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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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Casulo C, Larson MC, Day JR, Habermann TM, Lossos IS, Wang Y, Nastoupil LJ, Strouse C, Chihara D, Martin P, Cohen JB, Kahl BS, Ruan J, Burack WR, Koff JL, Friedberg JW, Cerhan JR, Flowers C, Link BK, Maurer MJ. Therapy for patients with POD24 follicular lymphoma: Treatment patterns and outcomes from the Lymphoma Epidemiology of Outcomes (LEO) Consortium. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7573] [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
7573 Background: While most patients (pts) with follicular lymphoma (FL) usually have favorable outcomes, those with refractory disease after first-line anti-CD20 based immunochemotherapy (IC), or progression within 24 months of diagnosis (POD24) have higher risk of premature death. There are no standard approaches for treating this vulnerable group and studies testing novel agents are ongoing in this setting. We sought to investigate clinical practice treatment choices and efficacy for pts with POD24 that align with eligibility criteria for the randomized SWOG1608 which compares IC with novel agents in this population. Methods: This was a multicenter observational cohort study from the LEO Consortium. Eligible pts had grade 1-3a FL diagnosed between 1/1/2002 and 2/1/2019, and initiated therapy after POD24 to first-line bendamustine or CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) based IC. Observation, radiotherapy, or rituximab monotherapy were permitted prior to IC and pts with transformation prior to the subsequent therapy after IC were excluded as per S1608. Outcomes of interest were overall and complete response rate (ORR/CR), progression-free survival (PFS), and overall survival (OS). Results: We identified 196 eligible pts with early progression to IC (39% antiCD20 Benda; 61% antiCD20 CHOP) who received subsequent therapy. Median age at post IC treatment was 57 years, 78% grade 1-2 FL. Treatments for pts with POD24 included CHOP- or Benda-based in 31%, salvage/hematopoietic stem cell transplant (HSCT) in 27%, novel therapies in 10% (including phosphatidylinositol 3-kinase inhibitors), antiCD20 monotherapy in 9%, and lenalidomide-based treatment in 8% (table); 21% of pts were treated on clinical trials. Across all treatments, ORR (CR) was 63% (37%) (95% CI: 55-70). At a median follow up of 6.2 years, 2 year PFS was 22% (95% CI: 17%-29%) and 5 year OS was 71% (95% CI: 65-79). Outcomes by regimen are shown in the table. Conclusions: Pts with FL experiencing POD24 following first-line IC are treated heterogeneously, with many pts still receiving IC as subsequent therapy. Despite modest CR rates and low 2-year PFS, 5-year OS appear to be improving compared to historical outcomes. This supports the ongoing need to investigate novel treatments in this population. [Table: see text]
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Affiliation(s)
- Carla Casulo
- University of Rochester Medical Center-James P. Wilmot Cancer Center, Rochester, NY
| | | | | | | | - Izidore S. Lossos
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL
| | - Yucai Wang
- Mayo Clinic, Division of Hematology, Rochester, MN
| | | | | | - Dai Chihara
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Peter Martin
- Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY
| | | | - Brad S. Kahl
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Jia Ruan
- Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | | | - Jean Louise Koff
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | | | | | | | - Brian K. Link
- University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City, IA
| | - Matthew J. Maurer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
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Chohan K, Abeykoon JP, Ansell SM, Gertz MA, Kapoor P, Paulus A, Ailawadhi S, Reeder CB, Witzig TE, Habermann TM, Lacy M, Kyle RA, Go RS, Paludo J. Insurance-based disparities in Waldenstrom Macroglobulinemia: An NCDB analysis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e19562] [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
e19562 Background: Considerable healthcare resource utilization and financial burden have been associated with the treatment of Waldenstrom Macroglobulinemia (WM); however, the impact of health insurance status on patient outcomes has not been explored. We aimed to assess the insurance-based outcome relationship in WM using the National Cancer Database (NCDB). Methods: We analyzed patient-level data obtained from the NCDB, a database representing more than 70% of newly diagnosed cancer cases nationwide. All newly diagnosed WM cases (n = 8540) between 2004 to 2017 were identified. Only patients who underwent treatment were included. Insurance status was recorded by assessing the primary payer at the time of diagnosis. Due to Medicare eligibility criteria, age-based (< 65 and ≥65 years) stratified analysis was conducted. Cox proportional hazards model was utilized to analyze survival. Time-to-event analysis was conducted based on date-of-diagnosis using the Kaplan-Meier method and log-rank test. Results: Analysis was conducted on 3878 patients after meeting inclusion criteria, with a median follow-up time of 54.6 months. Among patients < 65 years (n = 1249; median age: 58 years; male: 62.4%), those with non-private insurance had inferior survival on multivariate analysis (Table) after adjusting for patient demographics, comorbidities, income, education, treatment center characteristics, and treatment start time. Significant overall survival (OS) differences were seen in those < 65 years (log-rank p < 0.001), with 5-year OS highest among patients with private insurance 91.2%, compared to Medicaid 79.8%, uninsured 77.4%, and Medicare 70.2%. In patients < 65 years, compared to private insurance, uninsured patients were more likely to be of Black race, reside in lower income areas, and be treated at non-academic centers (all p < 0.05). Both Medicaid and Medicare patients < 65 years were more likely to have a higher Charlson-Deyo comorbidity index (> 1) and live in areas of lower educational attainment and household income compared to private insurance (all p < 0.05). In patients ≥65 years (n = 2629; median age: 75 years; 60.6% males), no insurance-based OS (log-rank p = 0.096) differences were seen. Conclusions: Based on our study, significant insurance-based disparities exist in WM, where patients < 65 years old who are uninsured, or non-privately insured are at a higher risk of mortality. While the root cause of these differences is not fully elucidated, efforts should focus on ensuring that all patients have equal access to care regardless of primary payer status.[Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Ronald S. Go
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN
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4
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Chohan K, Young JR, Lester S, Alhaj Moustafa M, Rosenthal AC, Tun HW, Hoppe B, Johnston PB, Micallef INM, Habermann TM, Ansell SM. Combined modality therapy for early-stage Hodgkin lymphoma in the PET era: A real-world study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e19532] [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
e19532 Background: The traditional approach to the treatment of early-stage classical Hodgkin lymphoma (cHL) has been combined modality therapy (CMT) with both chemotherapy and radiotherapy (RT). CMT has shown improved disease control, but RT can lead to long-term adverse effects, including secondary malignancies and cardiac toxicity. Multiple clinical trials have assessed treatment de-escalation strategies to chemotherapy-alone regimens, but results are conflicting. We aimed to assess the real-world implications of these trials by comparing patient outcomes based upon treatment with CMT or chemotherapy-alone. Furthermore, we proposed to assess differences in treatment outcomes stratified by disease bulk, favorable/unfavorable disease, and PET2 response. Methods: We conducted a retrospective, multi-center cohort study of consecutive adult patients with early-stage (stage IA-IIB) cHL treated between January 2010-December 2020. Baseline characteristics, treatment modality, and outcomes were abstracted by chart review. Available PET2 scans (n=110) were independently reviewed by a blinded nuclear radiologist. Deauville score (DS) ≥4 was characterized as positive (+), and DS≤3 negative (-). All analysis was conducted using intention-to-treat principles based upon the initial treatment plan (CMT or chemotherapy-alone). Results: In 125 patients [58% male, median age 34 (range, 18-78)] with early-stage cHL, CMT was intended in 63 (50%) patients, with chemotherapy-alone in 62 (50%). Bulky disease was observed in 43 (34%), unfavorable disease in 81 (65%), and 15 (14%) were found to be PET2+. With median follow-up of 59.8 months (95%CI, 48.6 to 71.0), 5 (4%) deaths occurred, and 17 (14%) patients had relapsed/refractory disease. No significant differences in overall survival (OS) were seen based upon treatment intention. However, there was substantially reduced progression-free survival (PFS) (Table) with chemotherapy-alone in the whole cohort, and also in those with bulky, unfavorable, and PET2+ disease. No significant PFS differences were seen based upon treatment intention for patients with non-bulky, favorable, or PET2- disease. Conclusions: Based on our real-world experience, CMT appears particularly beneficial for patients with bulky disease, unfavorable prognostic factors, and PET2+ disease. However, while recent trials showed a benefit of CMT in non-bulky, favorable and PET2- patients, chemotherapy-alone may be comparable for these patients in actual clinical practice.[Table: see text]
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Affiliation(s)
| | | | - Scott Lester
- Mayo Clinic Department of Radiation Oncology, Rochester, MN
| | | | | | - Han W. Tun
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL
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5
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McLaughlin N, Wang Y, Inwards DJ, Villasboas JC, Micallef INM, Habermann TM, Nowakowski GS, Witzig TE, Thanarajasingam G, Porrata LF, Lin Y, Thompson CA, Bennani NN, Johnston PB, Ansell SM, Paludo J. Outcomes in mantle cell lymphoma with central nervous system involvement. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e19527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19527 Background: While extra nodal involvement by MCL is relatively common, involvement of the central nervous system (CNS) is a rare ( < 5% of cases) complication with limited treatment options. We report the outcomes of a large cohort of patients (pts) with CNS MCL. Methods: MCL pts with CNS involvement seen at Mayo Clinic between 1/1/1995-9/16/2020 were identified. CNS involvement was defined by histologically confirmed CNS MCL, CSF analysis demonstrating lymphoma cells, and/or neuroimaging findings compatible with CNS lymphoma. Medical records were reviewed for baseline characteristics, treatment, and outcome. Kaplan-Meier method was used for time to event analysis. Results: Out of 1,753 pts with MCL, 36 (2%) had CNS involvement by MCL. Median age at MCL diagnosis was 64 years (range 36-83) and 26 were male (72%). At MCL diagnosis, non-CNS extranodal involvement was seen in 30 pts, 24 with 1 site and 6 with ≥ 2 sites; 24 had bone marrow involvement. 11 (31%) pts had blastoid variant. Median Ki-67 was 40% (range 15-100%). MIPI score was available in 17 pts [low risk (n = 5, 29%), intermediate risk (n = 9, 53%), high risk (n = 3, 18%)]. The most common frontline regimen for MCL was R-CHOP and 14 (39%) pts underwent autologous stem cell transplant in CR1. The incidence of CNS involvement was overall similar over the study period. Median time from MCL diagnosis to CNS involvement was 25 months (m) (range 0-167). 4 (11%) pts presented with CNS involvement at initial diagnosis and 32 presented at relapse (12 isolated CNS relapse and 20 concurrent CNS and systemic relapse. Abnormal CSF was noted in 27 (87%) pts [consistent with MCL diagnosis (n = 26), atypical lymphocytes (n = 1)]. Abnormal CNS imaging was reported in 27 (75%) pts [leptomeningeal (n = 18), leptomeningeal and parenchymal (n = 5), parenchymal (n = 2), ocular (n = 2)]. First line CNS-directed therapy data was available in 33 (92%) pts. 12 (34%) received intrathecal (IT) therapy alone, 19 (54%) received systemic +/- IT therapy, 2 (6%) received radiation alone, and 2 (6%) pts received no treatment (hospice). The overall CNS response to therapy was CR in 13 (42%) pts, PR in 3 (10%), SD in 8 (26%), and PD in 7 (22%) pts. Three pts received BTK inhibitors [ibrutinib (n = 2) or acalabrutinib (n = 1)] as the first CNS-directed therapy. One patient achieved a CR with a response lasting 4 m, another patient achieved a PR with response lasting 10 m. CNS response data was not available in the remaining pts. Median follow up from CNS involvement was 72 m (95% CI: 41-NR). Median EFS for the 1st CNS-directed therapy was 3.7 m (95% CI: 1.6-6.1). At last follow up, 30 pts were deceased. The cause of death was CNS lymphoma in 10 (33%) pts and systemic lymphoma in 9 (30%) pts. Median OS from CNS involvement was 4.7 m (95% CI: 2.3-6.7). Conclusions: CNS involvement by MCL has dismal outcomes as evident by a median OS of approximately 5 m. BTK inhibitors may have a role in treatment of this rare complication, but further prospective investigation is needed.
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Affiliation(s)
| | - Yucai Wang
- Mayo Clinic, Division of Hematology, Rochester, MN
| | | | | | | | | | | | | | | | | | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Jonas Paludo
- Mayo Clinic, Division of Hematology, Rochester, MN
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6
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Perera ND, Abeykoon JP, Castillo JJ, Gustine J, Varettoni M, Tedeschi A, Cavalloni C, Frustaci AM, Maurer MJ, Kapoor P, Habermann TM, Witzig TE, Kyle RA, Gertz MA, Treon SP, Ansell SM, Paludo J. Prognostic impact of depth of response in Waldenström macroglobulinemia patients treated with fixed duration chemoimmunotherapy. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.8049] [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
8049 Background: The treatment paradigm of Waldenström macroglobulinemia (WM) continues to evolve as new therapies expand our options for this indolent and incurable disease. While more profound responses are generally associated with longer treatment-free intervals, the impact of depth of response from fixed duration therapy in WM patients' survival needs further evaluation. In this international, multicenter cohort study, we report the prognostic impact of depth of response in WM. Methods: 319 WM patients treated with frontline fixed duration therapy [Dexamethasone/Rituximab/Cyclophosphamide (DRC), Bendamustine/Rituximab (BR), or Bortezomib/Dexamethasone/Rituximab (BDR)] were included. Response at the completion of therapy (6 months) was used in a landmark analysis for progression-free survival (PFS), time to next treatment (TTNT), and overall survival (OS) (defined as time from 6 months post treatment response to event or censor). Response was defined by modified IWWM-6 criteria. Associations between clinical variables and outcomes were evaluated using Cox proportional-hazard models. Results: The median age at the time of treatment initiation was 64 years (range: 29-94), 59% were men, and risk category by International Prognostic Scoring System (IPSS)-WM was low (n=67, 23%), intermediate (n=83, 29%), and high-risk (n=141, 48%). Evaluable responses at 6 months from frontline therapy [DRC (n=105; 41%), BR (n=83; 32%), BDR (n=68; 27%)] were available in 256 patients and included in the landmark analysis. Median follow-up was 63 months (95% CI: 59-70). The rate of major response (PR or better) at 6 months was 74% for the entire cohort. Five-year PFS rates from completion of therapy for patients who attained major response vs. those who did not were 71% and 43%, respectively (p<0.001). Five-year TTNT rates for patients who attained major response vs. not were 84% and 54%, respectively (p<0.001). Five-year OS rates for patients who attained major response vs. not were 92% and 77%, respectively (p<0.001). In multivariable analyses including other WM prognostic factors evaluated at initiation of frontline therapy, attaining a major response at 6 months was associated with superior PFS (HR 0.33, p<0.001), TTNT (HR 0.23, p<0.001), and OS (HR 0.31, p=0.001–Table). Conclusions: Achieving a major response at 6 months after frontline chemoimmunotherapy emerges as a significant prognostic factor for PFS, TTNT and OS in patients with WM.[Table: see text]
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Affiliation(s)
| | | | - Jorge J. Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Joshua Gustine
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Marzia Varettoni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Chiara Cavalloni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Matthew J. Maurer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - Steven P. Treon
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - Jonas Paludo
- Mayo Clinic, Division of Hematology, Rochester, MN
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7
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Andrade-Gonzalez X, Saliba AN, Fuentes HE, Xie Z, Habermann TM, Villasboas JC, Paludo J, Thanarajasingam G, Thompson CA, Lin Y, Bennani NN, Johnston PB, Micallef INM, Porrata LF, Inwards DJ, Witzig TE, Ansell SM, Nowakowski GS, Wang Y. Survival trends of older adult patients with diffuse large B-cell lymphoma: A National Cancer Database analysis. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7542] [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
7542 Background: 60-70% of patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) can be cured with R-CHOP or R-CHOP-like immunochemotherapy. However, patients ≥80 years of age were either excluded or underrepresented in modern DLBCL trials, and their outcomes are understudied. The aim of this study is to define the survival trends and risk factors for inferior survival in older adult patients with DLBCL. Methods: Patients with newly diagnosed DLBCL were identified from the National Cancer Database (2004-2017, representing the rituximab era). Clinical characteristics, treatment, and outcomes were compared between patients ages ≥ 80, 65-79, and < 65 years. The Kaplan-Meier method and Cox proportional hazards model were used for survival analysis. Results: A total of 231,756 patients with newly diagnosed DLBCL were identified; 46,250 (20%) were ≥80 years, 87,702 (38%) were 65-79 years, and 97,904 (42%) were < 65 years. Patients ≥80 years were more likely to have a higher Charlson-Deyo Comorbidity Index score (CDS) (CDS ≥2, 12% vs 11% vs 8%, p = 0.001), less likely to receive systemic chemotherapy (63% vs 83% vs 89%, p < 0.001), and more likely to receive treatment at a non-academic center (71% vs 65% vs 48%, p < 0.001), compared to patients 65-79 and < 65 years, respectively. Median overall survival (OS) was significantly worse for patients ≥80 years compared to patients 65-79 years (11.6 vs 61.0 months, p = 0.001) and patients < 65 years (11.6 vs 178.1 months, p = 0.001). During the study period, the median OS had only minimally improved for patients ≥80 years (10.6 months in 2004-2007 vs 11.5 months in 2008-2011 vs 12.3 months in 2012-2016, p = 0.006). In contrast, the OS improvement appears more meaningful in patients 65-79 years (median in months: 51 vs 61.2 vs 65.9, p = < 0.001) and patients < 65 years (median in years: 14.6 vs 11.3 vs not reached, p < 0.001) in the prespecified intervals (2004-07, 2008-11, and 2012-16). In multivariate analysis, the most substantial risk factor for worse survival in patients ≥80 years was not receiving systemic therapy (hazard ratio [HR] = 3.26, 95%CI = 3.01-3.54, p = 0.001). Other risk factors associated with worse survival included high-risk IPI score (HR = 2.16, 95%CI = 1.96-2.39, p = 0.001), CDS score ≥2 (HR = 1.56, 95%CI = 1.40-1.73, p = 0.001), male sex (HR = 1.16, 95%CI = 1.09-1.24, p = 0.001), B symptoms at diagnosis (HR = 1.16, 95%CI = 1.08-1.25, p = 0.001), and treatment at a non-academic center (HR = 1.1, 95%CI = 1.01-1.20, p = 0.001). Conclusions: Patients ≥ 80 years of age with DLBCL have a significantly inferior survival which has not meaningfully improved in recent years. More than 1/3 of patients ≥ 80 years did not receive systemic therapy. Older adult patients with DLBCL should be assessed for fitness for chemotherapy using validated geriatric assessment tools. Novel therapeutic strategies with favorable safety profiles are urgently needed for this expanding patient population.
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Affiliation(s)
| | | | | | - Zhuoer Xie
- Mayo Clinic, Division of Hematology, Rochester, MN
| | | | | | - Jonas Paludo
- Mayo Clinic, Division of Hematology, Rochester, MN
| | | | | | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | | | | | - Yucai Wang
- Mayo Clinic, Division of Hematology, Rochester, MN
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8
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Desai S, Mwangi R, King RL, Maurer MJ, Cerhan JR, Feldman AL, Habermann TM, Mou E, Farooq U, Thompson CA, Wang Y, Witzig TE, Nowakowski GS. Type of tissue biopsy and outcomes in diffuse large B-cell lymphoma (DLBCL). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e13569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
e13569 Background: Progress in understanding the molecular biology of DLBCL has led to development of complex molecular classifications that rely on sequencing methods. These molecular clusters are defined by activation of distinct pathways and may aid in selecting targeted therapy. In the molecular era, tissue requirements in clinical trials have increased to ensure sufficient tissue for molecular testing, potentially resulting in bias for enrollment of patients with larger excisional biopsies (EB). We examined the impact of tissue biopsy method on outcomes of DLBCL in a prospective observational study. Methods: Consecutive adult patients with DLBCL within 9 months from their initial diagnosis were enrolled into the Molecular Epidemiology Resource (MER) of the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence (SPORE). Demographics, clinical variables, type of tissue biopsy (EB vs. core needle biopsy (CNB)) for initial diagnosis and initial treatment were recorded at baseline. Pts were contacted every 6 months from the date of diagnosis for first 3 years and then annually thereafter. Study objectives were event free survival (EFS) and overall survival (OS) by tissue biopsy method. Results: A total of 1061 patients with newly diagnosed DLBCL, from 2002 to 2015, were included. The table lists baseline characteristics of the cohort. 593 (56%) pts underwent EB and 468 (44%) underwent CNB for initial diagnosis. A significantly higher proportion of patients receiving CNB had performance status >=2, advanced stage, high risk disease by international prognostic index (IPI), abnormal lactate dehydrogenase. Median time from diagnosis to treatment initiation (DTI) was significantly shorter in the CNB group (13 days) than EB group (19 days). 2-year EFS (60% vs 75%, HR 0.75 (0.6-0.9), p <0.01) was significantly lower in CNB than EB group. There was a trend towards lower OS (75% vs 80%, HR: 0.8 (0.6-0.95), p =0.049) in CNB than EB group. Conclusions: Patients undergoing CNB are more likely to have higher risk disease, shorter DTI and survival compared to those undergoing EB. A need for large amount of diagnostic tissue in biomarker driven clinical trials may result in disproportional exclusion of high risk DLBCL pts who have inferior outcomes after standard treatment and could potentially benefit from novel agents, resulting in overperformance of the control arm. The need for tissue must be carefully balanced against resulting selection bias.[Table: see text]
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Affiliation(s)
| | | | - Rebecca L. King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Matthew J. Maurer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | | | | | - Eric Mou
- Stanford Health Care, Stanford, CA
| | - Umar Farooq
- University of Iowa Carver College of Medicine, Iowa City, IA
| | | | - Yucai Wang
- Mayo Clinic, Division of Hematology, Rochester, MN
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9
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Desai S, Wang Y, Rosenthal AC, Reeder CB, Inwards DJ, Ayala E, Nowakowski GS, Tun HW, Paludo J, Villasboas JC, Porrata LF, Alhaj Moustafa M, Kharfan-Dabaja M, Johnston PB, Ansell SM, Habermann TM, Micallef INM. Salvage therapies in transplant-eligible relapsed classic Hodgkin lymphoma, are novel regimens better? J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7530] [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
7530 Background: Clinical trials of novel salvage therapies (ST) have encouraging outcomes for relapsed/refractory classic Hodgkin lymphoma (R/R cHL) eligible for autologous stem cell transplant (ASCT). In this observational study, we report efficacies and outcomes of different ST in ASCT-eligible R/R cHL. Methods: Consecutive ASCT-eligible R/R cHL pts at 3 Mayo Clinic sites were included. Demographics and clinical variables at relapse were recorded by medical records review. Time to event endpoints were defined from relapse. Univariate associations were confirmed in multivariate models of age, sex, B symptoms, stage, bulky disease (BD, single mass > 6 cm) extra nodal disease (END), primary refractory disease (PRD) and early relapse (ER, within 1 year). Results: From Jan 2008 to May 2020, 207 ASCT-eligible pts with R/R cHL were included. Median age was 33 (24-43) years, 53% were male, 52% had advanced stage, 24% had BD, 36% had B symptoms, 41% had END, 11% had PRD and 43% had ER. All patients received ST and underwent ASCT; 43 (21%) received 2 ST, 14 (7%) 3 ST and 4 (0.5%) received 4 ST. 6 groups of ST were identified: ifosfamide, carboplatin and etoposide (ICE), bendamustine/brentuximab (BBV), brentuximab vedotin (BV), gemcitabine-based therapy (Gem), checkpoint inhibitor (CPI), and others. Table lists response to first line ST. BBV had significantly higher overall response rate (ORR) and complete response (CR) as first ST in univariate and multivariate models. 114 (79%) after ICE, 30 (97%) after BBV, 15 (56%) after BV, 25 (76%) after Gem, 8 (73%) after CPI and 15 (79%) after other ST underwent ASCT. Higher number of pts were bridged to ASCT after BBV than ICE (p<0.01). 110 (53%) went to ASCT in CR, 74 (36%) in partial response (PR) and 11% in progressive disease (PD). 43 received BV maintenance (BVm) after ASCT. Pts going to ASCT in PR or PD had significantly lower progression free survival (PFS) compared to pts in CR (2 yr PFS: 62%, 18% vs 77%, respectively, p<0.0001) in univariate and multivariate models. There was no difference in PFS and overall survival (OS) by type of ST. BVm was associated with higher PFS (HR 0.3 (CI95 0.2-0.8)) and higher number of ST was associated with lower OS (HR 2 (CI95 1.4-3)) in multivariate model (p<0.001). For pts transplanted in CR, there was no significant difference in PFS and OS by type of ST but higher number of ST predicted lower OS (HR 2.4 (CI95 1.2-3.5), p<0.01). Conclusions: Type of ST did not predict survival, response to and number of ST did. For pts with CR, number of ST not type of ST predicted survival. BBV had higher response rates, higher rates of bridge to ASCT, and may be a preferable ST than ICE. Large, randomized trials are needed to evaluate efficacy of BBV compared to ICE.[Table: see text]
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Affiliation(s)
| | - Yucai Wang
- Mayo Clinic, Division of Hematology, Rochester, MN
| | | | | | | | - Ernesto Ayala
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL
| | | | - Han W. Tun
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL
| | - Jonas Paludo
- Mayo Clinic, Division of Hematology, Rochester, MN
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10
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Kuhlman JJ, Alhaj Moustafa M, Seegobin K, Iqbal M, Ayala E, Ansell SM, Rosenthal AC, Paludo J, Micallef INM, Johnston PB, Inwards DJ, Habermann TM, Kharfan-Dabaja M, Witzig TE, Nowakowski GS, Tun HW. Diffuse large B-cell lymphoma with leukemic involvement. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e19552] [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
e19552 Background: Leukemic involvement (LI) in diffuse large B cell lymphoma (L-DLBCL) is very rare and has been sparsely reported. We report our experience with this entity in a large academic multi-center setting. Methods: Medical records of patients with DLBCL who received care at Mayo Clinic between 1/2003 and 6/2020 were reviewed. DLBCL patients with LI were identified. LI was defined as increased white blood cell counts and the presence of clonal B cells on peripheral blood flow-cytometry. Kaplan-Meier method was used for survival analysis. Results: Twenty patients with L-DLBCL were identified with a median follow-up of 32.5 months (CI95%, 32.5-NR). Median age at initial diagnosis was 62 (45-80) years. 60% (12/20) were male; 90% (18/20) were Caucasian. Pathologically, 90% (18/20) had DLBCL and 10% (2/20) had high-grade B cell lymphoma (HGBCL) with intermediate features between DLBCL and Burkitt lymphoma. By Hans criteria, 58% (11/19) had germinal center B-cell DLBCL (GCB-DLBCL) and 42% (8/19) had non-germinal center B-cell DLBCL (non-GCB-DLBCL). 40% (8/20) had transformed DLBCL (t-DLBCL); 36% (5/14) had double-hit lymphoma (DHL) by FISH analysis. LI was present in 55% (11/20) at initial diagnosis and 45% (9/20) at relapse. Median WBC was 39.5/ul (range, 4.3-121) with median absolute lymphocyte count of 25 k/ul (range, 0.7-117). Immunophenotypically, the leukemic lymphoma cells expressed CD19, CD20, and CD79a. Bone marrow involvement and pancytopenia were documented in all patients with a median bone marrow cellularity of 80%. Other extranodal sites of involvement with LI included spleen (65%;13/20), liver (20%;4/20), breast and soft tissue (20%;4/20), bladder or kidneys (10%;2/20), skeleton (10%;2/20), and myocardium (5%;1/20). 65% (13/20) had B-symptoms. All patients had LDH elevation (UNL 222 U/L) with a median of 2125 U/L (range, 308-10,760). 45% (5/11) of patients with LI at initial diagnosis had CNS involvement on relapse/progression. All patients with LI at initial diagnosis received anthracycline-based chemoimmunotherapy with or without CNS prophylaxis. Patients with LI at relapse had had a median of 2 prior treatments (range, 1-5) before LI. Median overall survival (OS) for the whole group was 9 months (CI 95%; 5.8-11.8). There were no long-term survivors. Median progression free survival after LI was 4.7 months (CI95%; 0.8-7.6) in the newly diagnosed group and 3 months (CI95%; 0.9-20) in the relapsed group. 90% (18/20) died due to their progressive disease. Cell of origin, DHL status, or newly diagnosed vs. relapsed status did not have a significant impact on OS in patients with L-DLBCL. Conclusions: Leukemic involvement at any time during the course of DLBCL is associated with poor prognosis. It also appears to be a major risk factor for CNS relapse. It is most frequently associated with DHL and t-DLBCL. Novel therapeutic approaches at the time of initial therapy need to be developed for L-DLBCL.
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Affiliation(s)
| | | | - Karan Seegobin
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL
| | - Madiha Iqbal
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL
| | - Ernesto Ayala
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL
| | | | | | - Jonas Paludo
- Mayo Clinic, Division of Hematology, Rochester, MN
| | | | | | | | | | | | | | | | - Han W. Tun
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL
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11
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Tun AM, Maliske S, Wang Y, Maurer MJ, Micallef INM, Inwards DJ, Porrata LF, Rosenthal AC, Kharfan-Dabaja M, Orme J, Link BK, Cerhan JR, Thompson CA, Habermann TM, Witzig TE, Ansell SM, Nowakowski GS, Farooq U, Johnston PB. Progression-free survival at 24 months as a landmark after autologous stem cell transplant in relapsed or refractory diffuse large B-cell lymphoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7522 Background: Patients with newly diagnoseddiffuse large B-cell lymphoma (DLBCL) who achieve event-free survival at 24 months (EFS24) following immunochemotherapy (IC) have excellent overall survival (OS) similar to that of age- and sex-matched general population. The standard of care for patients with relapsed or refractory (RR) DLBCL following frontline IC is salvage therapy followed by autologous stem cell transplant (ASCT). The goal of this study is to evaluate the role of progression-free survival (PFS) at 24 months (PFS24) as a landmark after ASCT in patients with RR DLBCL. Methods: Patients with RR DLBCL after frontline R-CHOP or R-CHOP-like IC who underwent salvage therapy and ASCT at Mayo Clinic or University of Iowa between 07/2000 and 4/2020 were identified from institutional lymphoma transplant databases. Clinical characteristics, treatment information, and outcome data were abstracted. Post-ASCT PFS, OS, and post-relapse survival (PRS) were plotted by Kaplan-Meier method, and cumulative incidences of relapse vs non-relapse mortality (NRM) and different causes of death were compared accounting for competing events. Statistical analyses were performed in EZR v1.54. Results: A total of 437 patients were identified. Median age at ASCT was 61 years (range 19-78), and 280 (64%) were male. After a median post-ASCT follow up of 8.0 years (95% CI 7.2-8.7), 215 patients had a relapse (or disease progression), 180 within 2 years and 35 after 2 years. For the entire cohort, post-ASCT relapse rate was much higher than NRM rate (48.1 vs 9.1% at 5-year). Median PFS and OS after ASCT was 2.7 and 5.4 years, respectively. Lymphoma was the primary cause of death after ASCT. In contrast, for patients who had achieved PFS24 (n = 220), rates of post-PFS24 relapse and NRM were similar (14.8% and 12.3% at 5-year). Median PFS and OS after achieving PFS24 was 10.0 and 11.5 years, respectively. Lymphoma related and unrelated death rates were similar after achieving PFS24 (Table). For all patients who had a post-ASCT relapse, median PRS was 0.7 years (95% CI 0.5-0.9), and late relapse ( > 2 vs ≤2 years after ASCT) was associated with better PRS (median 2.3 [1.7-4.8] vs 0.5 [0.3-0.7] years, p < 0.001). Conclusions: Post-ASCT PFS24 is an important prognostic predictor of post-ASCT outcomes in patients with RR DLBCL following frontline IC.[Table: see text]
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Affiliation(s)
- Aung M. Tun
- The University of Kansas Cancer Center, Westwood, KS
| | | | - Yucai Wang
- Mayo Clinic, Division of Hematology, Rochester, MN
| | | | | | | | | | | | | | | | - Brian K. Link
- University of Iowa Carver College of Medicine, Iowa City, IA
| | | | | | | | | | | | | | - Umar Farooq
- University of Iowa Carver College of Medicine, Iowa City, IA
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12
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Tun AM, Wang Y, Maliske S, Farooq U, Micallef INM, Inwards DJ, Porrata LF, Ansell SM, Rosenthal AC, Kharfan-Dabaja M, Link BK, Villasboas JC, Paludo J, Cerhan JR, Habermann TM, Witzig TE, Nowakowski GS, Johnston PB. Impact of time to relapse and response to salvage therapy on post autologous stem cell transplant outcomes in relapsed or refractory diffuse large B-cell lymphoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e19501] [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
e19501 Background: The current standard of care for patients with relapsed or refractory (RR) diffuse large B-cell lymphoma (DLBCL) following frontline immunochemotherapy (IC) is salvage therapy, followed by high-dose chemotherapy and autologous stem cell transplant (ASCT) rescue in patients responding to salvage therapy. Time to first relapse (or refractory status) and response to salvage therapy in patients with RR DLBCL may reflect the chemosensitivity of the underlying disease. The aim of this study is to determine whether these factors impact post-ASCT outcomes. Methods: Patients with DLBCL that relapsed after R-CHOP or R-CHOP-like frontline therapy who underwent salvage therapy and ASCT at Mayo Clinic or University of Iowa between 07/2000 and 4/2020 were identified from institutional lymphoma and transplant databases. Clinical characteristics, treatment information, and outcome data were abstracted. Progression-free survival (PFS) and overall survival (OS) from the time of ASCT were analyzed using Kaplan-Meier method and Cox proportional hazards models. Results: A total of 437 patients with RR DLBCL who underwent salvage therapy and ASCT were identified. 280 (64%) were male. Median time from initial diagnosis to 1st relapse/salvage was 1.0 years (range 0.1-16.4). A median of 1 line (range 1-3) of salvage therapy was required. Response prior to ASCT was complete response (CR) in 211 (48%), partial response in 199 (46%), stable disease in 24 (5%), and unknown in 3 (1%) patients. Median age at ASCT was 61 years (range 19-78), and median follow up after ASCT was 8.0 years (95% CI 7.2-8.7). Median PFS and OS was 2.7 (95% CI 1.5-4.3) and 5.4 (4.2-7.4) years, respectively. Time to 1st relapse/salvage (≤1 vs 1-2 vs > 2 years) was not associated with PFS (median 0.8 vs 2.4 vs 4.9 years, p = 0.170) but was associated with OS (2.4 vs 7.4 vs 6.8 years, p = 0.013). Patients who required > 1 line of salvage therapy had significantly inferior PFS (median 0.3 vs 4.5 years, p < 0.001) and OS (0.9 vs 7.4 years, p < 0.001). In addition, patients who failed to achieve a CR prior to ASCT had significantly worse PFS (median 0.8 vs 5.3 years, p < 0.001) and OS (2.7 vs 9.2 years, p < 0.001). In multivariate Cox regression models adjusted for age and sex, time to 1st relapse/salvage was not associated with PFS (p = 0.313) or OS (p = 0.081); however, lines of salvage and response prior to ASCT remain significantly prognostic for PFS ( > 1 line of salvage: HR 2.14, 95% CI 1.59-2.87, p < 0.001; non-CR: HR 1.61, 95% CI 1.26-2.05, p < 0.001) and OS ( > 1 line of salvage: HR 2.25, 95% CI 1.66-3.05, p < 0.001; non-CR: HR 1.63, 95% CI 1.26-2.12, p < 0.001). Conclusions: In patients with RR DLBCL following frontline IC, requiring more than 1 line of salvage therapy and failure to achieve CR are strong independent risk factors for poor PFS and OS after ASCT. Novel therapies such as CAR-T cell therapy should be studied in this population.
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Affiliation(s)
- Aung M. Tun
- The University of Kansas Cancer Center, Westwood, KS
| | - Yucai Wang
- Mayo Clinic, Division of Hematology, Rochester, MN
| | | | - Umar Farooq
- University of Iowa Carver College of Medicine, Iowa City, IA
| | | | | | | | | | | | | | - Brian K. Link
- University of Iowa Carver College of Medicine, Iowa City, IA
| | | | - Jonas Paludo
- Mayo Clinic, Division of Hematology, Rochester, MN
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13
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Kraft RM, Ansell SM, Villasboas JC, Bennani NN, Wang Y, Habermann TM, Thanarajasingam G, Inwards DJ, Porrata LF, Micallef INM, Witzig TE, Thompson CA, Johnston PB, Nowakowski GS, Lin Y, Paludo J. Outcomes in primary cutaneous diffuse large B-cell lymphoma, leg type. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e19547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
e19547 Background: Primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL, LT) is a rare, aggressive lymphoma characterized by skin involvement predominantly in the lower extremities, and is associated with an inferior prognosis compared to other primary cutaneous B-cell lymphomas. Immunochemotherapy with or without involved-field radiation therapy (IFRT) is considered standard, front-line therapy. Interestingly, over-expression of PD-L1/PD-L2 has been shown in a high proportion of PCDLBCL, LT cases, but efficacy of immune checkpoint inhibitors (ICI) in relapsed/refractory, PCDLBCL, LT has not been thoroughly studied. Therefore, we describe the outcomes of 1) immunochemotherapy with and without IFRT as front-line treatment of PCDLBCL, LT, and 2) ICIs in the relapsed/refractory setting. Methods: We conducted a retrospective cohort study of patients diagnosed with PCDLBCL, LT seen at Mayo Clinic from January 1, 2000 to December 31, 2020. Using the Kaplan-Meier method, we calculated progression-free survival (PFS), duration of response (DOR), and overall survival (OS) in patients who received front-line R-CHOP with and without IFRT, and salvage ICI therapy for relapsed/refractory disease. Results: A total of 28 patients with PCDLBCL, LT were identified. The median age at diagnosis was 71.6 years (range 48.0-91.7), 50% (N = 14) were male, and 78.6% (N = 22) had disease involvement of the lower extremities at diagnosis. For front-line treatment, 31.2% (N = 9) received R-CHOP with IFRT, and 31.2% (N = 9) received R-CHOP without IFRT. The median PFS in patients treated with R-CHOP plus IFRT was 41.8 months [95% CI: 30.2-69.6] compared to 13.7 months [95% CI: 10.7-27.7; p= 0.01] in those treated with R-CHOP without IFRT. The median OS in patients treated with R-CHOP plus IFRT was 74.7 months [95% CI: 53.0-108.6] compared to 38.2 months [95% CI: 26.0-80.4; p= 0.14] in those treated with R-CHOP without IFRT. Patient and disease characteristics were similar among these two groups. ICIs were used in 17.9% (N = 5) of patients with relapsed/refractory, PCDLBCL, LT, and these patients had received a median of three (range 2-10) prior systemic therapies. The overall response rate was 60% as three patients treated with ICIs achieved a complete response, and the other two patients showed no clinical response. The median DOR from ICIs was 23.0 months [95% CI: 3.6-26.0]. The median PFS from ICI therapy was 10.2 months [95% CI: 3.6 – not reached]. Only one of the five patients was noted to have a mild side effect from ICI treatment (elevated alkaline phosphatase, grade 1). Conclusions: R-CHOP with IFRT was associated with a longer median PFS compared to R-CHOP without IFRT as front-line therapy for PCDLBCL, LT. Furthermore, ICIs may have a role in treating relapsed/refractory disease as reasonable activity in heavily pre-treated patients and a favorable safety profile were observed in this study. Further studies would be of benefit to confirm our findings.
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Affiliation(s)
| | | | | | | | - Yucai Wang
- Mayo Clinic, Division of Hematology, Rochester, MN
| | | | | | | | | | | | | | | | | | | | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Jonas Paludo
- Mayo Clinic, Division of Hematology, Rochester, MN
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14
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Sidana S, Allmer C, Larson MC, Dueck AC, Yost KJ, Warsame RM, Thanarajasingam G, Cerhan JR, Paludo J, Rajkumar SV, Habermann TM, Nowakowski GS, Lin Y, Gertz MA, Witzig TE, Dispenzieri A, Gonsalves WI, Ansell SM, Thompson CA, Kumar S. Quality of life (QOL), financial burden, and perception of care in patients enrolled on clinical trials (CTs). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
e19112 Background: We sought to study the longitudinal QOL, financial burden and perception of care (PoC) in patients with multiple myeloma (MM) or lymphoma (LYM) enrolled on CTs vs. those receiving standard care (Non-CT). Methods: QOL was evaluated using the FACT-G questionnaire (baseline, 1, 2, 3, 6 & 12 months). Financial burden was evaluated using 10 questions adapted from the MEPS survey and PoC was evaluated using 6 questions adapted from the CAHPS survey (baseline, 3, 6 & 12 months). Results: 35 (28%) of 123 enrolled patients were treated on CTs. Demographics, QOL and financial burden are shown in the Table. Baseline QOL scores were similar in CT vs non-CT groups. Age, gender and self-reported performance status were significantly associated with baseline QOL, while lines of therapy & cancer type were not. There were no significant differences in change in QOL vs. baseline in patients treated on CTs vs. non-CTs at 1, 2, 3, 6 and 12 months from baseline, including the total FACT-G score and the subdomains of functional, physical, emotional and social well-being. Within each group, there was a decline in QOL over the first 3 months, specifically physical WB, which gradually returned to baseline. Baseline answers to financial burden questions were similar, except patients on CTs reported less need for taking extended time-off from work (22% vs. 46%, p = 0.02). The only statistically significant difference in individual Qs over 1 year was ‘worry about having to pay large medical bills’ at the 6-month timepoint (CT: 0%, non-CT: 52%, p = 0.01). Using a composite score from 4 MEPS questions, financial burden over time was lower in the CT group, though the differences were not statistically significant. There were no significant differences in PoC at baseline, 3, 6 and 12 months in the two groups based on answers to each of the six questions adapted from the CAHPS survey. Conclusions: Over 1 year, patients on CTs experienced a similar QOL and perceived their care to be similar as non-CT patients. Financial burden was lower in the CT group, though differences were not statistically significant. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Yi Lin
- Mayo Clinic, Rochester, MN
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15
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Khurana A, Mwangi R, Nowakowski GS, Habermann TM, Ansell SM, LaPlant B, Link BK, Cerhan JR, Maurer MJ, Witzig TE. Impact of organ function based standard exclusion criteria in diffuse large b-cell lymphoma (DLBCL) patients: Who gets left behind? J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e14100] [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
e14100 Background: Only 3-5% of adult cancer patients in the US enroll in clinical trials. Patients with organ dysfunction are often excluded from clinical trials, regardless of specific drug metabolism or relative function of the organ. The ASCO and the US FDA recommend modernizing criteria related to baseline organ function and comorbidities. In hematological malignancies, often the disease itself is the reason for organ function derangement. In order to better inform clinical trial eligibility and improve participation in the future, we evaluated the impact of baseline organ function on the potential eligibility for clinical trial enrollment for real world patients with newly diagnosed DLBCL. Methods: Consecutive, newly diagnosed lymphoma patients were offered enrollment from 2002-2015 into the Molecular Epidemiology Resource (MER) of the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence. This analysis is based on 1270 DLBCL patients receiving immunochemotherapy. Baseline organ function parameters were identified from the exclusion criteria for hemoglobin, absolute neutrophil count (ANC), platelet count, creatinine, and bilirubin reported in recent frontline trials in DLBCL (Table). Abstracted clinical labs from the MER were used to determine the percent of patients that would be excluded based on the criteria. Results: We determined that 11-23% of MER DLBCL patients receiving standard of care frontline therapy would have been excluded in the various trials utilizing baseline organ function alone (Table). Hemoglobin and renal function had the greatest impact on exclusion. Conclusions: Current national and international (phase II and III) trials are excluding up to 23% of patients from clinical trial participation based on organ function alone in DLBCL. These data will be useful in future clinical trial development to meet ASCO recommendations to increase trial accrual, while balancing the drug toxicities and patient safety. An online tool was developed based on these results to aid future trial development. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | - Brian K. Link
- University of Iowa Carver College of Medicine, Iowa City, IA
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16
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St-Pierre F, Broski SM, LaPlant B, Ristow K, Macon WR, Habermann TM, Witzig TE. Association between bone involvement on PET/CT and event free survival (EFS) in follicular lymphoma (FL) grade 3b. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e20068] [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
e20068 Background: FL grade 3B (FL3B) is an aggressive subtype of FL with a distinct morphologic, cytogenetic and immunohistochemical profile that is associated with higher mortality compared to other subtypes of FL. FL3B is a rare disease, and data regarding its prognostication beyond grading is lacking. Recent data suggests that spleen and extranodal (EN) involvement on PET/CT predict early clinical failure in FL grades 1-3A[1]. We aimed to determine the incidence of spleen and EN involvement on PET/CT in FL3B, and whether these can predict EFS. Methods: Patients with untreated FL3B diagnosed between 2003-2016, with available pre-treatment PET/CT, were identified using the Mayo Clinic Lymphoma Database and the University of Iowa/Mayo Clinic Lymphoma SPORE database. 27 patients were included in this analysis. All but two patients received treatment with immunochemotherapy. Associations with outcomes were assessed using EFS, defined as disease progression, relapse, transformation, or death. Results: 11/27 (40.7%) of patients had EN involvement on PET/CT. The most common EN site was bone, in 8/27 (29.5%) of patients. Soft tissue involvement was present in 4/27 (14.8%) of patients. Liver, brain, and endometrial involvement were each noted once. 11/27 (40.7%) of patients had spleen involvement on PET/CT. Presence of bone involvement as detected on PET/CT was associated with lower EFS (p = 0.02). EN involvement was associated with a trend toward a lower EFS but statistical significance was not reached likely secondary to low numbers in this cohort. Results in the table are compared to results obtained from our analysis in patients with FL grade 1-3A[1]. Conclusions: Bone involvement on pre-treatment PET/CT in FL3B was associated with early clinical failure in this small cohort of 27 patients. EN involvement at diagnosis may also be associated with poorer outcomes. These findings are similar to our analysis of a large (n = 613) cohort of patients with FL grade 1-3A. These findings may aid in the prognostication of patients with newly diagnosed FL3B, to guide therapy in select higher risk patients. [Table: see text]
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Mondello P, Fama A, Larson MC, Feldman AL, Yang ZZJ, Villasboas JC, Huet S, Tesson B, Slager SL, Link BK, Syrbu S, Novak A, Habermann TM, Witzig TE, Nowakowski GS, Salles GA, Cerhan JR, Ansell SM. Prognostic relevance of CD4+ T-cells in the microenvironment of newly diagnosed follicular lymphoma (FL) patients is independent of the tumor gene expression profile. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.8052] [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
8052 Background: A significant proportion of patients with FL experience an early relapse and a subsequent poor outcome. While several prognostic indices have been developed, none were designed to predict early failure. Recently, we established that lack of intrafollicular CD4+ T-cell expression predicted risk of early failure, and integrating this microenvironment biomarker with the Follicular Lymphoma International Prognostic Index, termed BioFLIPI, further improved identification of FL patients at risk of early failure ( Blood 2019;134(suppl1):121). However, the microenvironment may be influenced by the genetic composition of tumor. We investigated whether the CD4 biomarker and BioFLIPI were impacted by genetic features of the tumor as assessed by a 23-gene expression prognostic score ( Lancet Oncol 2018;19:549-61). Methods: Of the 186 cases with FL grade 1-3A treated with immunochemotherapy (IC) in our prior study, 152 had digital expression quantification of 23 selected genes (23-GEP score), which used RNA from formalin-fixed, paraffin-embedded samples. Event-free survival (EFS) was defined as time from diagnosis to progression, relapse, retreatment, or death. Early failure was defined as failing to achieve EFS at 24 months. Risk of early failure was estimated using odds ratios (ORs) and 95% confidence intervals from logistic regression models. We also used Cox regression to assess associations with continuous EFS and overall survival (OS). Results: 28% of patients failed to achieve EFS24. Lack of CD4+ intrafollicular expression (38% of patients, OR = 2.33, p = 0.024) and high risk 23-GEP score (26% of patients, OR = 3.52, p = 0.001) each predicted early failure, and in a multivariable model that included FLIPI, both CD4+ (OR = 2.26, p = 0.046) and 23-GEP score (OR = 2.26, p = 0.0.057) remained predictors. Similarly, BioFLIPI modeled as a continuous score (1-4, OR per one point increase = 2.31, p < 0.001) predicted early failure, and the association remained (OR = 2.14, p < 0.001) when the high risk 23-GEP score (OR = 2.79, p = 0.013) was included in the model. When stratified on 23-GEP score, BioFLIPI was a stronger predictor of early failure in low risk (74%, OR = 2.51, p = 0.002) relative to high risk (26%, OR = 1.55, p = 0.27) patients. Similar patterns were observed for EFS and OS. Conclusions: CD4+ T-cell infiltrate and tumor gene expression appear to be independently predictive of early failure in newly diagnosed FL patients treated with IC. Future studies should integrate and validate these measures.
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Affiliation(s)
| | - Angelo Fama
- Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | | | | | | | | | - Sarah Huet
- Hospices Civils de Lyon, Pierre-Bénite, France
| | | | | | - Brian K. Link
- University of Iowa Carver College of Medicine, Iowa City, IA
| | - Sergei Syrbu
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Anne Novak
- Division of Hematology, Mayo Clinic, Rochester, MN
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Higgins A, Richter MD, Patel S, McCullough KB, Habermann TM, Ansell SM, Thompson CA, Bennani NN, Thanarajasingam U, Thanarajasingam G. Onset, duration, and clinical impact of immune-related adverse events in Hodgkin lymphoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.5_suppl.95] [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
95 Background: The incidence of immune-related adverse events (irAEs) in patients (pts) with Hodgkin lymphoma (HL) treated with PD-1 antibodies (ICI) is reported at 28 - 36%. However, clinically relevant information on irAE onset, duration, or impact on ability to continue therapy in HL is lacking. Additionally, these incidence rates reflect CTCAE definition and grading, and not ASCO Clinical Practice Guidelines irAE-specific criteria (Brahmer et al, JCO 2018). The objectives of this study were to evaluate the rate and severity of irAEs in HL pts using ASCO criteria, to characterize irAE time profile and to assess their impact on continued therapy. Methods: HL pts who received a PD-1 inhibitor for the treatment of HL at Mayo Clinic Rochester between January 1, 2011 and March 1, 2018 were identified. We conducted a detailed, longitudinal retrospective chart review with definition and grading of irAEs in accordance with ASCO guidelines. Results: Fifty-one pts were identified (35% women, median age at ICI initiation 35 years [range: 19-87]). Median duration of follow up from ICI start was 30 months (range: 1-70). Thirty-one pts (61%) had any irAE. Most common irAEs were inflammatory/bullous dermatoses (23.5%/5.9% any grade/grade3-4; median onset/duration of 81/57 days[d]), followed by thyroiditis (22%/0%; 86/84 d), colitis (14%/8%; 82/106 d), pneumonitis (14%/10%; 241/182 d), and hepatitis (14%/4%; 71/35 d). Fifteen pts (29%) required treatment with steroids. Among the total cohort, ICI was held for an irAE 28 times (50% of 56 total irAEs). Median treatment cycles held was 2.5 and ICI was permanently discontinued due to irAE in 18%. The most common irAE leading to treatment discontinuation was pneumonitis, followed by neuritis (5.9%/3.9%; 179/374 d), colitis, and rash. Conclusions: The rate of irAEs of 61% in this cohort as defined by ASCO consensus criteria was higher than reported in trials. Most irAEs were characterized by delayed onset of several months and prolonged duration, particularly pneumonitis and neuritis. Treatment discontinuation due to irAEs was infrequent overall. Further studies are needed to determine whether the development or duration of irAEs is predictive of treatment outcomes in HL.
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19
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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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20
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St-Pierre F, Broski SM, LaPlant B, Ristow K, Maurer MJ, Macon WR, Habermann TM, Ansell SM, Thompson CA, Micallef INM, Nowakowski GS, Witzig TE. Extranodal (EN) and spleen disease by FDG-PET/CT is associated with early clinical failure in untreated follicular lymphoma (FL). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.7554] [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
7554 Background: Predicting early clinical failure in patients with untreated FL is important but difficult. Lymphoma involvement of EN sites is better detected by FDG-PET/CT than CT alone, but PET parameters are not part of the usual predictive indices. We aimed to determine the incidence and patterns of spleen and EN disease using PET/CT, and learn if they are useful in predicting early clinical failure. Methods: PET/CT images from 613 cases of newly diagnosed FL between 2003 – 2016 were retrospectively reviewed. The location, pattern, and number of EN sites, as well as splenic involvement, were recorded. Associations with outcomes were assessed using event-free survival (EFS) and overall survival (OS). Results: 49% (301/613) of patients had PET/CT-detected EN involvement, and 28% (171/613) had spleen involvement. Presence of ≥2 EN sites, spleen, bone, or soft tissue involvement, as well as a multifocal on diffuse pattern of bone involvement by imaging, were univariate predictors of EFS; presence of ≥2 EN sites and bone involvement pattern were also predictive of OS. In a multivariate analysis with FLIPI-2 factors, spleen involvement, pattern of bone involvement, and soft tissue involvement independently predicted a lower EFS (Table). When the multivariate analysis was performed using PRIMA-PI factors, the presence of ≥2 EN sites was an adverse independent prognostic factor for OS (HR 2.28; 95% CI 1.01-5.18; p=0.05). Conclusions: Baseline PET/CT identifies EN and spleen sites of disease that can predict early clinical failure of FL. These results may be useful to better identify high-risk patients and guide appropriate therapy. [Table: see text]
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21
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Thanarajasingam G, Dueck AC, Novotny PJ, Habermann TM, Advani RH, Gascoyne RD, Witzig TE, Quon A, Ranheim E, Kahl BS, Evens AM, Hong F. Longitudinal toxicity analysis with novel summary metrics of lenalidomide maintenance in follicular lymphoma in ECOG-ACRIN 2408. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.6511] [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
6511 Background: Conventional adverse event (AE) analysis (ToxC) focuses on incidence of grade (gr) 3+ toxicities, and fails to capture AE time profile. Novel metrics that reflect chronic low gr and overall AE burden are needed. We applied the Toxicity over Time (ToxT) approach to ECOG-ACRIN 2408 to depict time-dependent toxicity of lenalidomide (L) with rituximab maintenance (MR) in follicular lymphoma (FL), and we developed a novel summary metric of symptomatic AE burden, the maximum gr over time (MGOT). Methods: In E2408, high risk FL patients (pts) were randomized (1:2:2) to: A) bendamustine-rituxumab (BR) x 6 then MR x 2 years (yrs) vs B) BR-bortezomib x 6 then MR x 2 yrs vs C) BR x 6 then MR x 2 yrs + L x 1 yr (MRL). Analysis included 3 laboratory and 5 symptomatic AEs of highest incidence during maintenance on arms A and C. Treatment-related AEs of any gr were analyzed by ToxC and ToxT. Repeated measures, time-to-event (TTE) and area under the curve (AUC) analyses capture trends over time in ToxT. MGOT combines the 5 symptomatic AEs. Results: 104 randomized pts (30 MR, 74 MRL) were included. For the laboratory AEs, by ToxC, neutropenia incidence was significantly higher in MRL (84%) than MR (47%, p < .001). ToxT additionally shows neutropenia does not worsen over time (10/14/20% gr 1/2/3+ at c1, 6/21/12% gr 1/2/3+ at c12). For the symptomatic AEs, ToxC indicates 2% gr 3+ GI AEs. However, gr 1-2 GI AEs are more common on MRL (59%) than MR (26%, p < .001). ToxT AUC captures a higher burden of GI AEs over time on MRL(2.8) vs MR(1.4, p = .002). TTE depicts sooner GI AE onset in MRL (10% vs 0% gr 2+ GI by day 50, p = 0.03). Bar charts of incidence and grade by cycle illustrate this improves over time (34/7/4% gr 1/2/3+ at c1, 13/0/0% gr 1/2/3+ at c12). ToxT MGOT analyses demonstrate earlier time to gr 2+ symptomatic AE on MRL vs MR (63% vs 31% by day 50, p < .001) and suggest that overall AE burden over time is higher for patients on MRL(AUC 18.2) than MR(11.8, p < .001). Conclusions: ToxT depicts AE time profile and can guide AE interventions. Summary metrics suggest that symptomatic AEs occur earlier and their burden over time is higher on MRL. We are implementing ToxT in patient-reported AE data to better characterize pt tolerability.
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Affiliation(s)
| | | | | | | | | | - Randy D. Gascoyne
- Pathology and Lymphoid Cancer Research, British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | - Andrew Quon
- University of California Los Angeles, Los Angeles, CA
| | - Erik Ranheim
- University of Wisconsin, School of Medicine and Public Health, Madison, WI
| | - Brad S. Kahl
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | | | - Fangxin Hong
- Biostatistical Core, Harvard University, Boston, MA
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22
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Abeykoon JP, Zanwar S, Ansell SM, Kumar S, Thompson CA, Habermann TM, Witzig TE, Buadi F, Go RS, Gonsalves WI, Leung N, Dispenzieri A, Kourelis T, Lacy M, Warsame RM, Inwards DJ, Rajkumar SV, Kyle RA, Gertz MA, Kapoor P. Outcomes with rituximab plus bendamustine (R-Benda), dexamethasone, rituximab, cyclophosphamide (DRC), and bortezomib, dexamethasone, rituximab (BDR) as primary therapy in patients with Waldenstrom macroglobulinemia (WM). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.7509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7509 Background: Waldenstrom macroglobulinemia (WM) is a rare lymphoma for which scant comparative data exist to guide frontline therapy. Herein, we compare 3 commonly used regimens in WM: R-Benda, DRC, and BDR in frontline setting. Methods: Patients (Pts) with active WM seen at Mayo Clinic between 2000 & 2018 who received R-Benda, DRC or BDR as primary therapy were included in this retrospective study. Response rates were assessed by Consensus Criteria. All time to event analyses were performed from the frontline therapy, using Kaplan-Meier method. Results: The study included 172 pts with active WM (R-Benda, n=67, DRC, n=75, BDR, n=30).The median follow-up for the entire cohort was 3.7 years (y) (95% CI 3.7-3.0). Baseline characteristics, including IPSS, and time to frontline therapy from WM diagnosis were similar across the 3 cohorts. Clinically relevant endpoints are shown in the Table. Hematologic and non-hematologic toxicities were similar across the 3 groups. Grade 3 neuropathy requiring treatment discontinuation was encountered in 13% pts treated with BDR. 56 pts received subsequent salvage therapy [(10% in R-Benda arm, 44% in DRC arm, & 53% in BDR arm]; 29% pts in the R-Benda arm and 30% pts in DRC arm received a PI-based regimen while 69% pts in the BDR arm received alkylator-rituximab based therapy. Conclusions: Outcomes (MRR, TTNT and EFS) with frontline R-Benda are superior in comparison to frontline DRC or BDR in patients with WM. Clinically relevant endpoints are not significantly different with DRC vs. BDR. The toxicity profile across the 3 groups was comparable. [Table: see text]
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23
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Wang Y, Zhou S, Yang F, Nowakowski GS, Habermann TM, Wang M, Witzig TE. Efficacy of frontline treatment regimens in follicular lymphoma: A network meta-analysis of phase III randomized controlled trials. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.7556] [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
7556 Background: The frontline treatment for advanced follicular lymphoma has evolved with the introduction of maintenance therapy, bendamustine (Benda), obinutuzumab (G), and lenalidomide (Len). We conducted a network meta-analysis of phase 3 randomized controlled trials (RCTs) to identify the regimens with superior efficacy. Methods: Data were extracted from 7 RCTs (FOLL05, StiL NHL1, BRIGHT, PRIMA, GALLIUM, StiL NHL7, and RELEVANCE). Progression-free survival (PFS) was compared between 11 regimens with different immunochemotherapy and maintenance strategies. To incorporate direct and indirect comparisons, random-effects Bayesian network meta-analyses were conducted after adjusting for study-wise variation. The posterior inference was derived based on Markov chain Monte Carlo methods and implemented using JAGS v4.3.0. Pairwise comparison of hazard ratios (HRs) and 95% credible intervals (CIs) were calculated. Results: PFS HRs of other regimens compared to the reference regimen are summarized in the Table. Compared to Rituximab(R)-Benda, R-CHOP had inferior PFS, R-CHOP-R, G-CHOP-G, and R-Len-R had similar PFS, while R-Benda-R, R-Benda-R4 and G-Benda-G had better PFS. Compared to R-CHOP-R, G-CHOP-G and R-Len-R had similar PFS, while R-Benda-R, R-Benda-R4 and G-Benda-G had better PFS. In addition, the PFS for G-Benda-G was similar to R-Benda-R4 (HR 0.94, 95% CI 0.78-1.09) but better than R-Benda-R (HR 0.82, 95% CI 0.75-0.97). Conclusions: Compared with the commonly used R-Benda and R-CHOP-R regimens, G-CHOP-G, R-Benda-R and R-Benda-R4 had better PFS, while the chemotherapy-free regimen R-Len-R had similar PFS. [Table: see text]
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Affiliation(s)
| | | | - Fang Yang
- The Comprehensive Cancer Centre of Drum Tower Hospital, Medical School of Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, China
| | | | | | - Michael Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX
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24
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Khan FA, Maqbool S, Elkhoury M, Habermann TM, Dufan T, Siddiqi AH, Han A, Sayed K, Ahmed Y, Kantawala K, Hamza M, Sonal A, Ahmed S, Yang C, Abdelrahman D. Impact of international collaboration utilizing E-consult and E-tumor board in the multidisciplinary management of cancer patients: A study from Mayo Clinic Care Network (MCCN) members. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18261] [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
e18261 Background: Multidisciplinary tumor board meetings have shown to improve quality and outcome in the care of cancer patients. Many tertiary centers conduct site specific tumor board meetings but not all the centers especially community oncology and international centers have the manpower capacity to hold site specific meetings, the overall impact of tumor boards on patients care may vary based on its structure and composition. We propose that institutional collaboration in the comprehensive care of cancer patients utilizing E-consult and E tumor board may help to improve patient care. Methods: Retrospective data of 134 patient cases seen at the American hospital Dubai between 2016-2018 was analyzed. Cases that were reviewed at the American Hospital multidisciplinary tumor board meeting (AHD-MDT) and also referred for second opinion utilizing Mayo e-consult/e-tumor board service were analyzed using electronic health record, AHD-MDT meeting minutes and reports of Mayo e-consult/e-tumor board. 3 major areas of case assessment for review were selected 1. Pathology . 2. Medical imaging. 3. Clinical recommendations. Variation in assessment and recommendations between AHD- MDT and Mayo Clinic were compared. Results: A total of 1018 cases were reviewed in the AHD-MDT between 2016 and 2018. 136 out of the 1018(13%) cases were referred for second opinion utilizing Mayo E-Consult or E-tumor board service. 117 cases were included in the analysis as there was missing data in 4 patients, 9 were duplicate and 4 were cancelled and 7 cases were not reviewed at AHD-MDT. In 78 cases pathology was reviewed at Mayo but 4 (5%) were not reviewed at AHD. In 74 (95%) cases, pathology was reviewed both at AHD and Mayo. There was change (Ch) in 2 (3%), 7(9%)updated(Ud) and no change(Ch) in 65 cases(88%). 97 cases of imaging had change(Ch) in 1 case (1%). 101 cases of e-consult/e-tumor board were assessed for clinical recommendations. There was change(Ch) in 3(3%), 2/3 cases had a change in plan due to change in the pathology. In 35(35%) the plan was updated (Ud) and 7 out of 35(20%) were due to updated(Ud) pathology. Conclusions: Our data indicates that international collaboration as part of MCCN has resulted in significant improvement in the patient care. In a select group of challenging cases, 35% had an improvement in the final treatment plan after utilization of e-consult/e-tumor board service.
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Affiliation(s)
- Faraz A. Khan
- American Hospital Dubai, Dubai, United Arab Emirates
| | - Saima Maqbool
- American Hospital Dubai, Dubai, United Arab Emirates
| | | | | | - Tariq Dufan
- American Hospital Dubai, Dubai, United Arab Emirates
| | | | - Aaron Han
- American Hospital, Dubai, United Arab Emirates
| | - Kadriya Sayed
- American Hospital Dubai, Dubai, United Arab Emirates
| | - Yasin Ahmed
- American Hospital Dubai, Dubai, United Arab Emirates
| | | | | | - Arjuna Sonal
- American Hospital Dubai, Dubai, United Arab Emirates
| | - Salima Ahmed
- American Hospital Dubai, Dubai, United Arab Emirates
| | - Carolyn Yang
- American Hospital Dubai, Dubai, United Arab Emirates
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Zanwar S, Abeykoon JP, Gertz MA, Kumar S, Inwards DJ, Porrata LF, Thompson CA, Witzig TE, Habermann TM, Go RS, Lacy M, Rajkumar SV, Dispenzieri A, Buadi F, Gonsalves WI, Leung N, Hayman SR, Kyle RA, Ansell SM, Kapoor P. Rituximab-based maintenance therapy in Waldenström macroglobulinemia: A case control study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.7559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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
7559 Background: Waldenström macroglobulinemia (WM) is a rare indolent lymphoma commonly treated with rituximab (R)-based therapy. The use of rituximab maintenance (mR) in WM is controversial. We present a case-control study of patients (pts) with WM treated with mR. Methods: Pts evaluated at Mayo Clinic, Rochester with active WM that received mR between 1/2000 & 6/2018 were included. Cases comprised pts who received mR following R-based induction as primary therapy. Cases were matched based on the time of diagnosis in 1:2 ratio with a control group treated with R-based primary induction therapy without mR. Time to event analyses were performed from initiation of R-based induction. Results: Of 776 pts with active WM, 42 (5%) cases received mR and 84 pts were selected as controls. The median follow-up and the proportion of high risk pts were comparable between the two cohorts (Table). Pts in the mR cohort show a trend toward longer time to next therapy (TTNT) and a significantly longer overall survival (OS) compared to the control group (Table). The R-based induction therapies were comparable in the two cohorts (p = 0.6). Median duration of mR was 1.9 yrs (95% CI 1.6-2) and mR was used most frequently every (q) 2 (range 1-6) months. Of the 42 mR pts, 25 (60%) received an R-based combination for induction and 17 (40%) received R monotherapy as induction. Five (12%) pts discontinued mR due to toxicity, infections were reported in 13 pts (31%) during mR therapy and 3 pts (7%) received IVIg infusions for recurrent infections. Conclusions: R-based induction followed by mR demonstrates a longer OS in WM compared to R-treated control population not receiving mR, albeit at a high rate of infections. Despite limitations of a retrospective study, with a heterogeneously treated cohort, these data add to the body of literature supporting Rituximab maintenance. Results from an ongoing randomized controlled trial are awaited. [Table: see text]
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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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27
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Fama A, Martin P, Casulo C, Nastoupil LJ, Thompson CA, Link BK, Lossos IS, Kahl B, Maurer M, Allmer C, Jaye DL, Feldman AL, Slager SL, Friedberg JW, Habermann TM, Flowers C, Cerhan JR. Prevalence and clinical correlates of vulnerable status using the Vulnerable Elders Survey 13 (VES-13) in newly diagnosed adult non-Hodgkin lymphoma (NHL) patients: A LEO cross-sectional analysis. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.10042] [Citation(s) in RCA: 1] [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)
| | | | - Carla Casulo
- University of Rochester, Wilmot Cancer Institute, Rochester, NY
| | | | | | - Brian K. Link
- University of Iowa Carver College of Medicine, Iowa City, IA
| | - Izidore S. Lossos
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Brad Kahl
- Washington University School of Medicine, Saint Louis, MO
| | - Matthew Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Cristine Allmer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, US
| | - David L. Jaye
- Department of Pathology and Laboratory Medicine, Winship Cancer Institute of Emory University, Atlanta, GA
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28
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Zanwar S, Abeykoon JP, Ansell SM, Kumar S, Dispenzieri A, Witzig TE, Lacy M, Nowakowski GS, Buadi F, Dingli D, Leung N, Rajkumar SV, Go RS, Habermann TM, Lin Y, Kourelis T, Kyle RA, Gertz MA, Kapoor P. Predictors of disease progression in smoldering Waldenström macroglobulinemia. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7571] [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)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yi Lin
- Mayo Clinic, Rochester, MN
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29
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Ip A, Pophali PA, Larson MC, Rosenthal AC, Maurer MJ, Link BK, Farooq U, Feldman AL, Allmer C, Slager SL, Habermann TM, Flowers C, Cerhan JR, Cohen JB, Thompson CA. Effect of physical activity (PA) before and after diagnosis on overall survival (OS) for patients (pts) with lymphoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.7_suppl.95] [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
95 Background: While PA is known to improve quality of life in lymphoma pts, its impact on OS is not known. We studied the effect of PA on OS in lymphoma pts enrolled at diagnosis in the Iowa/Mayo Molecular Epidemiology Resource. Methods: Godin Leisure Score Index (LSI; Range 0-50) was calculated based on level of PA pre-diagnosis (baseline) and 3 years post diagnosis (FU3), with pts grouped by tertile into high, moderate, or low PA. At FU3, pts also reported perceived change in PA since diagnosis. OS was measured as time from assessment (baseline or FU3) until death from any cause. Associations between LSI tertiles and OS were assessed using Cox models adjusted for lymphoma subtype, age and sex. Results: PA level was available for 3060 pts at baseline and 1371 pts at FU3. 95% had an ECOG performance status < 2, 37% had an aggressive subtype, 29% had BMI ≥ 30, and 54% were age > 60. Indolent lymphoma pts with higher PA at baseline had no difference in OS. Higher PA at FU3 had improved OS (moderate vs low HR 0.63, CI 0.42-0.93; high vs low HR 0.53, CI 0.33-0.86). Pts with BMI < 30 who had higher PA at baseline showed no difference in OS. Higher PA at FU3 had improved OS for pts with BMI < 30 (moderate vs low HR 0.68 CI, 0.48-0.98; high vs low HR = 0.41, CI 0.26-0.64). For pts > 60 years, high vs low baseline PA showed improved OS (HR 0.77, CI 0.63-0.93). Higher PA at FU3 (moderate vs low HR 0.68 CI 0.48-0.96, high vs low HR 0.53 CI 0.34-0.83) was associated with OS. At FU3, compared to no change, perceived reduction of PA was associated with worse OS for indolent lymphoma (HR 2.13, CI 1.56-2.91), BMI < 30 (HR 1.95, CI 1.45-2.62), BMI > 30 (HR 2.00, CI 1.21-3.30), age ≤ 60 (HR 3.06, CI 1.72-5.46), and age > 60 (HR 1.98, CI 1.52-2.58). Perceived increase in PA was not associated with OS. Higher PA in pts with aggressive lymphoma, BMI ≥30, and age < 60 was not significantly associated with OS but trended similarly. All results were similar when analyzing by continuous LSI score. Conclusions: Higher levels of PA, especially at FU3, were associated with superior OS. The effect was more pronounced in pts with indolent lymphoma, BMI < 30, or age > 60. Perceived reduction in PA was associated with worse outcomes. PA should be incorporated into lymphoma survivorship plans.
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Affiliation(s)
- Andrew Ip
- Winship Cancer Institute, Atlanta, GA
| | | | | | | | | | - Brian K. Link
- University of Iowa Carver College of Medicine, Iowa City, IA
| | - Umar Farooq
- University of Iowa Carver College of Medicine, Iowa City, IA
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30
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Larsen JT, Shanafelt TD, Leis JF, LaPlant B, Call T, Pettinger A, Hanson C, Erlichman C, Habermann TM, Reeder C, Nikcevich D, Bowen D, Conte M, Boysen J, Secreto C, Lesnick C, Tschumper R, Jelinek D, Kay NE, Ding W. Akt inhibitor MK-2206 in combination with bendamustine and rituximab in relapsed or refractory chronic lymphocytic leukemia: Results from the N1087 alliance study. Am J Hematol 2017; 92:759-763. [PMID: 28402581 PMCID: PMC5507724 DOI: 10.1002/ajh.24762] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/04/2017] [Accepted: 04/07/2017] [Indexed: 11/11/2022]
Abstract
Akt is a downstream target of B cell receptor signaling and is a central regulator of CLL cell survival. We aim to investigate the safety and efficacy of the Akt inhibitor MK-2206 in combination with bendamustine and rituximab (BR) in relapsed and/or refractory CLL in a phase I/II study. A standard phase I design was used with cohorts of three plus three patients to determine the maximum tolerated dose (MTD) of MK-2206 in combination with BR in relapsed CLL. Single-agent MK-2206 (weekly dosed) was administered one-week in advance before BR on cycle 1 and subsequently was given with BR at the same time for cycle 2-6. Phase II employed the MTD of MK-2206 with BR to evaluate safety and efficacy of this study combination. Thirteen relapsed/refractory CLL were treated for maximal 6-cycle of therapy. The maximum tolerated dose of MK-2206 was 90 mg by mouth once weekly. The most common grade 3/4 adverse events were neutropenia (46%), febrile neutropenia (23%), rash (15%), diarrhea (15%), and thrombocytopenia (15%). Overall response rate was 92% with a median progression free survival and treatment free survival of 16 and 24 months, respectively. Five patients (38%) achieved complete remission or complete remission with incomplete count recovery, two of whom were MRD negative. The efficacy and tolerability of this combination indicates that Akt inhibition combined with chemoimmunotherapy is a promising novel treatment combination in CLL and deserves further prospective clinical trial.
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Affiliation(s)
| | | | - Jose F. Leis
- Division of Hematology and Oncology; Mayo Clinic; Scottsdale Arizona
| | | | - Tim Call
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - Curtis Hanson
- Division of Hematopathology; Mayo Clinic; Rochester Minnesota
| | | | | | - Craig Reeder
- Division of Hematology and Oncology; Mayo Clinic; Scottsdale Arizona
| | | | - Deborah Bowen
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Michael Conte
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Justin Boysen
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Charla Secreto
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Connie Lesnick
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - Diane Jelinek
- Division of Immunology; Mayo Clinic; Rochester Minnesota
| | - Neil E. Kay
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Wei Ding
- Division of Hematology; Mayo Clinic; Rochester Minnesota
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31
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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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32
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Rosenthal AC, Maurer MJ, Allmer C, Ansell SM, Farooq U, Habermann TM, Link BK, Witzig TE, Yost KJ, Cerhan JR, Thompson CA. Psychosocial distress in lymphoma survivors at 3 years’ follow-up. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.5_suppl.193] [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
193 Background: National standards recommend distress screening as part of cancer care. While many patients report improved quality of life after cancer treatment concludes there remains a population who experience ongoing anxiety and depressive symptoms. We sought to describe psychosocial distress in lymphoma survivors and frequency of visits to mental health providers (MHP). Methods: Lymphoma patients were prospectively enrolled within 9 months of diagnosis in the University of Iowa/Mayo Clinic SPORE Molecular Epidemiology Resource and systematically followed. Brief Profile of Mood States (POMS) and State Trait Anxiety Inventory (STAI) were administered 3 yrs after diagnosis. Lower scores on POMS indicated more distress. A higher score on STAI indicated more anxiety, and a score ≥ 40 was considered clinically significant. Pts were asked if they ever saw a MHP due to their lymphoma. Results: Between 2002-2012, 2465 lymphoma pts age 18-91 (10% 18-40, 54% 41-65, and 36% > 65) were enrolled, met survivor definition, and completed 3-yr POMS and STAI questionnaires. 57% were male. 40% had aggressive and 60% had indolent lymphoma. The median score on STAI 1 (state) was 32 (range 20-76) and on STAI 2 (trait) was 31 (range 20-77). Median POMS total mood disturbance (TMD) score was 88 (range 1-100). 8% of pts reported seeing a MHP. 609 pts (25%) had clinically significant anxiety by STAI 1, 73 (12%) of whom saw a MHP. Those who reported clinically significant anxiety on STAI were more likely to be younger, unemployed, unmarried, and less likely to have seen a MHP. Anxiety levels were similar between those with aggressive lymphoma and indolent lymphoma regardless of treatment. Higher distress levels, measured by TMD, were more often reported by those who were unemployed or over age 65 while there was no association with lymphoma subtype, marital status, or choice of therapy. Conclusions: Clinically significant anxiety was reported in 25% of 3-yr survivors of lymphoma and was associated with younger age, unmarried status, and unemployment. Higher distress levels were associated with older age, and unemployment. However, only 8% of our cohort was seen by a MHP. Identifying distress and appropriately referring to a MHP is important for the optimal care of lymphoma survivors.
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Affiliation(s)
| | | | | | | | - Umar Farooq
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | | | - Brian K. Link
- University of Iowa Carver College of Medicine, Iowa City, IA
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33
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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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34
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Thanarajasingam G, Atherton PJ, Pederson L, Novotny PJ, Habermann TM, Sloan JA, Grothey A, Kumar S, Witzig TE. Beyond maximum grade: A novel method to assess toxicity over time in clinical trials of targeted therapy in lymphoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7546] [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)
| | | | | | | | | | | | | | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN
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35
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Paludo J, Abeykoon JP, Gertz MA, Kumar S, King RL, Kyle RA, Buadi F, Hayman SR, Habermann TM, Dingli D, Witzig TE, Dispenzieri A, Lacy M, Thompson CA, Go RS, Gonsalves WI, Lust JA, Rajkumar SV, Ansell SM, Kapoor P. Dexamethasone, rituximab and cyclophosphamide (DRC) in relapsed/refractory (R/R) and treatment naïve (TN) Waldenström macroglobulinemia (WM). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7552] [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)
- Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Rebecca L King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | | | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Ronald S. Go
- Division of Hematology, Mayo Clinic, Rochester, MN
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36
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Evens AM, Hong F, Habermann TM, Advani RH, Gascoyne RD, Witzig TE, Quon A, Wagner LI, Ansell SM, Petrich AM, Chang JE, O'Brien TE, Cheema PS, Cescon T, Sturtz K, Kahl BS. Effect of bortezomib on complete remission (CR) rate when added to bendamustine-rituximab (BR) in previously untreated high-risk (HR) follicular lymphoma (FL): A randomized phase II trial of the ECOG-ACRIN Cancer Research Group (E2408). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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)
| | - Fangxin Hong
- Biostatistical Core, Harvard University, Boston, MA
| | | | | | | | | | | | - Lynne I. Wagner
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | | | | | - Keren Sturtz
- Colorado Permanente Medical Group, Lone Tree, CO
| | - Brad S. Kahl
- University of Wisconsin Carbone Cancer Center, Madison, WI
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37
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Nowakowski GS, Ansell SM, Witzig TE, Macon WR, Ristow K, Colgan J, Inwards DJ, Johnston PB, Klebig R, Lin Y, Micallef INM, Markovic S, Porrata LF, Thompson CA, Habermann TM. Participation in clinical trials to improve outcomes of patients with relapsed lymphoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7523] [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)
| | | | | | | | | | | | | | | | | | - Yi Lin
- Mayo Clinic, Rochester, MN
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38
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Tracy SI, Maurer MJ, Witzig TE, Drake M, Ansell SM, Nowakowski GS, Thompson CA, Inwards DJ, Johnston PB, Micallef INM, Allmer C, Macon WR, Weiner GJ, Slager SL, Habermann TM, Link BK, Cerhan JR. Association of vitamin D insufficiency with inferior prognosis in follicular lymphoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e19067] [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)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Brian K. Link
- University of Iowa Carver College of Medicine, Iowa City, IA
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39
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Rosenthal AC, Maurer MJ, Allmer C, Ansell SM, Farooq U, Habermann TM, Link BK, Witzig TE, Yost KJ, Cerhan JR, Thompson CA. Health behaviors in survivors of aggressive NHL. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.3_suppl.236] [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
236 Background: Patients (pts) with aggressive lymphoma are generally treated with curative intent and many become long-term survivors. There is little data on health behaviors after lymphoma diagnosis and their effect on QOL and long-term outcomes. Methods: Lymphoma pts were prospectively enrolled within 9 months of diagnosis in the University of Iowa/Mayo Clinic SPORE Molecular Epidemiology Resource (MER) and systematically followed. We measured QOL (FACT-G) and health behaviors (tobacco/alcohol use; diet/exercise habits) 3 years after diagnosis. For this study, “survivor” was defined as alive at 3 years from diagnosis with no active disease or treatment within the previous year. Results: From 2002-2012, 671 patients with aggressive lymphoma were enrolled, met survivor definition, and completed 3-year QOL and health behavior questionnaires. At 3-years, 31% of female (F) and 48% of male (M) reported a history of tobacco use for 6+ months. Of these, 13% of F and 7% of M were still smoking; 52% reported decreased use from baseline. 66% reported no change in alcohol intake at 3-years while 25% of F and 34% of M reported decreased intake. 60% often chose whole grains and 65% get 2+ servings of vegetables daily. 42% of F and 38% of M “somewhat” believed diet could change the course of their lymphoma. Most pts endorsed no significant change in diet as a result of diagnosis. Those who made changes did so primarily out of concern for “health problems other than cancer”. Overweight/obese responders were 72% pre- and 66% post-treatment. A desire to lose weight was reported by 55% of pts. 14% of F and 23% of M often engaged in regular physical activity (PA). Nearly 50% reported a decrease in PA. Pts with advanced stage (p = 0.006), age > 60 (p = 0.001), ECOG PS > 2 (p = 0.04), and worse prognostic score (p = 0.006) were more likely to report decreased PA since diagnosis. 68% of F and 61% of M intend to become more active in the next months. Regular PA (p = < 0.0001) was associated with higher QOL, while increased alcohol intake was associated with lower QOL (p = 0.009) at 3 years. Conclusions: Many survivors of aggressive NHL strive to adopt healthy behaviors and these behaviors are associated with higher QOL. Interventions aimed at emphasizing these behaviors may have potential to improve long-term outcomes and QOL.
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Affiliation(s)
| | | | | | | | - Umar Farooq
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | | | - Brian K. Link
- University of Iowa Carver College of Medicine, Iowa City, IA
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40
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Thompson CA, Towns JN, Dripps L, Jenkins S, Lackore K, Yost KJ, Ristow K, Colgan J, Habermann TM, Inwards DJ, Johnston PB, Klebig R, Lin Y, Markovic S, Micallef INM, Nowakowski GS, Porrata LF, Rosenthal AC, Witzig TE, Ansell SM. Impact of lymphoma survivorship clinic visit on patient-centered outcomes. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.3_suppl.64] [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
64 Background: The goals of our Lymphoma Survivorship Clinic (SC) are to coordinate care, educate patients, and create a survivorship care plan (SCP). The aim of this study was to determine if patient-centered outcomes are improved after a SC visit. Methods: From 11/13-5/15, surveys were mailed to recently-treated lymphoma patients who were within 4 weeks of their last visit and in remission. Quality of life (QOL) was measured with PROMIS and distress was measured with the Impact of Events scale. Responses between those who attended SC and those who were eligible but did not attend were analyzed. Results: There were 96 surveys sent to the SC group; 59 were returned (61% response rate). Of the non-SC group, 140 surveys were sent and 84 were returned (60% response rate). Mean age was 57 years (range 23-77) in the SC group and 59 years (23-88) in the non-SC group. There were more females in the SC group (52% vs 30%) but no differences in race, marital status, education, or health literacy. Those who attended the SC were more likely to recall receiving a summary of cancer treatment and recommendations for follow-up care (90% SC vs. 75% non-SC, p = 0.03). Furthermore, SC attendees were more likely to “definitely” recall discussion on improving health or preventing illness (89% vs. 53%), getting help in making changes in habits/lifestyle (76% vs. 50%), diet (80% vs. 31%), and exercise (82% vs. 51%), all p < 0.001. There were no differences in discussions regarding smoking, follow-up testing, and symptom monitoring. The SC group was less likely to need more information regarding sexuality (6% vs 20%, p = 0.045). There were no differences in need for information regarding anxiety, fitness, familial cancer risk, fertility, complementary therapies, and social issues. The SC group was slightly more confident that they could get information or advice related to cancer (completely confident 76% vs. 61%, p = 0.07). There were no differences in QOL or distress. Conclusions: A Lymphoma SC visit increased receipt of SCP and provided more information on survivorship issues, particularly health behaviors, but did not improve QOL or distress. Further study is needed to determine if this leads to long-term health benefits.
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Affiliation(s)
| | | | | | - Sarah Jenkins
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | | | | | - Yi Lin
- Mayo Clinic, Rochester, MN
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41
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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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Johnston PB, LaPlant B, Nowakowski GS, Micallef INM, Ansell SM, Habermann TM, Colgan J, Witzig TE. Combination of everolimus with R-CHOP (ever R-CHOP) as an initial therapy for diffuse large B-cell lymphoma (DLBCL): A phase I and feasibility study (NCCTG N1085 [Alliance]). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8518] [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
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Ferzoco RM, Cerhan JR, Maurer MJ, Allmer C, Yost KJ, Habermann TM, Ansell SM, Inwards DJ, Witzig TE, Porrata LF, Nowakowski GS, Macon WR, Towns JN, Farooq U, Link BK, Thompson CA. Exercise patterns and quality of life among survivors of aggressive lymphoma. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8555] [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)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Umar Farooq
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Brian K. Link
- University of Iowa Carver College of Medicine, Iowa City, IA
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Thompson CA, Maurer MJ, Allmer C, Ansell SM, Ferzoco RM, Habermann TM, Inwards DJ, Johnston PB, Klebig R, Macon WR, Micallef INM, Yost KJ, Farooq U, Link BK, Cerhan JR. QOL at 3 years after diagnosis in aggressive lymphoma survivors. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9586] [Citation(s) in RCA: 2] [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)
| | | | | | | | | | | | | | | | | | | | | | | | - Umar Farooq
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Brian K. Link
- University of Iowa Carver College of Medicine, Iowa City, IA
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Nowakowski GS, LaPlant B, Macon WR, Gertz MA, Habermann TM, Inwards DJ, Micallef INM, Wender DB, Leonard J, Witzig TE. Bendamustine and rituximab and lenalidomide (BRR) in the treatment of relapsed and refractory low grade non-Hodgkin lymphoma (NHL): Final results of phase 1 study NCCTG N1088/ALLIANCE. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8540] [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)
| | | | | | | | | | | | | | | | - John Leonard
- Weill Cornell Medical College - New York Presbyterian Hospital, New York, NY
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46
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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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47
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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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Jackson AE, Smeltzer JP, Habermann TM, Jones JM, Burnette BL, Ristow K, Wiseman GA, Macon WR, Nowakowski GS, Witzig TE. Utility of restaging bone marrow biopsy (BMB) in PET-negative patients with diffuse large B-cell lymphoma (DLBCL) with bone marrow involvement. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.8541] [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
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49
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Griffin BR, Thompson CA, Habermann TM, Witzig TE, Ristow K, Herrmann J. Cardiovascular screening in long-term Hodgkin lymphoma survivors. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e20592] [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
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50
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Nowakowski GS, LaPlant B, Macon WR, Reeder CB, Foran JM, Nelson GD, Thompson CA, Rivera C, Inwards DJ, Micallef INM, Johnston PB, Porrata LF, Ansell SM, Habermann TM, Witzig TE. Effect of lenalidomide combined with R-CHOP (R2CHOP) on negative prognostic impact of nongerminal center (non-GCB) phenotype in newly diagnosed diffuse large B-cell lymphoma: A phase 2 study. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.8520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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