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von Tresckow J, Heyl N, Robrecht S, Giza A, Aldaoud A, Schlag R, Klausmann M, Linde H, Stein W, Schwarzer A, Fischer K, Cramer P, Eichhorst B, Hallek M, Fink AM. Treatment with idelalisib in patients with chronic lymphocytic leukemia - real world data from the registry of the German CLL Study Group. Ann Hematol 2023; 102:3083-3090. [PMID: 37358640 PMCID: PMC10567876 DOI: 10.1007/s00277-023-05314-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Abstract
Idelalisib in combination with rituximab is an efficacious treatment for patients suffering from chronic lymphocytic leukemia (CLL) with known limitations due to toxicities. However, the benefit after prior Bruton tyrosine kinase inhibitor (BTKi) therapy remains unclear. For this analysis, 81 patients included in a non-interventional registry study of the German CLL study group (registered at www.clinicaltrials.gov as # NCT02863692) meeting the predefined criteria of a confirmed diagnosis of CLL and being treated with idelalisib containing regimens outside clinical trials were considered. 11 patients were treatment naïve (13.6%) and 70 patients (86.4%) pretreated. Patients had median of one prior therapy line (range 0-11). Median treatment duration with idelalisib was 5.1 months (range 0-55.0 months). Of 58 patients with documented treatment outcome, 39 responded to idelalisib containing therapy (67.2%). Patients treated with the BTKi ibrutinib as last prior treatment prior to idelalisib responded in 71.4% compared to a response rate of 61.9% in patients without prior ibrutinib. Median event free survival (EFS) was 15.9 months with a 16 versus 14 months EFS in patients with ibrutinib as last prior treatment or not, respectively. Median overall survival was 46.6 months. In conclusion, treatment with idelalisib appears to have a valuable impact in patients being refractory to prior ibrutinib therapy even though there are limitations in our analysis due to the low number of patients included.
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Affiliation(s)
- Julia von Tresckow
- Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Nikola Heyl
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Adam Giza
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ali Aldaoud
- Praxis für Hämatologie und Onkologie, Leipzig, Germany
| | - Rudolf Schlag
- Hämatologisch-Onkologische Schwerpunktpraxis, Würzburg, Germany
| | | | - Hartmut Linde
- MVZ für Blut und Krebserkrankungen, Potsdam, Germany
| | | | | | - Kirsten Fischer
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Paula Cramer
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Barbara Eichhorst
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna Maria Fink
- Department I for Internal Medicine and Centre of Integrated Oncology Aachen, Bonn, Cologne, Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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2
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Fürstenau M, Giza A, Stumpf T, Robrecht S, Maurer C, Linde H, Jacobasch L, Dörfel S, Aldaoud A, Tresckow J, Koenigsmann M, Gaska T, Kaiser U, Harich H, Fischer K, Eichhorst B, Hallek M, Fink A. Second primary malignancies in treated and untreated patients with chronic lymphocytic leukemia. Am J Hematol 2021; 96:E457-E460. [PMID: 34591989 DOI: 10.1002/ajh.26363] [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] [Received: 07/19/2021] [Revised: 09/20/2021] [Accepted: 09/27/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Moritz Fürstenau
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group University of Cologne Cologne Germany
- Cancer Center Cologne Essen (CCCE)—Partner Site Cologne University of Cologne Cologne Germany
| | - Adam Giza
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group University of Cologne Cologne Germany
| | - Thomas Stumpf
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group University of Cologne Cologne Germany
| | - Sandra Robrecht
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group University of Cologne Cologne Germany
| | - Christian Maurer
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group University of Cologne Cologne Germany
- Cancer Center Cologne Essen (CCCE)—Partner Site Cologne University of Cologne Cologne Germany
| | - Hartmut Linde
- MVZ für Blut‐ und Krebserkrankungen Potsdam Potsdam Germany
| | - Lutz Jacobasch
- BAG Freiberg‐Richter, Jacobasch, Wolf, Illmer Dresden Germany
| | - Steffen Dörfel
- Onkologische Gemeinschaftspraxis Dres. Dörfel/Göhler/Boldt Dresden Germany
| | - Ali Aldaoud
- Praxis für Hämatologie/ Onkologie Dr. Aldaoud Leipzig Germany
| | - Julia Tresckow
- Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen University of Duisburg‐Essen Essen Germany
| | | | | | | | | | - Kirsten Fischer
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group University of Cologne Cologne Germany
| | - Barbara Eichhorst
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group University of Cologne Cologne Germany
- Cancer Center Cologne Essen (CCCE)—Partner Site Cologne University of Cologne Cologne Germany
| | - Michael Hallek
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group University of Cologne Cologne Germany
- Cancer Center Cologne Essen (CCCE)—Partner Site Cologne University of Cologne Cologne Germany
- Cologne Excellence Cluster on Cellular Stress Response in Aging‐Associated Diseases (CECAD) University of Cologne Cologne Germany
| | - Anna‐Maria Fink
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group University of Cologne Cologne Germany
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3
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Dechow T, Aldaoud A, Behlendorf T, Knauf W, Eschenburg H, Groschek M, Hansen R, Söling U, Grebhardt S, Siebenbach HU, Vannier C, Potthoff K. Pomalidomide plus dexamethasone for patients with relapsed or refractory multiple myeloma: Final results of the non-interventional study POSEIDON and comparison with the pivotal phase 3 clinical trials. Eur J Haematol 2021; 108:133-144. [PMID: 34714555 PMCID: PMC9298817 DOI: 10.1111/ejh.13719] [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: 07/20/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 12/30/2022]
Abstract
Background Prognosis of patients with multiple myeloma (MM) who have relapsed on or become refractory to immunomodulators and bortezomib is poor, and treatment options are limited. While pomalidomide plus low‐dose dexamethasone (POM/DEX) has demonstrated efficacy in clinical trials, real‐world evidence is scarce. Patients and Methods POSEIDON was a prospective non‐interventional study designed to evaluate effectiveness, safety and quality of life (QoL) of POM/DEX in patients with relapsed or refractory MM (R/RMM) pretreated with at least two prior therapy lines including both lenalidomide and bortezomib in real world in Germany. Patients received POM/DEX according to physicians’ choice. Data were analyzed descriptively. Results Between 2014 and 2017, 151 patients were enrolled, 144 patients with a median of three prior therapy lines qualified for effectiveness analysis. Median age was 73.2 years. Median progression‐free and overall survival were 6.3 months [95% confidence interval (CI) 5.2, 8.6] and 12.9 months [95% CI 10.6, 15.1]. Most frequent grade 3/4 adverse events were leukopenia (8.2%), pneumonia (7.5%) and anemia (5.5%). QoL was maintained after start of POM/DEX. Conclusion The results of POSEIDON support the effectiveness and safety of POM/DEX in R/RMM patients pretreated with lenalidomide and bortezomib and highlight the clinical value of the POM/DEX regimen in the real‐world setting. Registered at clinicaltrials.gov (NCT02075996).
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Affiliation(s)
| | - Ali Aldaoud
- Gemeinschaftspraxis für Hämatologie & Onkologie, Leipzig, Germany
| | - Timo Behlendorf
- Gemeinschaftspraxis für Innere Medizin, Hämatologie & Onkologie, Halle (Saale), Germany
| | - Wolfgang Knauf
- Centrum für Hämatologie und Onkologie Bethanien, Frankfurt am Main, Germany
| | | | | | - Richard Hansen
- Schwerpunktpraxis für Hämatologie und Onkologie, Kaiserlautern, Germany
| | - Ulrike Söling
- Hämato-onkologisches Zentrum Kassel GmbH, Kassel, Germany
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4
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Al-Batran SE, Hofheinz RD, Reichart A, Pauligk C, Schönherr C, Schlag R, Siegler G, Dörfel S, Koenigsmann M, Zahn MO, Schubert J, Aldaoud A, Höffkes HG, Schulz H, Hahn L, Uhlig J, Blau W, Stauch M, Weniger J, Wolf M, Jacobasch L, Bildat S, Wehmeyer J, Homann N, Trojan J, Waidmann O, Fietz T, Feustel HP, Groschek M, Wierecky J, Waibel K, Mahlmann S, Schwindel U, Peters U, Schuch G, Pink D, Eschenburg H, Wörns MA, Harich HD, von Weikersthal LF, Däßler KU, Behringer DM, Messmann H, Kretzschmar A, Gallmeier E, Forstbauer H, Kunzmann V, Papke J, Büchner-Steudel P, Vehling-Kaiser U, Springfeld C, Vogel A, Ettrich TJ, Schaaf M, Hausen GZ, Götze TO. Quality of life and outcome of patients with metastatic pancreatic cancer receiving first-line chemotherapy with nab-paclitaxel and gemcitabine: Real-life results from the prospective QOLIXANE trial of the Platform for Outcome, Quality of Life and Translational Research on Pancreatic Cancer registry. Int J Cancer 2020; 148:1478-1488. [PMID: 33038277 DOI: 10.1002/ijc.33336] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/07/2020] [Accepted: 08/21/2020] [Indexed: 01/05/2023]
Abstract
Few data exist on health-related quality of life (QoL) in patients with metastatic pancreatic cancer (mPC) receiving first-line chemotherapy (Awad L ZE, Mesbah M Boston, MA. Applying survival data methodology to analyze quality of life data, in Mesbah M, Cole BF, Ting Lee M-L (eds): Statistical Methods for Quality of Life Studies: Design, Measurements and Analysis. Kluwer Academic Publishers 2002). The QOLIXANE study is a prospective, noninterventional, multicenter substudy of the Platform for Outcome, Quality of Life and Translational Research on Pancreatic Cancer (PARAGON) registry, which evaluated QoL in patients with mPC receiving first-line gemcitabine and nab-paclitaxel chemotherapy in real-life setting. QoL was prospectively measured via EORTC QLQ-C30 questionnaires at baseline and every month thereafter. Therapy and efficacy parameters were prospectively collected. Main objectives were the rate of patients without deterioration of Global Health Status/QoL (GHS/QoL) at 3 and 6 months. Six hundred patients were enrolled in 95 German study sites. Median progression-free survival was 5.9 months (95% confidence interval [CI], 5.2-6.3). Median overall survival (OS) was 8.9 months (95% CI, 7.9-10.2), while median time to deterioration of GHS/QoL was 4.7 months (95% CI, 4.0-5.6). With a baseline GHS/QoL score of 46 (SD, 22.8), baseline QoL of the patients was severely impaired, in most cases due to loss in role functioning and fatigue. In the Kaplan-Meier analysis, 61% and 41% of patients had maintained GHS/QoL after 3 and 6 months, respectively. However, in the QoL response analysis, 35% and 19% of patients had maintained (improved or stable) GHS/QoL after 3 and 6 months, respectively, while 14% and 9% had deteriorated GHS/QoL with the remaining patients being nonevaluable. In the Cox regression analysis, GHS/QoL scores strongly predicted survival with a hazard ratio of 0.86 (P < .0001). Patients with mPC have poor QoL at baseline that deteriorates within a median of 4.7 months. Treatment with gemcitabine and nab-paclitaxel is associated with maintained QoL in relevant proportions of patients. However, overall, results remain poor, reflecting the aggressive nature of the disease.
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Affiliation(s)
- Salah-Eddin Al-Batran
- Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany.,Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | | | - Alexander Reichart
- Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany.,Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Claudia Pauligk
- Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Caroline Schönherr
- Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Rudolf Schlag
- Gemeinschaftspraxis Schlag/Schöttker, Würzburg, Germany
| | | | | | | | | | | | - Ali Aldaoud
- HELIOS Park-Klinikum, Pankreaszentrum Leipzig, Leipzig, Germany
| | - Heinz-Gert Höffkes
- Universitätsmedizin Marburg, Klinikum Fulda, Fulda, Germany.,MVZ Osthessen GmbH, Fulda, Germany
| | - Holger Schulz
- Pioh Frechen-Köln Praxis Internistischer Onkologie und Hämatologie, Frechen, Germany
| | - Lars Hahn
- Dokusan Gesellschaft für med. Studien GmbH und Co. KG, Herne, Germany
| | - Jens Uhlig
- Hämatologisch-Onkologische Schwerpunktpraxis, Naunhof, Germany
| | - Wolfgang Blau
- Medizinische Klinik IV/V des Universitätsklinikums Gießen und Marburg, Gießen, Germany
| | - Martina Stauch
- Schwerpunktpraxis für Hämatologie/Onkologie, Kronach, Germany
| | - Jörg Weniger
- Gemeinschaftspraxis für Hämatologie und Onkologie Dres. Weniger/Bittrich/Schütze, Erfurt, Germany
| | - Martin Wolf
- Klinikum Kassel GmbH, Klinik für Hämatologie und Onkologie, Kassel, Germany
| | - Lutz Jacobasch
- Onkologische Gemeinschaftspraxis Dr. med. Lutz Jacobasch, Dresden, Germany
| | - Stephan Bildat
- Klinikum Herford, Medizinische Klinik II & MVZ für Onkologie, Onkologisches Zentrum, Herford, Germany
| | - Jürgen Wehmeyer
- Gemeinschaftspraxis für Hämatologie und Onkologie, Münster, Germany
| | - Nils Homann
- Med. Klinik II Klinikum Wolfsburg, Wolfsburg, Germany
| | - Jörg Trojan
- Klinikum der J. W. Goethe-Universität Frankfurt, Frankfurt, Germany
| | - Oliver Waidmann
- Klinikum der J. W. Goethe-Universität Frankfurt, Frankfurt, Germany
| | - Thomas Fietz
- Schwerpunktpraxis für Hämatologie, Onkologie und Gastroenterologie Dres Banhardt/Fietz/Hertkorn, Singen, Germany
| | | | | | - Jan Wierecky
- Überörtliche Gemeinschaftspraxis, Schwerpunkt Hämatologie, Onkologie und Palliativmedizin, Hamburg, Germany
| | - Karin Waibel
- medius Kliniken gGmbH, medius Klinik Ostfildern-Ruit, Ostfildern-Ruit, Germany
| | | | - Uwe Schwindel
- GPR Gesundheits- und Pflegezentrum gGmbH, I. Medizinische Klinik, Rüsselsheim, Germany
| | - Uwe Peters
- Ambulantes Tumorzentrum Spandau Dres. Peters und Saeuberlich-Knigge, Berlin, Germany
| | - Gunter Schuch
- Hämatologisch-Onkologische Praxis Altona (HOPA), Hamburg, Germany
| | - Daniel Pink
- Klinik und Poliklinik für Innere Medizin C, Hämatologie und Onkologie, Transplantationszentrum, Palliativmedizin, Universität Greifswald, Greifswald, Germany.,Klinik für Hämatologie, Onkologie und Palliativmedizin, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Bad-Saarow, Brandenburg, Germany
| | | | - Marcus-A Wörns
- I. Med. Klinik und Poliklinik, Universitätsmedizin Mainz, Germany
| | | | | | | | | | - Helmut Messmann
- Universitätsklinikum Augsburg, III. Medizinische Klinik, Augsburg, Germany
| | | | - Eike Gallmeier
- Universitätsklinikum Gießen und Marburg GmbH, Klinik für Innere Medizin, Marburg, Germany
| | | | - Volker Kunzmann
- Universitätsklinik Würzburg, Zentrum Innere Medizin, Medizinische Klinik und Poliklinik II, Würzburg, Germany
| | - Jens Papke
- Praxis Prof. Dr. med. Jens Papke, Neustadt/Sa, Germany
| | - Petra Büchner-Steudel
- Universitätsklinikum Halle (Saale), Klinik und Poliklinik für Innere Medizin I, Halle, Germany
| | | | - Christoph Springfeld
- Nationales Centrum für Tumorerkrankungen (NCT), Abt. Medizinische Onkologie Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Arndt Vogel
- Medizinische Hochschule Hannover, Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Hannover, Germany
| | - Thomas J Ettrich
- Universitätsklinikum Ulm, Klinik für Innere Medizin I, Ulm, Germany
| | - Marina Schaaf
- Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Gerrit Zur Hausen
- Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Thorsten Oliver Götze
- Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany.,Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
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Kubasch AS, Franke GN, Aldaoud A, Weibl K, Jentzsch M, Sabri O, Horny HP, Fend F, Behre G, Platzbecker U, Vucinic V. Allogeneic Hematopoietic Stem Cell Transplantation in a Rare Case of Tonsillar Mast Cell Sarcoma. Front Oncol 2020; 10:219. [PMID: 32181155 PMCID: PMC7059127 DOI: 10.3389/fonc.2020.00219] [Citation(s) in RCA: 4] [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: 12/17/2019] [Accepted: 02/07/2020] [Indexed: 12/03/2022] Open
Abstract
Mast cell sarcoma comprises a rare aggressive mast cell neoplasia with histological, clinical, and genetic features distinct from other mast cell neoplasm. Until now, prognosis is still poor due to high rates of progression to mast cell leukemia and failure of conventional chemotherapies. Our here presented first report about successful allogeneic hematopoietic stem cell transplantation leading to remission in a case of tonsillar MCS represents a promising potential curative treatment option for this rare and often fatal disease.
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Affiliation(s)
- Anne Sophie Kubasch
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Georg-Nikolaus Franke
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Ali Aldaoud
- Outpatient-Centre for Hematology and Oncology, Leipzig, Germany
| | - Konstantin Weibl
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Madlen Jentzsch
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Hans-Peter Horny
- Institute of Pathology, Ludwig-Maximilians University Munich, Munich, Germany
| | - Falko Fend
- Institute of Pathology and Neuropathology, University of Tuebingen and Comprehensive Cancer Center, University Hospital Tuebingen, Tuebingen, Germany
| | - Gerhard Behre
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Vladan Vucinic
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany
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Hegewisch-Becker S, Aldaoud A, Wolf T, Krammer-Steiner B, Linde H, Scheiner-Sparna R, Hamm D, Jänicke M, Marschner N. Results from the prospective German TPK clinical cohort study: Treatment algorithms and survival of 1,174 patients with locally advanced, inoperable, or metastatic pancreatic ductal adenocarcinoma. Int J Cancer 2018; 144:981-990. [PMID: 30006989 PMCID: PMC6585733 DOI: 10.1002/ijc.31751] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/16/2018] [Accepted: 06/07/2018] [Indexed: 02/06/2023]
Abstract
Pancreatic cancer is a highly lethal malignancy. Developments in recent years have broadened our therapeutic armamentarium. Novel drugs such as nab‐paclitaxel, liposomal irinotecan and chemotherapy regimens such as FOLFIRINOX have been successfully tested in clinical trials. Data on patients outside of clinical trials are scarce but necessary to assess and improve the standard of care. We present data on treatment and survival of 1,174 patients with locally advanced, inoperable, or metastatic pancreatic ductal adenocarcinoma. Between February 2014 and June 2017, patients were recruited by 104 sites at start of first‐line therapy into the ongoing, prospective clinical cohort study TPK (Tumour Registry Pancreatic Cancer). As first‐line therapy, 89% of patients received one of the three treatment regimens: gemcitabine monotherapy (23%), nab‐paclitaxel plus gemcitabine (42%), or FOLFIRINOX (24%). The corresponding subgroups differed: Patients receiving gemcitabine monotherapy were older and more comorbid (median age 78 years, 73% ECOG ≥ 1) than patients receiving nab‐paclitaxel plus gemcitabine (median age 71, 64% ECOG ≥ 1) or patients receiving FOLFIRINOX (median age 60, 52% ECOG ≥ 1). At least 40% of patients died before receiving second‐line treatment. First‐line progression‐free survival was 4.6 months (95% CI: 3.7–5.2) for gemcitabine, 5.6 months (95% CI: 5.0–6.2) for nab‐paclitaxel plus gemcitabine, and 6.3 months (95% CI: 5.5–6.9) for FOLFIRINOX. Our data represent the treatment reality in a German community setting. Although there are no stringent inclusion criteria for our cohort study, overall survival is comparable to that reported by randomised clinical trials. What's new? More than four‐fifths of patients with pancreatic cancer present with locally advanced, inoperable (LAPC) or metastatic (MPC) disease at diagnosis. Beyond clinical trials, relatively little data is available on survival outcomes for these patients. Here, real‐world data, derived from an unselected cohort of 1,174 patients enrolled between 2014 and 2017 in a prospective study in Germany, show that the vast majority of first‐line therapies given to LAPC/MPC patients consisted of either gemcitabine monotherapy, nab‐paclitaxel plus gemcitabine, or FOLFIRINOX. About 40 percent of the patients received second‐line therapy. Overall cohort survival was comparable to that reported for randomized clinical trials.
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Affiliation(s)
| | - Ali Aldaoud
- HELIOS Park-Klinikum, Pankreaszentrum, Leipzig, Germany
| | - Thomas Wolf
- Outpatient Centre for Oncology, Dresden, Germany
| | | | - Hartmut Linde
- Ambulatory Healthcare Centre for Cancer and Blood Diseases, Potsdam, Germany
| | | | - David Hamm
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Martina Jänicke
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Norbert Marschner
- Outpatient-Centre for Interdisciplinary Oncology and Haematology, Freiburg, Germany
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7
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Schönherr C, Götze T, zur Hausen G, Reichart A, Pauligk C, Schlag R, Siegler G, Dörfel S, Aldaoud A, Hahn L, Schubert J, Zahn MO, Höffkes HG, Reiser M, Koenigsmann M, Blau W, Waidmann O, Homann N, Trojan J, Al-Batran SE. Quality of life (QoL) in patients with metastatic pancreatic cancer receiving first-line Nab-paclitaxel/gemcitabine chemotherapy: Results of the large QoL study AIO-QoliXane/PARAGON. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Knauf W, Aldaoud A, Hutzschenreuter U, Klausmann M, Dille S, Wetzel N, Jänicke M, Marschner N. Survival of non-transplant patients with multiple myeloma in routine care differs from that in clinical trials-data from the prospective German Tumour Registry Lymphatic Neoplasms. Ann Hematol 2018; 97:2437-2445. [PMID: 30069704 PMCID: PMC6208687 DOI: 10.1007/s00277-018-3449-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 05/29/2018] [Accepted: 07/17/2018] [Indexed: 11/29/2022]
Abstract
Despite increasing treatment options, multiple myeloma (MM) remains incurable for most patients. Data on improvement of outcomes are derived from selected patient populations enrolled in clinical trials and might not be conferrable to all patients. Therefore, we assessed the trial eligibility, sequential treatment, and survival of non-transplant patients with MM treated in German routine care. The prospective clinical cohort study TLN (Tumour Registry Lymphatic Neoplasms) recruited 285 non-transplant patients with symptomatic MM at start of first-line treatment in 84 centres from 2009 to 2011. Demographic and clinical data were collected until August 2016. Trial-ineligibility was determined by presence of at least one of the common exclusion criteria: heart/renal failure, liver/renal diseases, polyneuropathy, HIV positivity. All other patients were considered potentially trial-eligible. Thirty percent of the patients in our study were classified as trial-ineligible. Median first-line progression-free survival (PFS) and overall survival (OS) of trial-ineligible patients were inferior to that of potentially trial-eligible patients: PFS 16.2 months (95% CI (confidence interval) 11.1–20.4) vs. 27.3 months (95% CI 23.3–33.0); OS 34.2 months (95% CI 21.6–48.1) vs. 58.6 months (95% CI 48.6–64.4). A high percentage of non-transplant patients with MM in German routine care would be ineligible for participation in clinical trials. Despite similar treatment algorithms, their first-line PFS and OS were shorter than those of potentially trial-eligible patients; the survival data of the latter were similar to results from clinical trials. Physicians should be aware of the fact that results from clinical trials may not mirror “real world” patient outcomes when discussing outcome expectations with patients. Trial registration: Clinicaltrials.gov identifier: NCT00889798.
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Affiliation(s)
- Wolfgang Knauf
- Joint Outpatient-Centre for Oncology, Frankfurt a. M., Germany
| | - Ali Aldaoud
- Joint Outpatient-Centre for Haematology and Oncology, Leipzig, Germany
| | | | - Martine Klausmann
- Joint Outpatient-Centre for Haematology and Oncology, Aschaffenburg, Germany
| | | | - Natalie Wetzel
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Martina Jänicke
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Norbert Marschner
- Outpatient-Centre for Interdisciplinary Oncology and Haematology, Wirthstrasse 11c, 79110, Freiburg, Germany.
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Schoenherr C, Goetze TO, zur Hausen G, Reichart A, Pauligk C, Schlag R, Siegler GM, Doerfel S, Aldaoud A, Hahn L, Schubert JEA, Zahn MO, Hoeffkes HG, Reiser M, Koenigsmann M, Blau W, Uhlig J, Homann N, Trojan J, Al-Batran SE. Real life data of 601 patients from the QoliXane pancreatic cancer study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16248] [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)
| | | | - Gerrit zur Hausen
- IKF Cancer Research GmbH at Krankenhaus Nordwest, Frankfurt, Germany
| | - Alexander Reichart
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| | - Claudia Pauligk
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| | - Rudolf Schlag
- Hämatologisch-Onkologische Schwerpunktpraxis, Würzburg, DE
| | | | | | - Ali Aldaoud
- Gemeinschaftspraxis Aldaoud/Schwarzer, Leipzig, Germany
| | - Lars Hahn
- Praxisklinik – Dialysezentrum Herne, Herne, Germany
| | | | | | | | - Marcel Reiser
- PIOH - Praxis Internistische Onkologie und Haematologie, Cologne, Germany
| | | | | | - Jens Uhlig
- Hämatologie und Onkologie Muldental, Naunhof, Germany
| | - Nils Homann
- Department of Internal Medicine II, Academic Teaching Hospital Wolfsburg, Wolfsburg, Germany
| | - Jorg Trojan
- University Hospital Frankfurt, Frankfurt, Germany
| | - Salah-Eddin Al-Batran
- Institute of Clinical Cancer Research, Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
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Knauf W, Aldaoud A, Losem C, Mittermueller J, Neise M, Niemeier B, Harde J, Trarbach T, Potthoff K. Lenalidomide plus dexamethasone for patients with relapsed or refractory multiple myeloma: Final results of a non-interventional study and comparison with the pivotal phase 3 clinical trials. Leuk Res 2018; 68:90-97. [PMID: 29579627 DOI: 10.1016/j.leukres.2018.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 03/02/2018] [Accepted: 03/09/2018] [Indexed: 10/17/2022]
Abstract
Lenalidomide (LEN) is an immunomodulatory drug with significant clinical activity against relapsed and refractory multiple myeloma (r/r MM). Based on the pivotal phase 3 trials MM-009 and MM-010, LEN in combination with dexamethasone (DEX) is approved for treatment of patients with MM who have received at least one prior therapy. LEN monotherapy is also approved in first line treatment. Here, we evaluated LEN/DEX combination therapy in a non-interventional study in patients with r/r MM in routine clinical practice. Patients received LEN/DEX as per Summary of Product Characteristics. Ninety-eight patients were treated with at least 1 cycle of LEN/DEX (median age 71 years; range, 42-88), forty-eight patients with at least 6 cycles. The Kaplan-Meier estimate for overall median time to progression was 12.0 months, 13.9 months for patients receiving second-line therapy and 10.3 months for third-line or higher-line therapy. The overall response rate was 60.2%. The median overall survival was 24.3 months. The most common adverse events were anemia (32.7%), thrombocytopenia (27.6%) and leukopenia (24.5%). Seven (7.1%) patients developed thromboembolic events despite prophylaxis. In conclusion, the combination of LEN/DEX administered to patients with r/r MM in routine clinical practice showed similar effectiveness and safety as demonstrated in the registration trials.
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Affiliation(s)
- Wolfgang Knauf
- Center for Hematology and Oncology, Agaplesion Bethanien Hospital, Im Prüfling 17-19, 60389 Frankfurt am Main, Germany.
| | - Ali Aldaoud
- Joint Outpatient Center for Hematology and Oncology, Strümpellstr. 41, 04289 Leipzig, Germany.
| | - Christoph Losem
- Center for Hematology and Oncology, Johanna-Etienne-Hospital, Am Hasenberg 46, 41462 Neuss, Germany.
| | | | | | - Beate Niemeier
- iOMEDICO AG, Hanferstr. 28, 79108 Freiburg im Breisgau, Germany.
| | - Johanna Harde
- iOMEDICO AG, Hanferstr. 28, 79108 Freiburg im Breisgau, Germany.
| | - Tanja Trarbach
- Center for Tumor Biology and Integrative Medicine, Klinikum Wilhelmshaven, Friedrich-Paffrath-Straße 100, 26389 Wilhelmshaven, Germany.
| | - Karin Potthoff
- iOMEDICO AG, Hanferstr. 28, 79108 Freiburg im Breisgau, Germany.
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Fink AM, Bahlo J, Robrecht S, Al-Sawaf O, Aldaoud A, Hebart H, Jentsch-Ullrich K, Dörfel S, Fischer K, Wendtner CM, Nösslinger T, Ghia P, Bosch F, Kater AP, Döhner H, Kneba M, Kreuzer KA, Tausch E, Stilgenbauer S, Ritgen M, Böttcher S, Eichhorst B, Hallek M. Lenalidomide maintenance after first-line therapy for high-risk chronic lymphocytic leukaemia (CLLM1): final results from a randomised, double-blind, phase 3 study. Lancet Haematol 2017; 4:e475-e486. [PMID: 28916311 DOI: 10.1016/s2352-3026(17)30171-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/03/2017] [Accepted: 08/04/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND The combined use of genetic markers and detectable minimal residual disease identifies patients with chronic lymphocytic leukaemia with poor outcome after first-line chemoimmunotherapy. We aimed to assess lenalidomide maintenance therapy in these high-risk patients. METHODS In this randomised, double-blind, phase 3 study (CLLM1; CLL Maintenance 1 of the German CLL Study Group), patients older than 18 years and diagnosed with immunophenotypically confirmed chronic lymphocytic leukaemia with active disease, who responded to chemoimmunotherapy 2-5 months after completion of first-line therapy and who were assessed as having a high risk for an early progression with at least a partial response after four or more cycles of first-line chemoimmunotherapy, were eligible if they had high minimal residual disease levels or intermediate levels combined with an unmutated IGHV gene status or TP53 alterations. Patients were randomly assigned (2:1) to receive either lenalidomide (5 mg) or placebo. Randomisation was done with a fixed block size of three, and was stratified according to the minimal residual disease level achieved after first-line therapy. Maintenance was started with 5 mg daily, and was escalated to the target dose of 15 mg. If tolerated, medication was administered until disease progression. The primary endpoint was progression-free survival according to an independent review. The pre-planned interim analysis done by intention to treat was done after 20% of the calculated progression-free survival events. This study is registered with ClinicalTrials.gov, number NCT01556776; treatment in the lenalidomide group is still ongoing. FINDINGS Between July 5, 2012, and March 15, 2016, 468 previously untreated patients with chronic lymphocytic leukaemia were screened for the study; 379 (81%) were not eligible. Recruitment was closed prematurely due to poor accrual after 89 of 200 planned patients were randomly assigned: 60 (67%) enrolled patients were assigned to the lenalidomide group and 29 (33%) to the placebo group, of whom 56 (63%) received lenalidomide and 29 (33%) placebo, with a median of 11·0 (IQR 4·5-20·5) treatment cycles at data cutoff. After a median observation time of 17·9 months (IQR 9·1-28·1), the hazard ratio for progression-free survival assessed by an independent review was 0·168 (95% CI 0·074-0·379). Median progression-free survival was 13·3 months (95% CI 9·9-19·7) in the placebo group and not reached (95% CI 32·3-not evaluable) in the lenalidomide group. The most frequent adverse events were skin disorders (35 patients [63%] in the lenalidomide group vs eight patients [28%] in the placebo group), gastrointestinal disorders (34 [61%] vs eight [28%]), infections (30 [54%] vs 19 [66%]), haematological toxicity (28 [50%] vs five [17%]), and general disorders (28 [50%] vs nine [31%]). One fatal adverse event was reported in each of the treatment groups (one [2%] patient with fatal acute lymphocytic leukaemia in the lenalidomide group and one patient (3%) with fatal multifocal leukoencephalopathy in the placebo group). INTERPRETATION Lenalidomide is an efficacious maintenance therapy reducing the relative risk of progression in first-line patients with chronic lymphocytic leukaemia who do not achieve minimal residual disease negative disease state following chemoimmunotherapy approaches. The toxicity seems to be acceptable considering the poor prognosis of the eligible patients. The trial independently confirms the clinical significance of a novel, minimal residual disease-based algorithm to predict short progression-free survival, which might be incorporated in future clinical trials to identify candidates for additional maintenance treatment. FUNDING Celgene Corporation.
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Affiliation(s)
- Anna Maria Fink
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital of Cologne, Cologne, Germany.
| | - Jasmin Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital of Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital of Cologne, Cologne, Germany
| | - Othman Al-Sawaf
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital of Cologne, Cologne, Germany
| | - Ali Aldaoud
- Gemeinschaftspraxis für Hämatologie und Onkologie, Leipzig, Germany
| | - Holger Hebart
- Zentrum für Innere Medizin, Hämatologie/Onkologie, Stauferklinikum Schwäbisch-Gmünd, Germany
| | | | | | - Kirsten Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital of Cologne, Cologne, Germany
| | - Clemens-Martin Wendtner
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital of Cologne, Cologne, Germany; Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Munich, Germany
| | - Thomas Nösslinger
- 3rd Department for Hematology and Oncology, Hanusch Hospital, Vienna, Austria
| | - Paolo Ghia
- Strategic Research Program on CLL, Università Vita-Salute San Raffaele and IRCCS Istituto Scientifico San Raffaele, Milan, Italy
| | - Francesc Bosch
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain; on behalf of the Spanish Group of CLL (GELLC)
| | - Arnon P Kater
- Department of Hematology, Academic Medical Center Amsterdam, University of Amsterdam, Netherlands; on behalf of the Dutch-Belgium HOVON CLL study group
| | - Hartmut Döhner
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Michael Kneba
- Campus Kiel, 2nd Deptartment of Internal Medicine, University of Schleswig-Holstein, Kiel, Germany
| | - Karl-Anton Kreuzer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital of Cologne, Cologne, Germany
| | - Eugen Tausch
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | | | - Matthias Ritgen
- Campus Kiel, 2nd Deptartment of Internal Medicine, University of Schleswig-Holstein, Kiel, Germany
| | - Sebastian Böttcher
- Campus Kiel, 2nd Deptartment of Internal Medicine, University of Schleswig-Holstein, Kiel, Germany; Department of Medicine III-Hematology/Oncology/Palliative Care, Rostock University Medical Center, Rostock, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital of Cologne, Cologne, Germany
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12
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Al-Batran SE, Reichart A, Schoenherr C, zur Hausen G, Pauligk C, Schöttger B, Siegler G, Doerfel S, Aldaoud A, Hahn L, Schubert J, Waidmann O, Trojan J, Hoeffkes HG, Schnell R, Koenigsmann M, Blau W, Uhlig J, Homann N, Götze T. Metastatic pancreatic cancer: Real Life data from the german quality of life and translational research on pancreatic cancer study (QoliXane). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Hausen G, Waidmann O, Woerns M, Hoeffkes H, Doerfel S, Zahn M, Aldaoud A, Stauch M, Springfeld C, Haertel N, Reichart A, Goetze T, Schwarz S, Pauligk C, Roemmler-Zehrer J, Hofheinz R, Al-Batran SE. Nab-paclitaxel/gemcitabine first line therapy in patients with metastatic pancreatic carcinoma and high-bilirubin values - Data from the German QoliXane pancreatic cancer registry. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw371.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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zur Hausen G, Waidmann O, Woerns MA, Hoeffkes HG, Doerfel S, Zahn MO, Aldaoud A, Stauch M, Springfeld C, Haertel N, Reichart A, Pauligk C, Roemmler-Zehrer J, Hofheinz R, Al-Batran SE. Nab-paclitaxel/gemcitabine first-line therapy in patients with metastatic pancreatic carcinoma and high-bilirubin levels: Data from the German QoliXane Pancreatic Cancer Registry. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e15739] [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)
- Gerrit zur Hausen
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| | | | | | | | | | | | - Ali Aldaoud
- Forschungsgemeinschaft Aldaoud/Schwarzer, Leipzig, Germany
| | - Martina Stauch
- Onkologische Schwerpunktpraxis Kronach, Kronach, Germany
| | | | | | - Alexander Reichart
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| | - Claudia Pauligk
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt Am Main, Germany
| | | | | | - Salah-Eddin Al-Batran
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
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15
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Knauf W, Abenhardt W, Aldaoud A, Nusch A, Grugel R, Münz M, Hartmann H, Marschner N, on behalf of the TLN Study Group. Treatment of Non-Transplant Patients with Multiple Myeloma: Routine Treatment by Office-Based Haematologists in Germany - Data from the Prospective Tumour Registry Lymphatic Neoplasms (TLN). Oncol Res Treat 2014; 37:635-6, 638-44. [DOI: 10.1159/000368315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/22/2014] [Indexed: 11/19/2022]
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Binder C, Ziepert M, Pfreundschuh M, Dührsen U, Eimermacher H, Aldaoud A, Rosenwald A, Loeffler M, Schmitz N, Truemper L. CHO(E)P-14 followed by alemtuzumab consolidation in untreated peripheral T cell lymphomas: final analysis of a prospective phase II trial. Ann Hematol 2013; 92:1521-8. [PMID: 23978945 PMCID: PMC3790248 DOI: 10.1007/s00277-013-1880-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 03/19/2013] [Accepted: 08/06/2013] [Indexed: 12/16/2022]
Abstract
The rate of long-term remissions after treatment of peripheral T cell lymphomas (PTCL) with standard CHOP-like protocols is unsatisfactory. A prospective multicenter phase II trial was initiated in untreated patients with PTCL of all International Prognostic Index-risk groups, evaluating alemtuzumab consolidation in patients with complete or good partial remission after CHO(E)P-14 induction. Twenty-nine (70.7 %) of the 41 enrolled patients received alemtuzumab consolidation (133 mg in total). The main grades 3–4 toxicities during alemtuzumab therapy were infections and neutropenia with one potentially treatment-related death. Complete responses were seen in 58.5 %, partial responses in 2.4 % and 29.3 % had progressive disease. After a median observation time of 46 months, 19 patients have died, 16 of them due to lymphoma and/or salvage therapy complications. Event-free and overall survival at 3 years in the whole intent to treat population are 32.3 and 62.5 %, respectively, and 42.4 and 75.1 % in the patients who received alemtuzumab. In conclusion, application of a short course of alemtuzumab after CHO(E)P-14 induction is feasible although complicated by severe infections. A current phase III trial, applying alemtuzumab as part of the initial chemotherapy protocol to avoid early progression, will further clarify its significance for the therapeutic outcome.
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Affiliation(s)
- C Binder
- Department of Haematology and Oncology, Göttingen Comprehensive Cancer Center (G-CCC), Georg-August-University, 37099, Goettingen, Germany
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Knauf WU, Lissitchkov T, Aldaoud A, Liberati AM, Loscertales J, Herbrecht R, Juliusson G, Postner G, Gercheva L, Goranov S, Becker M, Fricke HJ, Huguet F, Del Giudice I, Klein P, Merkle K, Montillo M. Bendamustine compared with chlorambucil in previously untreated patients with chronic lymphocytic leukaemia: updated results of a randomized phase III trial. Br J Haematol 2012; 159:67-77. [DOI: 10.1111/bjh.12000] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 06/15/2012] [Indexed: 11/26/2022]
Affiliation(s)
| | - Toshko Lissitchkov
- Haematology and Transfusion Medicine; National Haematological Centre; Sofia; Bulgaria
| | - Ali Aldaoud
- Praxis für Haematologie and Onkologie; Leipzig; Germany
| | - Anna M. Liberati
- Azienda Ospidaliera Santa Maria di Terni; Universita degli Studi di Perugia; Perugia; Italy
| | | | - Raoul Herbrecht
- Oncology and Haematology; Hopital de Hautepierre; Strasbourg Cedex; France
| | | | - Gerhard Postner
- Franz-Josef-Spital; LBI-ACR and ACR-ITR Vienna; Vienna; Austria
| | - Liana Gercheva
- University Hospital for Active Treatment; Varna; Bulgaria
| | - Stefan Goranov
- University Hospital for Active Treatment “St. George; Plovdiv; Bulgaria
| | - Martin Becker
- Onkologische Schwerpunktpraxis; Porta Westphalika; Germany
| | | | | | - Ilaria Del Giudice
- Division of Haematology, Department of Cellular Biotechnologies and Haematology; Sapienza University; Rome; Italy
| | | | | | - Marco Montillo
- Ematologia e centro trapianti midollo osseo, Ospedale Niguarda Ca'Granda; Milano; Italy
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Ernst J, Kuhnt S, Schwarzer A, Aldaoud A, Niederwieser D, Mantovani-Löffler L, Kuchenbecker D, Schröder C. The desire for shared decision making among patients with solid and hematological cancer. Psychooncology 2011; 20:186-93. [PMID: 20238372 DOI: 10.1002/pon.1723] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jochen Ernst
- Independent Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany.
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Ernst J, Brähler E, Aldaoud A, Schwarzer A, Niederwieser D, Mantovani-Löffler L, Schröder C. Desired and perceived participation in medical decision-making in patients with haemato-oncological diseases. Leuk Res 2010; 34:390-2. [DOI: 10.1016/j.leukres.2009.06.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 06/25/2009] [Accepted: 06/25/2009] [Indexed: 10/20/2022]
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20
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Knauf WU, Lissichkov T, Aldaoud A, Liberati A, Loscertales J, Herbrecht R, Juliusson G, Postner G, Gercheva L, Goranov S, Becker M, Fricke HJ, Huguet F, Del Giudice I, Klein P, Tremmel L, Merkle K, Montillo M. Phase III randomized study of bendamustine compared with chlorambucil in previously untreated patients with chronic lymphocytic leukemia. J Clin Oncol 2009; 27:4378-84. [PMID: 19652068 DOI: 10.1200/jco.2008.20.8389] [Citation(s) in RCA: 307] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This randomized, open-label, parallel-group, multicenter study was designed to compare the efficacy and safety of bendamustine and chlorambucil in previously untreated patients with advanced (Binet stage B or C) chronic lymphocytic leukemia (CLL). PATIENTS AND METHODS Patients (<or= 75 years of age) were randomly assigned to receive bendamustine 100 mg/m(2)/d intravenously on days 1 to 2, or chlorambucil 0.8 mg/kg (Broca's normal weight) orally on days 1 and 15; treatment cycles were repeated every 4 weeks for a maximum of six cycles. The response to treatment was assessed according to National Cancer Institute Working Group criteria, and the final determination of response was made by a blinded independent review committee. RESULTS A total of 319 patients were randomly assigned (162 bendamustine, 157 chlorambucil). Complete or partial responses were achieved in 110 (68%) of 162 bendamustine-treated and 48 (31%) of 157 chlorambucil-treated patients (P < .0001). More patients showed complete responses with bendamustine than with chlorambucil (31% v 2%). Median progression-free survival was 21.6 months with bendamustine and 8.3 months with chlorambucil (P < .0001). Bendamustine was also associated with an improvement in duration of remission, compared with chlorambucil (median, 21.8 v 8.0 months). Hematologic National Cancer Institute Common Toxicity Criteria grade 3 to 4 adverse events were more common with bendamustine than with chlorambucil (occurring in 40% v 19% of patients). Severe infections (grade 3 to 4) occurred in 8% of bendamustine-treated patients and 3% of chlorambucil-treated patients. CONCLUSION Bendamustine offers significantly greater efficacy than chlorambucil, and a manageable toxicity profile, when used as first-line therapy in patients with advanced CLL.
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Affiliation(s)
- Wolfgang U Knauf
- Onkologische Gemeinschaftspraxis, Frankfurter Diakonie Kliniken, Im Pruefling 17-19, 60389 Frankfurt, Germany.
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Ernst J, Schwarz R, Schwarzer A, Aldaoud A, Niederwieser D, Mantovani-Löffler L, Schröder C. [The role of next of kin in medical decision-making--empirical findings from haemato-oncological diseases]. Gesundheitswesen 2009; 71:469-75. [PMID: 19387932 DOI: 10.1055/s-0029-1202327] [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: 10/20/2022]
Abstract
AIM OF THE STUDY Models of shared decision making in the patient-doctor relationship are attracting increasing attention. A recent study focuses on the so far inadequate attention paid to the role of next of kin. It was examined in which decision areas next of kin of haematological cancer patients were included, further what support next of kin could provided and finally which factors encouraged the participation of next of kin in that process. METHODS From 2006-2008 empirical data were collected from hemato-oncological patients undergoing treatment as well as from their families. The participating family members of patients were mailed questionnaires based on the patient sample (designation of a family member by the patient: 118/177 or 66.7%) on average half of a year following the patient's (in- or outpatient) treatment. The response rate of the participants was 67.8% (80/118). Of the respondents, 65% were spouses or partners of the patients, the average age was 53.9 years, and 66.3% were female. RESULTS Family members think it makes sense for them to take an active part in medical decisions affecting their loved ones and a majority of them reported having participated in decision-making processes concerning a variety of issues. Being involved in their loved one's discussions with their doctors has a significant influence on this. Family members' level of education was the only clear predictor for participation in discussions with doctors that could be isolated. CONCLUSION It is clear that family members, especially spouses and partners, consider it meaningful to participate in medical decisions affecting their loved ones, and that they want to be able to do this in the clinical context. One limitation that must be mentioned is that due to the small size of the sample and an approach that focused on initial exploration, the results should be interpreted as a point of orientation. Further studies should look in more detail at how inner family structures play a role in patient-doctor shared decision-making, as well as the concrete conditions and implications that play a role in family members' participation in this process, i.e., adherence to "doctor's orders" and possible decision-making conflicts on the part of the patient.
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Affiliation(s)
- J Ernst
- Universität Leipzig, Medizinische Fakultät, Abteilung Sozialmedizin, Philipp-Rosenthal-Strasse 55, Leipzig.
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Huebner G, Link H, Kohne CH, Stahl M, Kretzschmar A, Steinbach S, Folprecht G, Bernhard H, Al-Batran SE, Schoffski P, Burkart C, Kullmann F, Otremba B, Menges M, Hoffmann M, Kaiser U, Aldaoud A, Jahn A. Paclitaxel and carboplatin vs gemcitabine and vinorelbine in patients with adeno- or undifferentiated carcinoma of unknown primary: a randomised prospective phase II trial. Br J Cancer 2008; 100:44-9. [PMID: 19066607 PMCID: PMC2634671 DOI: 10.1038/sj.bjc.6604818] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [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] [Indexed: 01/04/2023] Open
Abstract
Platinum/taxane combinations are widely used in patients with carcinoma of unknown primary (CUP), yielding response rates of 30% and median overall survival of 9-11 months in selected patients. Yet these combinations have not been subject to a randomised trial to overcome selection bias, a major problem in CUP. We randomised 92 patients to either paclitaxel/carboplatin (arm A) or the non-platinum non-taxane regimen gemcitabine/vinorelbine (arm B). The primary endpoint was rate of practicability as defined: application of >or=2 cycles of therapy (1) with a maximal delay of 1 week (2) and survival of >or=8 months (3). Practicability was shown in 52.4% (95% CI 36-68%) in arm A and in 42.2% (95% CI 28-58%) in arm B, respectively. The median overall survival, 1-year survival -rate and response rate of patients treated in arm A was 11.0 months, 38, and 23.8%, arm B 7.0 months, 29, and 20%. In conclusion, the paclitaxel/carboplatin regimen showed clinically meaningful activity in this randomised trial (Clinical trial registration number 219, 'Deutsches KrebsStudienRegister', German Cancer Society.)
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Affiliation(s)
- G Huebner
- Westpfalz-Klinikum, Hellmut-Hartert-Str 1, 67655 Kaiserslautern, Germany.
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23
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Aldaoud A. Long-term bexarotene monotherapy in large cell CD30+ pleomorphic T-cell lymphoma. Dermatol Clin 2008; 26 Suppl 1:15-17. [PMID: 18405181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Weide R, Hess G, Köppler H, Heymanns J, Thomalla J, Aldaoud A, Losem C, Schmitz S, Haak U, Huber C, Unterhalt M, Hiddemann W, Dreyling M. High anti-lymphoma activity of bendamustine/mitoxantrone/rituximab in rituximab pretreated relapsed or refractory indolent lymphomas and mantle cell lymphomas. A multicenter phase II study of the German Low Grade Lymphoma Study Group (GLSG). Leuk Lymphoma 2007; 48:1299-306. [PMID: 17613757 DOI: 10.1080/10428190701361828] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
On the basis of a preceding phase I study, the current trial explored bendamustine in combination with mitoxantrone and rituximab (BMR) in patients with stage III/IV relapsed or refractory indolent lymphomas and mantle cell lymphoma (MCL) with or without prior rituximab containing chemo-immunotherapy (R-chemo) treatment. Therapy consisted of bendamustine 90 mg/m(2) days 1 + 2, mitoxantrone 10 mg/m(2) day 1, rituximab 375 mg/m(2) day 8. Treatment was repeated on day 29 for a total of four cycles. Between 3 April and 04 July, 57 patients were recruited from 24 participating institutions, 39% of whom had received prior R-chemo therapy. Median age was 66 years (40 - 83). Lymphoma subtypes were 29 follicular (FL), 18 MCL, and 10 other indolent lymphomas. The overall response rate (ORR) was 89% with 35% CR and 54% PR. ORR in R-chemo pretreated patients was 76% (38% CR, 38% PR). After a median observation time of 27 months (1 - 43), the estimated median progression free survival is 19 months. The 2 year overall survival is 60% for patients with FL and MCL. Treatment related toxicities of grade 3/4 comprised a reversible myelosuppression (10% anemia, 78% leukocytopenia, 46% granulocytopenia, 16% thrombocytopenia). However, unexpected hospitalisations were necessary after 4% of BMR-application only. BMR is a very effective new outpatient immuno-chemotherapy with low toxicity for patients with relapsed/refractory FL, MCL and other indolent lymphomas.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/toxicity
- Bendamustine Hydrochloride
- Female
- Humans
- Lymphoma, Follicular/complications
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/mortality
- Lymphoma, Mantle-Cell/drug therapy
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/mortality
- Male
- Middle Aged
- Mitoxantrone/administration & dosage
- Nitrogen Mustard Compounds/administration & dosage
- Remission Induction
- Rituximab
- Salvage Therapy/methods
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- Rudolf Weide
- Praxisklinik for Hematology and Oncology, Koblenz, Germany
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Trumper LH, Hohloch K, Kloess M, Dührsen U, Eimermacher H, Haas A, Aldaoud A, Loeffler M, Schmitz N, Pfreundschuh M, Binder C. CHOP/CHOEP-14 followed by consolidation with alemtuzumab in untreated aggressive T-cell lymphomas (DSHNHL 2003–1): Feasibility and toxicity of a phase II trial of the German High Grade Non-Hodgkin’s Lymphoma Group DSHNHL. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7538 Background: The clinical course of peripheral T-cell lymphomas (PTCL) is unfavourable. Treatment protocols developed for aggressive B-NHL are employed, with significantly worse outcomes. The MoAb alemtuzumab (CAM) has shown promising activity in T-NHL, although its use may be complicated by severe infections. Methods: In 2003, the DSHNHL group initiated a prospective multicenter phase II trial for previously untreated PTCL. Six cycles of either CHOEP-14 (< 60 y) or CHOP-14 (> 60 y) with G-CSF support are followed by a short consolidation course with CAM, when either a CR or a good PR has been achieved. Inclusion criteria: PTCL-NOS, AILD, intestinal T-NHL, anaplastic large cell T-NHL (ALK negative); age 18–70 y; all IPIs; ECOG PS 0–3. The primary endpoint is feasibility, measured by occurrence SAE and protocol adherence. Secondary endpoints are remission rate, TTF, OS, DFS, tumor control and TRM. CAM is given at a total dose of 133 mg over 4 weeks. Prophylaxis against PCP and herpes infections is mandatory during CAM therapy and is continued until CD 4 cells are > 200/μl. CMV-positive patients are monitored weekly. Results: 35 (of the planned 37) pts have been enrolled, 31 are evaluable. 5/31 pts are still undergoing chemotherapy. 7/31 pts had progressive disease or NC under/after chemotherapy and did not receive CAM. 18 of the 19 pts who achieved a CR/PR (15/4) received CAM. 12 of the CAM pts are in continuous CR, 7 had progressive disease or relapsed. There was no treatment-related death. Of 7 registered SAEs, 3 were related to chemotherapy, 4 to CAM (1 fungal pneumonia, 2 CMV pneumonias, 1 bacterial sepsis after dental procedure). Other CAM side effects were: Herpes Zoster (1), CMV-reactivation (1), grade III-IV neutropenias (2). All pts recovered with appropriate treatment. Conclusion: Preliminary analysis demonstrates that the combination of CHO/E/P-14 followed by a short course of CAM consolidation therapy is feasible without TRM. The adverse effects related to infections can be severe but manageable upon careful monitoring and close follow-up. The phase II trial will close in 4/2006, to be followed by a randomized phase III trial of A-CHOP-14 vs CHOP-14. No significant financial relationships to disclose.
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Affiliation(s)
- L. H. Trumper
- University of Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany; University of Essen, Essen, Germany; Cath. Clinic, Hagen, Germany; Ernst von Bergmann Clinic, Potsdam, Germany; Outpatient Clinic, Leipzig, Germany; St. Georg-Hospital, Hamburg, Germany; University of Saarland, Homburg, Germany
| | - K. Hohloch
- University of Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany; University of Essen, Essen, Germany; Cath. Clinic, Hagen, Germany; Ernst von Bergmann Clinic, Potsdam, Germany; Outpatient Clinic, Leipzig, Germany; St. Georg-Hospital, Hamburg, Germany; University of Saarland, Homburg, Germany
| | - M. Kloess
- University of Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany; University of Essen, Essen, Germany; Cath. Clinic, Hagen, Germany; Ernst von Bergmann Clinic, Potsdam, Germany; Outpatient Clinic, Leipzig, Germany; St. Georg-Hospital, Hamburg, Germany; University of Saarland, Homburg, Germany
| | - U. Dührsen
- University of Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany; University of Essen, Essen, Germany; Cath. Clinic, Hagen, Germany; Ernst von Bergmann Clinic, Potsdam, Germany; Outpatient Clinic, Leipzig, Germany; St. Georg-Hospital, Hamburg, Germany; University of Saarland, Homburg, Germany
| | - H. Eimermacher
- University of Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany; University of Essen, Essen, Germany; Cath. Clinic, Hagen, Germany; Ernst von Bergmann Clinic, Potsdam, Germany; Outpatient Clinic, Leipzig, Germany; St. Georg-Hospital, Hamburg, Germany; University of Saarland, Homburg, Germany
| | - A. Haas
- University of Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany; University of Essen, Essen, Germany; Cath. Clinic, Hagen, Germany; Ernst von Bergmann Clinic, Potsdam, Germany; Outpatient Clinic, Leipzig, Germany; St. Georg-Hospital, Hamburg, Germany; University of Saarland, Homburg, Germany
| | - A. Aldaoud
- University of Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany; University of Essen, Essen, Germany; Cath. Clinic, Hagen, Germany; Ernst von Bergmann Clinic, Potsdam, Germany; Outpatient Clinic, Leipzig, Germany; St. Georg-Hospital, Hamburg, Germany; University of Saarland, Homburg, Germany
| | - M. Loeffler
- University of Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany; University of Essen, Essen, Germany; Cath. Clinic, Hagen, Germany; Ernst von Bergmann Clinic, Potsdam, Germany; Outpatient Clinic, Leipzig, Germany; St. Georg-Hospital, Hamburg, Germany; University of Saarland, Homburg, Germany
| | - N. Schmitz
- University of Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany; University of Essen, Essen, Germany; Cath. Clinic, Hagen, Germany; Ernst von Bergmann Clinic, Potsdam, Germany; Outpatient Clinic, Leipzig, Germany; St. Georg-Hospital, Hamburg, Germany; University of Saarland, Homburg, Germany
| | - M. Pfreundschuh
- University of Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany; University of Essen, Essen, Germany; Cath. Clinic, Hagen, Germany; Ernst von Bergmann Clinic, Potsdam, Germany; Outpatient Clinic, Leipzig, Germany; St. Georg-Hospital, Hamburg, Germany; University of Saarland, Homburg, Germany
| | - C. Binder
- University of Goettingen, Goettingen, Germany; University of Leipzig, Leipzig, Germany; University of Essen, Essen, Germany; Cath. Clinic, Hagen, Germany; Ernst von Bergmann Clinic, Potsdam, Germany; Outpatient Clinic, Leipzig, Germany; St. Georg-Hospital, Hamburg, Germany; University of Saarland, Homburg, Germany
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Hiddemann W, Kneba M, Dreyling M, Schmitz N, Lengfelder E, Schmits R, Reiser M, Metzner B, Harder H, Hegewisch-Becker S, Fischer T, Kropff M, Reis HE, Freund M, Wörmann B, Fuchs R, Planker M, Schimke J, Eimermacher H, Trümper L, Aldaoud A, Parwaresch R, Unterhalt M. Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly improves the outcome for patients with advanced-stage follicular lymphoma compared with therapy with CHOP alone: results of a prospective randomized study of the German Low-Grade Lymphoma Study Group. Blood 2005; 106:3725-32. [PMID: 16123223 DOI: 10.1182/blood-2005-01-0016] [Citation(s) in RCA: 994] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Phase 2 studies suggest that the monoclonal antibody rituximab may improve the prognosis of patients with follicular lymphoma (FL) when it is added to chemotherapy. In the current study, 428 patients with untreated, advanced-stage FL were randomly assigned for therapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) alone (n = 205) or CHOP combined with rituximab (R-CHOP) (n = 223). R-CHOP reduced the relative risk for treatment failure by 60% and significantly prolonged the time to treatment failure (P < .001). In addition, a significantly higher overall response rate (96% vs 90%; P = .011) and a prolonged duration of remission (P = .001) were achieved. In spite of a relatively short observation time, these beneficial effects even translated to superior overall survival (P = .016), with 6 deaths in the R-CHOP group compared with 17 deaths in the CHOP group within the first 3 years. The predominant treatment-related adverse effect was myelosuppression. Severe granulocytopenia was more frequently observed after R-CHOP (63% vs 53%; P = .01). However, severe infections were rare and of similar frequency after R-CHOP and CHOP (5% and 7%). Hence, adding rituximab to CHOP significantly improves the outcome for patients with previously untreated advanced-stage FL and does not induce major adverse effects.
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Affiliation(s)
- Wolfgang Hiddemann
- Department of Internal Medicine III, University of Munich, Grosshadern Marchioninistr 15, 81377 München, Germany.
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Weide R, Heymanns J, Thomalla J, Köppler H, Hess G, Aldaoud A, Schmitz S, Unterhalt M, Dreyling MH, Hiddemann W. Bendamustine/mitoxantrone/rituximab (BMR): A very effective and well tolerated immuno-chemotherapy for relapsed and refractory indolent lymphomas. Results of a multicentre phase-II study of the German Low Grade Lymphoma Study Group (GLSG). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6616] [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)
- R. Weide
- Haematology/Oncology Group Practice, Koblenz, Germany; Johannes Gutenberg-University, Mainz, Germany; Haematology/Oncology Group Practice, Leipzig, Germany; Haematology/Oncology Group Practice, Cologne, Germany; Ludwig-Maximilians Univ, Munich, Germany
| | - J. Heymanns
- Haematology/Oncology Group Practice, Koblenz, Germany; Johannes Gutenberg-University, Mainz, Germany; Haematology/Oncology Group Practice, Leipzig, Germany; Haematology/Oncology Group Practice, Cologne, Germany; Ludwig-Maximilians Univ, Munich, Germany
| | - J. Thomalla
- Haematology/Oncology Group Practice, Koblenz, Germany; Johannes Gutenberg-University, Mainz, Germany; Haematology/Oncology Group Practice, Leipzig, Germany; Haematology/Oncology Group Practice, Cologne, Germany; Ludwig-Maximilians Univ, Munich, Germany
| | - H. Köppler
- Haematology/Oncology Group Practice, Koblenz, Germany; Johannes Gutenberg-University, Mainz, Germany; Haematology/Oncology Group Practice, Leipzig, Germany; Haematology/Oncology Group Practice, Cologne, Germany; Ludwig-Maximilians Univ, Munich, Germany
| | - G. Hess
- Haematology/Oncology Group Practice, Koblenz, Germany; Johannes Gutenberg-University, Mainz, Germany; Haematology/Oncology Group Practice, Leipzig, Germany; Haematology/Oncology Group Practice, Cologne, Germany; Ludwig-Maximilians Univ, Munich, Germany
| | - A. Aldaoud
- Haematology/Oncology Group Practice, Koblenz, Germany; Johannes Gutenberg-University, Mainz, Germany; Haematology/Oncology Group Practice, Leipzig, Germany; Haematology/Oncology Group Practice, Cologne, Germany; Ludwig-Maximilians Univ, Munich, Germany
| | - S. Schmitz
- Haematology/Oncology Group Practice, Koblenz, Germany; Johannes Gutenberg-University, Mainz, Germany; Haematology/Oncology Group Practice, Leipzig, Germany; Haematology/Oncology Group Practice, Cologne, Germany; Ludwig-Maximilians Univ, Munich, Germany
| | - M. Unterhalt
- Haematology/Oncology Group Practice, Koblenz, Germany; Johannes Gutenberg-University, Mainz, Germany; Haematology/Oncology Group Practice, Leipzig, Germany; Haematology/Oncology Group Practice, Cologne, Germany; Ludwig-Maximilians Univ, Munich, Germany
| | - M. H. Dreyling
- Haematology/Oncology Group Practice, Koblenz, Germany; Johannes Gutenberg-University, Mainz, Germany; Haematology/Oncology Group Practice, Leipzig, Germany; Haematology/Oncology Group Practice, Cologne, Germany; Ludwig-Maximilians Univ, Munich, Germany
| | - W. Hiddemann
- Haematology/Oncology Group Practice, Koblenz, Germany; Johannes Gutenberg-University, Mainz, Germany; Haematology/Oncology Group Practice, Leipzig, Germany; Haematology/Oncology Group Practice, Cologne, Germany; Ludwig-Maximilians Univ, Munich, Germany
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Lenz G, Dreyling M, Hoster E, Wörmann B, Dührsen U, Metzner B, Eimermacher H, Neubauer A, Wandt H, Steinhauer H, Martin S, Heidemann E, Aldaoud A, Parwaresch R, Hasford J, Unterhalt M, Hiddemann W. Immunochemotherapy with rituximab and cyclophosphamide, doxorubicin, vincristine, and prednisone significantly improves response and time to treatment failure, but not long-term outcome in patients with previously untreated mantle cell lymphoma: results of a prospective randomized trial of the German Low Grade Lymphoma Study Group (GLSG). J Clin Oncol 2005; 23:1984-92. [PMID: 15668467 DOI: 10.1200/jco.2005.08.133] [Citation(s) in RCA: 435] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Mantle cell lymphoma (MCL) is characterized by a poor prognosis with a low to moderate sensitivity to chemotherapy and a median survival of only 3 to 4 years. In an attempt to improve outcome, the German Low Grade Lymphoma Study Group (GLSG) initiated a randomized trial comparing the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) and rituximab (R-CHOP) with CHOP alone as first-line therapy for advanced-stage MCL. PATIENTS AND METHODS One hundred twenty-two previously untreated patients with advanced-stage MCL were randomly assigned to six cycles of CHOP (n = 60) or R-CHOP (n = 62). Patients up to 65 years of age achieving a partial or complete remission underwent a second randomization to either myeloablative radiochemotherapy followed by autologous stem-cell transplantation or interferon alfa maintenance (IFNalpha). All patients older than 65 years received IFNalpha maintenance. RESULTS R-CHOP was significantly superior to CHOP in terms of overall response rate (94% v 75%; P = .0054), complete remission rate (34% v 7%; P = .00024), and time to treatment failure (TTF; median, 21 v 14 months; P = .0131). No differences were observed for progression-free survival. Toxicity was acceptable, with no major differences between the two therapeutic groups. CONCLUSION The combined immunochemotherapy with R-CHOP resulted in a significantly higher response rate and a prolongation of the TTF as compared with chemotherapy alone. Hence, R-CHOP may serve as a new baseline regimen for advanced stage MCL, but needs to be further improved by novel strategies in remission.
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Affiliation(s)
- Georg Lenz
- Department of Internal Medicine III of the Ludwig-Maximilians University, Marchioninistrasse 15, 81377 Munich, Germany
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Dreyling M, Lenz G, Hoster E, Van Hoof A, Gisselbrecht C, Schmits R, Metzner B, Truemper L, Reiser M, Steinhauer H, Boiron JM, Boogaerts MA, Aldaoud A, Silingardi V, Kluin-Nelemans HC, Hasford J, Parwaresch R, Unterhalt M, Hiddemann W. Early consolidation by myeloablative radiochemotherapy followed by autologous stem cell transplantation in first remission significantly prolongs progression-free survival in mantle-cell lymphoma: results of a prospective randomized trial of the European MCL Network. Blood 2004; 105:2677-84. [PMID: 15591112 DOI: 10.1182/blood-2004-10-3883] [Citation(s) in RCA: 403] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mantle-cell lymphoma (MCL) is characterized by poor prognosis with a median survival of only 3 to 4 years. To improve clinical outcome, the European MCL Network initiated a randomized trial comparing consolidation with myeloablative radiochemotherapy followed by autologous stem cell transplantation (ASCT) to alpha-interferon maintenance (IFN alpha) in first remission. Patients 65 years of age or younger with advanced-stage MCL were assigned to ASCT or IFN alpha after achievement of complete or partial remission by a cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)-like induction therapy. According to the International Prognostic Index (IPI), 43% of patients had a low-risk, 41% a low-intermediate, 11% a high-intermediate, and 6% a high-risk profile. Sixty-two of 122 patients proceeded to ASCT and 60 received IFN alpha. Patients in the ASCT arm experienced a significantly longer progression-free survival (PFS) with a median of 39 months compared with 17 months for patients in the IFN alpha arm (P = .0108). The 3-year overall survival (OS) was 83% after ASCT versus 77% in the IFN group (P = .18). Early consolidation by myeloablative radiochemotherapy followed by ASCT is feasible and results in a significant prolongation of PFS in advanced-stage MCL. Longer follow-up is needed to determine the effect on OS.
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Affiliation(s)
- Martin Dreyling
- Department of Internal Medicine III, Ludwig-Maximilians University, Marchioninistrasse 15, 81377 Munich, Germany
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