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Mori S, Ai T, Taguchi T, Negi M, Otomo Y. Aggressive diffuse large B-cell lymphoma manifested by splenic rupture progressed 2 months after transverse myelitis: an autopsy case report. Acute Med Surg 2023; 10:e822. [PMID: 36844678 PMCID: PMC9949603 DOI: 10.1002/ams2.822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/23/2023] [Indexed: 02/25/2023] Open
Abstract
Background Splenic rupture by diffuse large B-cell lymphoma (DLBCL), which usually progresses insidiously, is extremely rare. Case Presentation A 60-year-old man presented with paralysis in his lower left extremity. A magnetic resonance imaging suggested transverse myelitis. No lymphadenopathy or organomegaly was noted. Two months after remission, he was referred to the emergency department complaining of presyncope. He was in preshock due to splenic rupture, and underwent laparotomy after attempts of transcatheter arterial embolization. Splenomegaly, hepatomegaly, and disseminated enlarged lymph nodes were observed. Histological examinations of the resected spleen showed DLBCL. He died of multiple organ failure associated with intractable bleeding. His autopsy revealed diffuse systemic invasions of lymphoma cells except for the brain and spinal cord. Microscopically, the spinal cord showed macular incomplete necrosis and histiocytic infiltration, suggestive of hemophagocytic syndrome. Conclusion The progression of DLBCL in our case is drastically rapid. Undiagnosed transverse myelitis preceded the onset.
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Affiliation(s)
- Shusuke Mori
- Trauma and Acute Critical Care CenterTokyo Medical and Dental UniversityTokyoJapan
| | - Tomohiko Ai
- Trauma and Acute Critical Care CenterTokyo Medical and Dental UniversityTokyoJapan
| | - Towako Taguchi
- Department of PathologyTokyo Medical and Dental UniversityTokyoJapan
| | - Mariko Negi
- Department of PathologyTokyo Medical and Dental UniversityTokyoJapan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care CenterTokyo Medical and Dental UniversityTokyoJapan
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Matsubayashi S, Suzuki M, Sakamoto K, Izumi S, Hojo M, Sugiyama H. Three different CT and FGD PET/CT findings of pulmonary involvement in methotrexate-associated lymphoproliferative disease. Respirol Case Rep 2020; 8:e00520. [PMID: 31956414 PMCID: PMC6957981 DOI: 10.1002/rcr2.520] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/12/2019] [Accepted: 12/18/2019] [Indexed: 12/29/2022] Open
Abstract
Lymphoproliferative disease (LPD) is one of the complications of methotrexate (MTX) therapy. In MTX-associated LPD (MTX-LPD), LPD lesions limited to the lungs are rare and show various types of opacity. A 75-year-old woman with rheumatoid arthritis (RA) presented with myalgia. She had been taking MTX for 11 years. Chest computed tomography (CT) scans showed a nodule in the left lower lobe that had grown significantly and a new nodule in the right lower lobe. 18F-fluorodeoxyglucose (FDG)/positron emission tomography (PET)/CT revealed significant FDG uptake in these nodules. Transbronchial biopsy specimen showed diffusely distributed CD20-positive lymphoid cells, and we made a diagnosis of MTX-LPD. All lung lesions disappeared within months after the immediate discontinuation of MTX. We also had two other patients with MTX-LPD lung lesions that had high FDG uptake. FDG PET/CT might be a useful diagnostic tool as it may reflect disease progression and help identify separate lesions.
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Affiliation(s)
- Sachi Matsubayashi
- Department of Respiratory MedicineNational Center for Global Health and MedicineTokyoJapan
- Department of Respiratory MedicineJikei Daisan HospitalTokyoJapan
| | - Manabu Suzuki
- Department of Respiratory MedicineNational Center for Global Health and MedicineTokyoJapan
| | - Keita Sakamoto
- Department of Respiratory MedicineNational Center for Global Health and MedicineTokyoJapan
| | - Shinyu Izumi
- Department of Respiratory MedicineNational Center for Global Health and MedicineTokyoJapan
| | - Masayuki Hojo
- Department of Respiratory MedicineNational Center for Global Health and MedicineTokyoJapan
| | - Haruhito Sugiyama
- Department of Respiratory MedicineNational Center for Global Health and MedicineTokyoJapan
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3
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Broccoli A, Casadei B, Chiappella A, Visco C, Tani M, Cascavilla N, Conconi A, Balzarotti M, Cox MC, Marino D, Goldaniga MC, Marasca R, Tecchio C, Patti C, Musuraca G, Devizzi L, Monaco F, Romano A, Fama A, Zancanella M, Paolini R, Rigacci L, Castellino C, Gaudio F, Argnani L, Zinzani PL. Lenalidomide in Pretreated Patients with Diffuse Large B-Cell Lymphoma: An Italian Observational Multicenter Retrospective Study in Daily Clinical Practice. Oncologist 2019; 24:1246-1252. [PMID: 30940746 DOI: 10.1634/theoncologist.2018-0603] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 03/04/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma subtype, and approximately 50% of the patients are >60 years of age. Patients with relapsed/refractory (rr) disease have a poor prognosis with currently available treatments. Lenalidomide is available in Italy for patients with rrDLBCL based on a local disposition of the Italian Drug Agency. SUBJECTS, MATERIALS, AND METHODS An observational retrospective study was conducted in 24 Italian hematology centers with the aim to improve information on effectiveness and safety of lenalidomide use for rrDLBCL in real practice. RESULTS One hundred fifty-three patients received lenalidomide for 21/28 days with a median of four cycles. At the end of therapy, there were 36 complete responses (23.5%) and 9 partial responses with an overall response rate (ORR) of 29.4%. In the elderly (>65 years) subset, the ORR was 33.6%. With a median follow-up of 36 months, median overall survival was reached at 12 months and median disease-free survival was not reached at 62 months. At the latest available follow-up, 29 patients are still in response out of therapy. Median progression-free survivals differ significantly according to age (2.5 months vs. 9.5 in the younger vs. elderly group, respectively) and to disease status at the latest previous therapy (15 months for relapsed patients vs. 3.5 for refractory subjects). Toxicities were manageable, even if 30 of them led to an early drug discontinuation. CONCLUSION Lenalidomide therapy for patients with rrDLBCL is effective and tolerable even in a real-life context, especially for elderly patients. IMPLICATIONS FOR PRACTICE Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, and approximately 50% of the patients are >60 years of age. Patients with relapsed/refractory (rr) disease have a poor prognosis, reflected by the remarkably short life expectancy of 12 months with currently available treatments. The rrDLBCL therapeutic algorithm is not so well established because data in the everyday clinical practice are still poor. Lenalidomide for patients with rrDLBCL is effective and tolerable even in a real-life context, especially for elderly patients.
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Affiliation(s)
| | | | - Annalisa Chiappella
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Carlo Visco
- Department of Cell Therapy and Hematology, San Bortolo Hospital, Vicenza, Italy
| | - Monica Tani
- Hematology Unit, S. Maria delle Croci Hospital, Ravenna, Italy
| | - Nicola Cascavilla
- Hematology Department, "Casa Sollievo della Sofferenza" Hospital, IRCCS - Italy
| | - Annarita Conconi
- Hematology Division, Ospedale degli Infermi di Biella, Ponderano, Italy
| | - Monica Balzarotti
- Departmento of Medical Oncology and Hematology Humanitas Cancer Center, Rozzano-Milan, Italy
| | | | - Dario Marino
- Dipartimento di Oncologia Clinica e Sperimentale, Oncologia Medica 1, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | | | - Roberto Marasca
- Department of Medical Sciences, Section of Hematology, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Tecchio
- Hematology and Bone Marrow Transplant Unit, Verona University, Verona, Italy
| | - Caterina Patti
- Department of Hematology Azienda Ospedali Riuniti Villa Sofia- Cervello, Palermo, Italy
| | - Gerardo Musuraca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Liliana Devizzi
- Division of Hematology, IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federico Monaco
- Hematology Unit, SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alessandra Romano
- Division of Hematology, AOU Policlinico-OVE, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | | | | | | | - Luigi Rigacci
- Hematology, AOU Careggi, Firenze, Italy
- Hematology Azienda San Camillo Forlanini, Rome, Italy
| | - Claudia Castellino
- Azienda Ospedaliera S. Croce e Carle - Hematology Department and BMT Unit, Cuneo, Italy
| | - Francesco Gaudio
- Unit of Hematology with Transplantation Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Lisa Argnani
- Institute of Hematology, University of Bologna, Bologna, Italy
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4
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Purdum A, Tieu R, Reddy SR, Broder MS. Direct Costs Associated with Relapsed Diffuse Large B-Cell Lymphoma Therapies. Oncologist 2019; 24:1229-1236. [PMID: 30850561 DOI: 10.1634/theoncologist.2018-0490] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/04/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND About one third of patients with diffuse large B-cell lymphoma (DLBCL) relapse after receiving first-line (1L) treatment of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Relapsed patients may then be eligible for second-line (2L) therapy. The study's objective was to examine health care use and costs among treated patients with DLBCL receiving 2L therapy versus those without relapse. MATERIALS AND METHODS We analyzed Truven Health MarketScan® claims data between 2006 and 2015. Patients (≥18 years of age) had ≥1 DLBCL claim from 1 year before to 90 days after beginning 1L therapy, and comprised those without 2L treatment for ≥2 years (cured controls) versus those who initiated non-R-CHOP chemotherapy after discontinuing 1L therapy (2L cohort). 2L patients were further subgrouped: hematopoietic stem cell transplant (HSCT [yes/no]) and time of relapse (months between 1L and 2L): early (≤3), mid (4-12), and late (>12) relapse. The primary outcome was 1- and 2-year health care costs. Hospitalization rate and length of stay were also measured. RESULTS A total of 1,374 patients with DLBCL received R-CHOP and fulfilled all criteria: 1,157 cured controls and 217 2L patients (87 early-relapse, 66 mid-relapse, 64 late-relapse). Twenty-eight percent of 2L patients received HSCT. Charlson Comorbidity Index/mortality risk was higher for 2L patients (4.2 [SD: 3.0]) versus controls (3.8 [2.6]; p = .039), as were yearly costs (Year 1: $210,488 [$172,851] vs. $25,044 [$32,441]; p < .001 and Year 2: $267,770 [$266,536] vs. $42,272 [$49,281]; p < .001). HSCT and chemotherapy were each significant contributors of cost among 2L patients. CONCLUSION DLBCL is resource intensive, particularly for 2L patients. Great need exists for newer, effective therapies for DLBCL that may save lives and reduce costs. IMPLICATIONS FOR PRACTICE This study identified multiple important drivers of cost in the understudied population of patients with diffuse large B-cell lymphoma (DLBCL) receiving second-line (2L) treatment. Such drivers included hematopoietic stem cell transplant (HSCT) and chemotherapy. Even though HSCT is currently the only curative therapy for DLBCL, less than one third of patients receiving 2L and subsequent treatment underwent transplant, which indicates potential underuse. The variation in chemotherapy regimens suggested a lack of consensus for best practices. Further research focusing on newer and more effective treatment options for DLBCL has the potential to decrease mortality, in addition to reducing the extensive costs related to therapy options such as transplant.
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MESH Headings
- Antibodies, Monoclonal, Murine-Derived/economics
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/economics
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/economics
- Cyclophosphamide/therapeutic use
- Doxorubicin/economics
- Doxorubicin/therapeutic use
- Female
- Humans
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/economics
- Lymphoma, Large B-Cell, Diffuse/epidemiology
- Male
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/economics
- Neoplasm Recurrence, Local/epidemiology
- Prednisone/economics
- Prednisone/therapeutic use
- Prognosis
- Rituximab/economics
- Rituximab/therapeutic use
- Treatment Outcome
- Vincristine/economics
- Vincristine/therapeutic use
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Affiliation(s)
- Anna Purdum
- Kite Pharma, Inc., Santa Monica, California, USA
| | - Ryan Tieu
- Partnership for Health Analytic Research, LLC, Beverly Hills, California, USA
| | - Sheila R Reddy
- Partnership for Health Analytic Research, LLC, Beverly Hills, California, USA
| | - Michael S Broder
- Partnership for Health Analytic Research, LLC, Beverly Hills, California, USA
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5
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Merli M, Frigeni M, Alric L, Visco C, Besson C, Mannelli L, Di Rocco A, Ferrari A, Farina L, Pirisi M, Piazza F, Loustaud-Ratti V, Arcari A, Marino D, Sica A, Goldaniga M, Rusconi C, Gentile M, Cencini E, Benanti F, Rumi MG, Ferretti VV, Grossi P, Gotti M, Sciarra R, Tisi MC, Cano I, Zuccaro V, Passamonti F, Arcaini L. Direct-Acting Antivirals in Hepatitis C Virus-Associated Diffuse Large B-cell Lymphomas. Oncologist 2018; 24:e720-e729. [PMID: 30552159 DOI: 10.1634/theoncologist.2018-0331] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 11/06/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND International guidelines suggest hepatitis C virus (HCV) eradication by direct-acting antivirals (DAAs) after first-line immunochemotherapy (I-CT) in patients with HCV-positive diffuse large B-cell lymphoma (DLBCL), although limited experiences substantiate this recommendation. Moreover, only a few data concerning concurrent administration of DAAs with I-CT have been reported. SUBJECTS, MATERIALS, AND METHODS We analyzed hematological and virological outcome and survival of 47 consecutive patients with HCV-positive DLBCL treated at 23 Italian and French centers with DAAs either concurrently (concurrent cohort [ConC]: n = 9) or subsequently (sequential cohort [SeqC]: n = 38) to first-line I-CT (mainly rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone [R-CHOP]-like). RESULTS Median age was 61 years, 89% of patients had stage III/IV, and 25% presented evidence of cirrhosis. Genotype was 1 in 56% and 2 in 34% of cases. Overall, 46 of 47 patients obtained complete response to I-CT. All patients received appropriate DAAs according to genotype, mainly sofosbuvir-based regimens (n = 45). Overall, 45 patients (96%) achieved sustained virological response, 8 of 9 in ConC and 37 of 38 in SeqC. DAAs were well tolerated, with only 11 patients experiencing grade 1-2 adverse events. Twenty-three patients experienced hepatic toxicity (grade 3-4 in seven) following I-CT in SeqC, compared to only one patient in ConC. At a median follow-up of 2.8 years, two patients died (2-year overall survival, 97.4%) and three progressed (2-year progression-free survival, 93.1%). CONCLUSION Excellent outcome of this cohort of HCV-positive DLBCL suggests benefit of HCV eradication by DAAs either after or during I-CT. Moreover, concurrent DAAs and R-CHOP administration appeared feasible, effective, and ideally preferable to deferred administration of DAAs for the prevention of hepatic toxicity. IMPLICATIONS FOR PRACTICE Hepatitis C virus (HCV)-associated diffuse large B-cell lymphomas (DLBCLs) represent a great therapeutic challenge, especially in terms of hepatic toxicity during immune-chemotherapy (I-CT) and long-term hepatic complications. The advent of highly effective and toxicity-free direct-acting antivirals (DAAs) created an exciting opportunity to easily eradicate HCV shortly after or in concomitance with first-line immunochemotherapy (usually R-CHOP). This retrospective international study reports the real-life use of the combination of these two therapeutic modalities either in the concurrent or sequential approach (DAAs after I-CT) in 47 patients. The favorable reported results on long-term outcome seem to support the eradication of HCV with DAAs in all patients with HCV-positive DLBCL. Moreover, the results from the concurrent approach were effective and safe and displayed an advantage in preventing hepatic toxicity during I-CT.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antiviral Agents/therapeutic use
- Cyclophosphamide/administration & dosage
- Disease-Free Survival
- Doxorubicin/administration & dosage
- Female
- Hepacivirus/drug effects
- Hepatitis C, Chronic/drug therapy
- Hepatitis C, Chronic/epidemiology
- Hepatitis C, Chronic/pathology
- Hepatitis C, Chronic/virology
- Humans
- Incidence
- Italy/epidemiology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/epidemiology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/virology
- Male
- Middle Aged
- Prednisone/administration & dosage
- Retrospective Studies
- Rituximab/administration & dosage
- Vincristine/administration & dosage
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Affiliation(s)
- Michele Merli
- Hematology, University Hospital Ospedale di Circolo e Fondazione Macchi-ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Marco Frigeni
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Laurent Alric
- Department of Internal Medicine and Digestive Diseases, University Hospital Toulouse, UMR 152 PharmaDev, IRD Toulouse 3 University, France
| | - Carlo Visco
- Cell Therapy and Hematology, Ospedale San Bortolo, Vicenza, Italy
| | - Caroline Besson
- Unit of Hematology-Oncology, Centre Hospitalier de Versailles, Le Chesnay; Université Versailles Saint Quentin en Yvelines; INSERM U1018, Centre pour la Recherche en Epidemiologie et Sante des Populations (CESP), Equipe Generations et Sante, Gustave Roussy, Villejuif, France
| | - Lara Mannelli
- Hematology, Azienda Ospedaliera Careggi, Florence, Italy
| | - Alice Di Rocco
- Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Angela Ferrari
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS Reggio Emilia, Italy
| | - Lucia Farina
- Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mario Pirisi
- Translational Medicine, University of Piemonte Orientale UPO, Novara, Italy
| | | | - Véronique Loustaud-Ratti
- Hepatology, Centre Hospitalier Universitaire de Limoges, U-1248 INSERM, Université de Limoges, Limoges, France
| | | | - Dario Marino
- Department of Clinical and Experimental Oncology, Veneto Institute of Oncology, IOV IRCCS, Padova, Italy
| | - Antonello Sica
- Oncology and Hematology, AOU "Luigi Vanvitelli", Naples, Italy
| | - Maria Goldaniga
- Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Rusconi
- Hematology and Oncology, Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Massimo Gentile
- Onco-Hematology, Hematology Unit, AO of Cosenza, Cosenza, Italy
| | - Emanuele Cencini
- Hematology, Azienda Ospedaliera Senese, University of Siena, Siena, Italy
| | | | - Maria Grazia Rumi
- Hepatology, Ospedale San Giuseppe IRCCS Multimedica, University of Milan, Milan, Italy
| | | | - Paolo Grossi
- Infectious and Tropical Diseases, University Hospital Ospedale di Circolo e Fondazione Macchi - ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Manuel Gotti
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta Sciarra
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Isabel Cano
- Hematology Department, Centre Hospitalier de Versailles, Versailles, France
| | - Valentina Zuccaro
- Infectious and Tropical Diseases, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francesco Passamonti
- Hematology, University Hospital Ospedale di Circolo e Fondazione Macchi-ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Luca Arcaini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Liu H, Zhang CL, Feng R, Li JT, Tian Y, Wang T. Validation and Refinement of the Age, Comorbidities, and Albumin Index in Elderly Patients with Diffuse Large B-Cell Lymphoma: An Effective Tool for Comprehensive Geriatric Assessment. Oncologist 2018; 23:722-729. [PMID: 29317552 PMCID: PMC6067934 DOI: 10.1634/theoncologist.2017-0361] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/07/2017] [Indexed: 01/22/2023] Open
Abstract
Diffuse large B‐cell lymphoma (DLBCL) is one of the most frequent types of malignant lymphoma in elderly people; thus, the management of elderly DLBCL patients is important. This study aimed to validate the ACA index in Chinese elderly DLBCL patients and to refine the ACA index to propose a more effective comprehensive geriatric assessment method that could serve as a guide for optimal personalized therapy for elderly DLBCL patients treated with R‐CHOP. Background. We aimed to validate and refine the Age, Comorbidities, and Albumin (ACA) index in elderly Chinese patients with diffuse large B‐cell lymphoma (DLBCL) and propose a more effective method for comprehensive geriatric assessment (CGA). Materials and Methods. Patients ≥65 years of age who had been diagnosed with de novo DLBCL in the Institute of Hematology, Beijing Hospital, were screened for eligibility (n = 99). Results. Based on the ACA index, 39, 31, 26, and 3 patients were categorized into the “excellent,” “good,” “moderate,” and “poor” groups, respectively. The 2‐year treatment‐related mortality rate was significantly higher and the survival rates poorer in the ACA “moderate to poor” group compared with those of the ACA “good” and “excellent” groups. Multivariable model analysis identified two independent predictors of overall survival: the instrumental activities of daily living (IADL) scale and the ACA index. IADL scores of 6 to 7 and the ACA “good” group were assigned 1 point; IADL scores ≤5 and the ACA “moderate to poor” group were assigned 2 points. Based on these data, we created a three‐category system (IADL ACA index [IACA index]): low risk, score 0; intermediate risk, score 1 to 2; and high risk, score 3 to 4. The IACA index could effectively discriminate the response rates, overall survival, and progression‐free survival rates in elderly patients with DLBCL. Conclusion. We observed that the ACA index could partially predict the clinical outcomes of elderly DLBCL patients in China. Based on this index, we proposed the IACA index as an effective tool for CGA in DLBCL. Implications for Practice. Diffuse large B‐cell lymphoma (DLBCL) is one of the most frequent types of malignant lymphoma in elderly people, and identifying patients suitable for curative therapy is critical in the improvement of clinical outcomes. Recently, some authors proposed the Age, Comorbidities, and Albumin (ACA) index. Combining the use of the instrumental activities of daily living (IADL) scale and the ACA index, this article describes the IADL ACA index (IACA index), which is an effective tool for comprehensive geriatric assessment in DLBCL.
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Affiliation(s)
- Hui Liu
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Chun-Li Zhang
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Ru Feng
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Jiang-Tao Li
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Yuan Tian
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Ting Wang
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
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7
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Sargent DJ, Shi Q, Flowers CR, Schmitz N, Habermann TM, Flament J, Fu T, Coiffier B. The Search for Surrogate Endpoints in Trials in Diffuse Large B-Cell Lymphoma: The Surrogate Endpoints for Aggressive Lymphoma Project. Oncologist 2017; 22:1415-1418. [PMID: 28798271 PMCID: PMC5728027 DOI: 10.1634/theoncologist.2017-0177] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/20/2017] [Indexed: 11/17/2022] Open
Abstract
This commentary describes the progress of the SEAL [Surrogate Endpoints for Aggressive Lymphoma] research group and invites collaboration in sharing data to continue building a large database of individual patient data from multiple clinical trials in DLBCL.
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Affiliation(s)
- Daniel J Sargent
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Qian Shi
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher R Flowers
- Department of Bone Marrow and Stem Cell Transplantation, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Norbert Schmitz
- Department of Internal Medicine A, Hematology, Oncology and Pneumonology, University Hospital Muenster, Muenster, Germany
| | | | | | - Tommy Fu
- Celgene Corporation, Summit, New Jersey, USA
| | - Bertrand Coiffier
- Department of Hematology, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
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8
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Miura K, Konishi J, Miyake T, Makita M, Hojo A, Masaki Y, Uno M, Ozaki J, Yoshida C, Niiya D, Kitazume K, Maeda Y, Takizawa J, Sakai R, Yano T, Yamamoto K, Sunami K, Hiramatsu Y, Aoyama K, Tsujimura H, Murakami J, Hatta Y, Kanno M. A Host-Dependent Prognostic Model for Elderly Patients with Diffuse Large B-Cell Lymphoma. Oncologist 2017; 22:554-560. [PMID: 28408622 DOI: 10.1634/theoncologist.2016-0260] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/29/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Decision-making models for elderly patients with diffuse large B-cell lymphoma (DLBCL) treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) are in great demand. PATIENTS AND METHODS The Society of Lymphoma Treatment in Japan (SoLT-J), in collaboration with the West-Japan Hematology and Oncology Group (West-JHOG), collected and retrospectively analyzed the clinical records of ≥65-year-old patients with DLBCL treated with R-CHOP from 19 sites across Japan to build an algorithm that can stratify adherence to R-CHOP. RESULTS A total of 836 patients with a median age of 74 years (range, 65-96 years) were analyzed. In the SoLT-J cohort (n = 555), age >75 years, serum albumin level <3.7 g/dL, and Charlson Comorbidity Index score ≥3 were independent adverse risk factors and were defined as the Age, Comorbidities, and Albumin (ACA) index. Based on their ACA index score, patients were categorized into "excellent" (0 points), "good" (1 point), "moderate" (2 points), and "poor" (3 points) groups. This grouping effectively discriminated the 3-year overall survival rates, mean relative total doses (or relative dose intensity) of anthracycline and cyclophosphamide, unanticipated R-CHOP discontinuance rates, febrile neutropenia rates, and treatment-related death rates. Additionally, the ACA index showed comparable results for these clinical parameters when it was applied to the West-JHOG cohort (n = 281). CONCLUSION The ACA index has the ability to stratify the prognosis, tolerability to cytotoxic drugs, and adherence to treatment of elderly patients with DLBCL treated with R-CHOP. The Oncologist 2017;22:554-560 IMPLICATIONS FOR PRACTICE: Currently, little is known regarding how to identify elderly patients with diffuse large B-cell lymphoma who may tolerate a full dose of chemotherapy or to what extent cytotoxic drugs should be reduced in some specific conditions. The Society of Lymphoma Treatment in Japan developed a host-dependent prognostic model consisting of higher age (>75 years), hypoalbuminemia (<3.7 g/dL), and higher Charlson Comorbidity Index score (≥3) for such elderly patients. This model can stratify the prognosis, tolerability to cytotoxic drugs, and adherence to treatment of these patients and thus help clinicians in formulating personalized treatment strategies for this growing patient population.
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Affiliation(s)
- Katsuhiro Miura
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Jun Konishi
- Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Takaaki Miyake
- Department of Oncology/Hematology, Shimane University Hospital, Shimane, Japan
| | - Masanori Makita
- Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Atsuko Hojo
- Division of Hematology and Oncology, Kasukabe Medical Center, Saitama, Japan
| | - Yasufumi Masaki
- Department of Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
| | - Masatoshi Uno
- Division of Internal Medicine, Kaneda Hospital, Okayama, Japan
| | - Jun Ozaki
- Department of Hematology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Chikamasa Yoshida
- Department of Hematology, National Hospital Organization Minami-Okayama Medical Center, Okayama, Japan
| | - Daigo Niiya
- Department of Hematology, Okayama Rosai Hospital, Okayama, Japan
| | - Koichi Kitazume
- Department of Hematology, Showa General Hospital, Tokyo, Japan
| | - Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Jun Takizawa
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan
| | - Rika Sakai
- Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Tomofumi Yano
- Department of Hematology, Okayama Rosai Hospital, Okayama, Japan
| | | | - Kazutaka Sunami
- Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Yasushi Hiramatsu
- Department of Hematology and Oncology, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan
| | - Kazutoshi Aoyama
- Department of Hematology, Chugoku Central Hospital, Hiroshima, Japan
| | - Hideki Tsujimura
- Division of Hematology-Oncology, Chiba Cancer Center, Chiba, Japan
| | - Jun Murakami
- The Third Department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yoshihiro Hatta
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Masatoshi Kanno
- Oncology Center, Nara Medical University Hospital, Nara, Japan
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Go S, Park MJ, Song H, Kim H, Kang MH, Lee HR, Kim Y, Kim RB, Lee SI, Lee G. Prognostic impact of sarcopenia in patients with diffuse large B-cell lymphoma treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone. J Cachexia Sarcopenia Muscle 2016; 7:567-576. [PMID: 27104110 PMCID: PMC4833756 DOI: 10.1002/jcsm.12115] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 02/24/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Sarcopenia is known to be related to an increased risk of chemotherapy toxicity and to a poor prognosis in patients with malignancy. We assessed the prognostic role of sarcopenia in patients with diffuse large B-cell lymphoma (DLBCL). METHODS In total, 187 consecutive patients with DLBCL treated with induction rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) immunochemotherapy were reviewed. Sarcopenia was defined as the lowest sex-specific quartile of the skeletal muscle index, calculated by dividing the pectoralis muscle area by the height. Clinical outcomes were compared between the sarcopenic and non-sarcopenic groups. A nomogram was constructed from the Cox regression model for overall survival (OS). RESULTS Treatment-related mortality (21.7 vs. 5.0%, P = 0.002) and early discontinuation of treatment (32.6 vs. 14.9%, P = 0.008) were more common in the sarcopenic group than in the non-sarcopenic group. The 5 year progression-free survival (PFS) rates were 35.3% in the sarcopenic group and 65.8% in the non-sarcopenic group (P < 0.001). The 5 year OS rates were 37.3% in the sarcopenic group and 68.1% in the non-sarcopenic group (P < 0.001). Sarcopenia and the five variables of the International Prognostic Index (IPI) were independent prognostic factors in a multivariate analysis for PFS and OS and were used to construct the nomogram. The calibration plot showed good agreement between the nomogram predictions and actual observations. The c index of the nomogram (0.80) was higher than those of other prognostic indices (IPI, 0.77, P = 0.009; revised-IPI, 0.74, P < 0.001; National Comprehensive Cancer Network-IPI, 0.77, P = 0.062). CONCLUSIONS Sarcopenia is associated with intolerance to standard R-CHOP chemotherapy as well as a poor prognosis. Moreover, sarcopenia itself can be included in prognostic models in DLBCL.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/adverse effects
- Cyclophosphamide/therapeutic use
- Doxorubicin/adverse effects
- Doxorubicin/therapeutic use
- Female
- Humans
- Kaplan-Meier Estimate
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Male
- Middle Aged
- Muscle, Skeletal/diagnostic imaging
- Muscle, Skeletal/pathology
- Neoplasm Staging
- Prednisone/adverse effects
- Prednisone/therapeutic use
- Prognosis
- Proportional Hazards Models
- Retrospective Studies
- Rituximab
- Sarcopenia/diagnosis
- Sarcopenia/etiology
- Sarcopenia/mortality
- Tomography, X-Ray Computed
- Treatment Outcome
- Vincristine/adverse effects
- Vincristine/therapeutic use
- Young Adult
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Affiliation(s)
- Se‐Il Go
- Division of Hematology‐Oncology, Department of Internal MedicineGyeongsang National University Hospital, Gyeongsang National University School of MedicineGangnam‐ro 79JinjuKorea
| | - Mi Jung Park
- Department of RadiologyGyeongsang National University Hospital, Gyeongsang National University School of MedicineGangnam‐ro 79JinjuKorea
| | - Haa‐Na Song
- Division of Hematology‐Oncology, Department of Internal MedicineGyeongsang National University Hospital, Gyeongsang National University School of MedicineGangnam‐ro 79JinjuKorea
| | - Hoon‐Gu Kim
- Division of Hematology‐Oncology, Department of Internal MedicineGyeongsang National University Hospital, Gyeongsang National University School of MedicineGangnam‐ro 79JinjuKorea
- Gyeongsang Institute of Health SciencesGangnam‐ro 79JinjuKorea
| | - Myoung Hee Kang
- Division of Hematology‐Oncology, Department of Internal MedicineGyeongsang National University Hospital, Gyeongsang National University School of MedicineGangnam‐ro 79JinjuKorea
| | - Hyang Rae Lee
- Division of Hematology‐Oncology, Department of Internal MedicineGyeongsang National University Hospital, Gyeongsang National University School of MedicineGangnam‐ro 79JinjuKorea
| | - Yire Kim
- Division of Hematology‐Oncology, Department of Internal MedicineGyeongsang National University Hospital, Gyeongsang National University School of MedicineGangnam‐ro 79JinjuKorea
| | - Rock Bum Kim
- Department of Preventive Medicine and Environmental Health CenterGyeongsang National University Hospital, Gyeongsang National University School of MedicineGangnam‐ro 79JinjuKorea
| | - Soon Il Lee
- Department of Internal MedicineDankook University College of MedicineCheonanKorea
| | - Gyeong‐Won Lee
- Division of Hematology‐Oncology, Department of Internal MedicineGyeongsang National University Hospital, Gyeongsang National University School of MedicineGangnam‐ro 79JinjuKorea
- Gyeongsang Institute of Health SciencesGangnam‐ro 79JinjuKorea
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10
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Sun ML, Shang B, Gao JH, Jiang SJ. Rare case of primary pleural lymphoma presenting with pleural effusion. Thorac Cancer 2015; 7:145-50. [PMID: 26813352 PMCID: PMC4718130 DOI: 10.1111/1759-7714.12256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 12/11/2014] [Indexed: 12/22/2022] Open
Abstract
Primary pleural lymphoma is rare and has been described in association with human immunodeficiency virus (HIV) infection or pyothorax. We report a rare case of primary pleural lymphoma in a 73-year-old man who presented with chest pain and no history of HIV infection or pyothorax. Chest imaging showed pleural thickening and pleural effusion. Thoracoscopic pleural biopsy was performed. Histopathological and immunohistochemical examinations conformed to that of a diffuse large B-cell lymphoma. Physicians should be aware of this rare location of primary lymphoma and implement thoracoscopy as soon as possible.
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Affiliation(s)
- Mei-Ling Sun
- Department of Respiratory Medicine Provincial Hospital Affiliated to Shandong University Jinan China
| | - Bin Shang
- Department of Thoracic Surgery Provincial Hospital Affiliated to Shandong University Jinan China
| | - Jian-Hua Gao
- Department of Respiratory Medicine Wendeng Central Hospital Weihai China
| | - Shu-Juan Jiang
- Department of Respiratory Medicine Provincial Hospital Affiliated to Shandong University Jinan China
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11
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Tokunaga T, Tomita A, Sugimoto K, Shimada K, Iriyama C, Hirose T, Shirahata-Adachi M, Suzuki Y, Mizuno H, Kiyoi H, Asano N, Nakamura S, Kinoshita T, Naoe T. De novo diffuse large B-cell lymphoma with a CD20 immunohistochemistry-positive and flow cytometry-negative phenotype: molecular mechanisms and correlation with rituximab sensitivity. Cancer Sci 2013; 105:35-43. [PMID: 24147568 PMCID: PMC4317883 DOI: 10.1111/cas.12307] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 09/30/2013] [Accepted: 10/16/2013] [Indexed: 12/30/2022] Open
Abstract
CD20 is expressed in most B-cell lymphomas and is a critical molecular target of rituximab. Some B-cell lymphomas show aberrant CD20 expression, and rituximab use in these patients is controversial. Here we show both the molecular mechanisms and the clinical significance of de novo diffuse large B-cell lymphomas (DLBCL) that show a CD20 immunohistochemistry (IHC)-positive and flow cytometry (FCM)- negative (IHC[+]/FCM[−]) phenotype. Both IHC and FCM using anti-CD20 antibodies L26 and B1, respectively, were analyzed in 37 of the 106 cases of de novo DLBCL; 8 (22%) of these cases were CD79a(+)/CD20(+) with IHC and CD19(+)/CD20(−) with FCM. CD20 (MS4A1) mRNA expression was significantly lower in IHC(+)/FCM(−) cells than in IHC(+)/FCM(+) cells (P = 0.0005). No genetic mutations were detected in MS4A1 promoter and coding regions. Rituximab-mediated cytotoxicity in the CDC assay using IHC(+)/FCM(−) primary cells was significantly lower than in IHC(+)/FCM(+) cells (P < 0.05); however, partial effectiveness was confirmed. FCM using rituximab detected CD20 more efficiently than B1. No significant difference was observed between IHC(+)/FCM(−) and IHC(+)/FCM(+) patients in overall survival (P = 0.664). Thus, lower expression of CD20 mRNA is critical for the CD20 IHC(+)/FCM(−) phenotype. Lower CD20 expression with FCM does not rule out rituximab use in these patients if expression is confirmed with IHC. FCM using rituximab may be more informative than B1 for predicting rituximab effectiveness in IHC(+)/FCM(−) cases.
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Affiliation(s)
- Takashi Tokunaga
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Hematology/Oncology Research, Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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