patient age ranged from 35 to 94 years (median, 68). Ann Arbor stages were cIEA (34), cIIEA (six), cIIIEA (two), and cIVEA (six). Radiation doses ranged between 15 and 53.8 Gy (median, 27.5 Gy). RESULTS Follow-up ranged from 0.14 to 18.23 years (median, 5.35). Median overall survival and cause-specific survival were 6.5 and 15.5 years, respectively. Patients with clinical stage I or II disease had significantly better overall and cause-specific survival than patients with stage III or IV disease. Ten-year relapse-free survival in 41 patients with stage I or II disease was 66%. However, there was continued downward pressure on relapse-free survival out to 18 years. One local failure occurred. Twenty-five patients sustained acute complications. There were 17 minor and four major late complications. All major late complications occurred with doses more than 35 Gy. CONCLUSIONS Excellent local control with radiation doses ranging from 15 to 30 Gy is achieved. Patients with stage I or II disease have better overall and cause-specific survival than patients with stage III or IV disease. Late relapse occurs in sites other than the treated orbit, even in patients with early-stage disease. Doses 35 Gy or higher result in significant late complications and are therefore not indicated for patients with low-grade tumors.
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Affiliation(s)
- S L Stafford
- Division of Radiation Oncology, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
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Habermann TM, Ziemer RE, Beck CS. Images and reflections from Mayo Clinic heritage. Mayo Clin Proc 2001; 76:448. [PMID: 11322363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- T M Habermann
- Mayo Graduate School of Medicine and the Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA
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49
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Affiliation(s)
- T M Habermann
- Mayo Graduate School of Medicine and the Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA
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Ansell SM, Stenson M, Habermann TM, Jelinek DF, Witzig TE. Cd4+ T-cell immune response to large B-cell non-Hodgkin's lymphoma predicts patient outcome. J Clin Oncol 2001; 19:720-6. [PMID: 11157023 DOI: 10.1200/jco.2001.19.3.720] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.7] [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: 11/20/2022] Open
Abstract
PURPOSE Previous studies in patients with non-Hodgkin's lymphoma (NHL) and other malignancies have suggested that the presence of host infiltrates in the tumors of these patients may predict a better outcome. This study was undertaken to determine the prognostic importance of the presence of T cells in the biopsy specimens of patients with B-cell NHL. PATIENTS AND METHODS Seventy-two patients with diffuse large B-cell NHL were prospectively evaluated at a single institution between 1987 and 1994. The percentage of CD3+, CD3+/HLA-DR+, CD4+, CD8+, and natural killer cells was determined by flow cytometry in the pretreatment diagnostic biopsy specimen and correlated with patient outcome. RESULTS An increase in the percentage CD4+ T cells in the pretreatment tumor biopsies significantly correlated with patient outcome. The percent of CD4+ T cells was also highly correlated with CD3+/HLA-DR+, CD45RO+, and low L-selectin (CD62L) expression, indicating that the CD4+ T cells are activated memory T-helper cells. Those patients with increased numbers of CD4+ T cells, compared with other patients, had a significantly longer 5-year failure-free survival (72% v 43%, respectively; P =.04), as well as a significantly longer 5-year overall survival (65% v 38%, respectively; P =.05). When evaluated in a multivariate model, the International Prognostic Index and more than 20% infiltrating CD4+ T cells in the pretreatment biopsy were significant independent predictors of relapse-free and overall survival. CONCLUSION The presence of increased numbers of activated CD4+ cells in the area of B-cell diffuse large-cell NHL predicts a better prognosis. This finding provides a strong rationale for the investigation of cellular immunotherapy in B-cell NHL.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biopsy
- CD4-Positive T-Lymphocytes/immunology
- Disease-Free Survival
- Female
- Flow Cytometry
- Humans
- Immunophenotyping
- Lymphocyte Activation/immunology
- Lymphocytes, Tumor-Infiltrating/immunology
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Prospective Studies
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Affiliation(s)
- S M Ansell
- Division of Hematology and Internal Medicine, Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
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