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Karakatsanis SJ, Bouzani M, Symeonidis A, Angelopoulou MK, Papageorgiou SG, Michail M, Gainaru G, Kourti G, Sachanas S, Kalpadakis C, Katodritou E, Leonidopoulou T, Kotsianidis I, Hatzimichael E, Kotsopoulou M, Dimou M, Variamis E, Boutsis D, Kanellias N, Dimopoulou MN, Michali E, Karianakis G, Tsirkinidis P, Vadikolia C, Poziopoulos C, Pigaditou A, Vrakidou E, Economopoulos T, Kyriazopoulou L, Siakantaris MP, Kyrtsonis MC, Anargyrou K, Papaioannou M, Hatjiharissi E, Vervessou E, Tsirogianni M, Palassopoulou M, Stefanoudaki E, Zikos P, Tsirigotis P, Tsourouflis G, Assimakopoulou T, Verrou E, Papadaki H, Lampropoulou P, Dimopoulos MA, Pappa V, Konstantopoulos K, Karmiris T, Roussou P, Panayiotidis P, Pangalis GA, Vassilakopoulos TP. Real-life Experience With Rituximab-CHOP Every 21 or 14 Days in Primary Mediastinal Large B-cell Lymphoma. In Vivo 2022; 36:1302-1315. [PMID: 35478115 DOI: 10.21873/invivo.12831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Primary mediastinal large B-cell lymphoma (PMLBCL) is an aggressive B-cell non-Hodgkin lymphoma (NHL), whose prognosis has greatly improved since the incorporation of the anti-CD20 monoclonal antibody rituximab into current therapeutic regimens. Evidence, however, on the optimal time interval between consecutive chemoimmunotherapy (CIT) cycles is still scarce. This study aimed to evaluate the efficacy outcomes of the more commonly administered 3-weekly regimens to the biweekly ones in a PMLBCL patients' population, who were mostly treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone every 21 days (R-CHOP-21) or R-CHOP-14. PATIENTS AND METHODS We retrospectively studied our cohort of consecutively treated PMLBCL patients, focusing on their treatment density, in order to determine possible differences in treatment outcomes. RESULTS CIT, in the form of both R-CHOP-21 as well as R-CHOP-14 (or similar regimens), is highly active in PMLBCL, with low rates of early treatment failure. In our cohort of patients, R-CHOP-14 did not result in a meaningful improvement of freedom from progression (FFP) or overall survival (OS). CONCLUSION Both R-CHOP-14 and R-CHOP-21 are probably equally effective in PMLBCL, yet further, prospective, randomized studies are warranted to clarify whether dose-dense regimens can be associated with better disease control and long-term results.
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Affiliation(s)
- Stamatis J Karakatsanis
- Third Department of Internal Medicine and Laboratory, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - Maria Bouzani
- Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Argyris Symeonidis
- Hematology Division, Department of Internal Medicine, University of Patras, Patras, Greece
| | - Maria K Angelopoulou
- Department of Haematology and Bone Marrow Transplantation,Laikon General Hospital, Athens, Greece
| | - Sotirios G Papageorgiou
- Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Chaidari, Greece
| | - Michail Michail
- Department of Hematology, Nicosia General Hospital, Nicosia, Cyprus
| | | | - Georgia Kourti
- Third Department of Internal Medicine and Laboratory, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece.,Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | | | | | - Eirini Katodritou
- Department of Hematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece
| | | | - Ioannis Kotsianidis
- Department of Hematology, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Maria Kotsopoulou
- Department of Hematology, Metaxa Anticancer Hospital, Piraeus, Greece
| | - Maria Dimou
- Department of Haematology and Bone Marrow Transplantation,Laikon General Hospital, Athens, Greece
| | - Eleni Variamis
- First Department of Internal Medicine,Laikon General Hospital, Athens, Greece
| | | | - Nick Kanellias
- Department of Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Maria N Dimopoulou
- Department of Haematology and Bone Marrow Transplantation,Laikon General Hospital, Athens, Greece
| | - Evridiki Michali
- Department of Clinical Hematology, G.Gennimatas Athens General Hospital, Athens, Greece
| | | | | | | | | | - Anna Pigaditou
- Department of Hematology, Athens Medical Center, Marousi, Greece
| | | | | | - Lydia Kyriazopoulou
- Department of Hematology, University of Ioannina, Medical School, Ioannina, Greece
| | - Marina P Siakantaris
- Department of Haematology and Bone Marrow Transplantation,Laikon General Hospital, Athens, Greece
| | | | | | - Maria Papaioannou
- Hematology Unit, 1 Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evdoxia Hatjiharissi
- Department of Hematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece.,Hematology Unit, 1 Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Maria Tsirogianni
- Department of Hematology, Aghios Savvas Anticancer Hospital, Athens, Greece
| | | | | | | | - Panayiotis Tsirigotis
- Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Chaidari, Greece
| | | | | | - Evgenia Verrou
- Department of Hematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece
| | - Helen Papadaki
- Department of Hematology,University Hospital of Heraklion, Heraklion, Greece
| | | | | | - Vassiliki Pappa
- Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Chaidari, Greece
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation,Laikon General Hospital, Athens, Greece
| | - Themis Karmiris
- Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Paraskevi Roussou
- Third Department of Internal Medicine and Laboratory, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - Panayiotis Panayiotidis
- Department of Haematology and Bone Marrow Transplantation,Laikon General Hospital, Athens, Greece
| | - Gerassimos A Pangalis
- Department of Haematology and Bone Marrow Transplantation,Laikon General Hospital, Athens, Greece.,Department of Hematology, Athens Medical Center, Psychikon, Greece
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Vassilakopoulos TP, Michail M, Papageorgiou S, Kourti G, Angelopoulou MK, Panitsas F, Sachanas S, Kalpadakis C, Katodritou E, Leonidopoulou T, Kotsianidis I, Hatzimichael E, Kotsopoulou M, Dimou M, Variamis E, Boutsis D, Terpos E, Dimopoulou MN, Karakatsanis S, Michalis E, Karianakis G, Tsirkinidis P, Vadikolia C, Poziopoulos C, Pigaditou A, Vrakidou E, Economopoulos T, Kyriazopoulou L, Siakantaris MP, Kyrtsonis MC, Symeonidis A, Anargyrou K, Papaioannou M, Hatjiharissi E, Vervessou E, Tsirogianni M, Palassopoulou M, Gainaru G, Stefanoudaki E, Zikos P, Tsirigotis P, Tsourouflis G, Assimakopoulou T, Konstantinidou P, A Papadaki H, Megalakaki K, Dimopoulos MA, Pappa V, Karmiris T, Roussou P, Panayiotidis P, Konstantopoulos K, Pangalis GA. Identification of Very Low-Risk Subgroups of Patients with Primary Mediastinal Large B-Cell Lymphoma Treated with R-CHOP. Oncologist 2021; 26:597-609. [PMID: 33870594 DOI: 10.1002/onco.13789] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 04/02/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND R-CHOP can cure approximately 75% of patients with primary mediastinal large B-cell lymphoma (PMLBCL), but prognostic factors have not been sufficiently evaluated yet. R-da- EPOCH is potentially more effective but also more toxic than R-CHOP. Reliable prognostic classification is needed to guide treatment decisions. MATERIALS AND METHODS We analyzed the impact of clinical prognostic factors on the outcome of 332 PMLBCL patients ≤65 years treated with R-CHOP ± radiotherapy in a multicenter setting in Greece and Cyprus. RESULTS With a median follow-up of 69 months, 5-year freedom from progression (FFP) was 78% and 5-year lymphoma specific survival (LSS) was 89%. On multivariate analysis, extranodal involvement (E/IV) and lactate dehydrogenase (LDH) ≥2 times upper limit of normal (model A) were significantly associated with FFP; E/IV and bulky disease (model B) were associated with LSS. Both models performed better than the International Prognostic Index (IPI) and the age-adjusted IPI by Harrel's C rank parameter and Akaike information criterion. Both models A and B defined high-risk subgroups (13%-27% of patients [pts]) with approximately 19%-23% lymphoma-related mortality. They also defined subgroups composing approximately one-fourth or one-half of the patients, with 11% risk of failure and only 1% or 4% 5-year lymphoma-related mortality. CONCLUSION The combination of E/IV with either bulky disease or LDH ≥2 times upper limit of normal defined high-risk but not very-high-risk subgroups. More importantly, their absence defined subgroups comprising approximately one-fourth or one-half of the pts, with 11% risk of failure and minimal lymphoma-related mortality, who may not need more intensive treatment such as R-da-EPOCH. IMPLICATIONS FOR PRACTICE By analyzing the impact of baseline clinical characteristics on outcomes of a large cohort of patients with primary mediastinal large B-cell lymphoma homogeneously treated with R-CHOP with or without radiotherapy, we developed novel prognostic indices which can aid in deciding which patients can be adequately treated with R-CHOP and do not need more intensive regimens such as R-da-EPOCH. The new indices consist of objectively determined characteristics (extranodal disease or stage IV, bulky disease, and markedly elevated serum lactate dehydrogenase), which are readily available from standard initial staging procedures and offer better discrimination compared with established risk scores (International Prognostic Index [IPI] and age-adjusted IPI).
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Affiliation(s)
- Theodoros P Vassilakopoulos
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Michail Michail
- Department of Hematology, Nicosia General Hospital, Nicosia, Cyprus
| | - Sotirios Papageorgiou
- Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Georgia Kourti
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece.,Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Maria K Angelopoulou
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Fotios Panitsas
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Sotirios Sachanas
- Department of Hematology, Athens Medical Center, Psychikon Branch, Athens, Greece
| | | | - Eirini Katodritou
- Department of Hematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece
| | | | - Ioannis Kotsianidis
- Department of Hematology, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Maria Kotsopoulou
- Department of Hematology, Metaxa Anticancer Hospital, Piraeus, Greece
| | - Maria Dimou
- First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Eleni Variamis
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | - Evangelos Terpos
- Department of Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Maria N Dimopoulou
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Stamatios Karakatsanis
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Eurydiki Michalis
- Department of Clinical Hematology, "G.Gennimatas" Athens General Hospital, Athens, Greece
| | | | | | | | | | - Anna Pigaditou
- Department of Hematology, Athens Medical Center, Amaroussion Branch, Athens, Greece
| | | | | | | | - Marina P Siakantaris
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Marie-Christine Kyrtsonis
- First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Argyris Symeonidis
- Hematology Division, Dept of Internal Medicine, University of Patras, Patras, Greece
| | | | - Maria Papaioannou
- Hematology Unit, 1st Dept of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evdoxia Hatjiharissi
- Department of Hematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece.,Hematology Unit, 1st Dept of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Maria Tsirogianni
- Department of Hematology, Aghios Savvas Anticancer Hospital, Athens, Greece
| | | | | | | | | | - Panayiotis Tsirigotis
- Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Gerasimos Tsourouflis
- Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | | | - Helen A Papadaki
- Department of Hematology, University of Crete, Iraklion, Crete, Greece
| | | | | | - Vassiliki Pappa
- Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Themis Karmiris
- Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Paraskevi Roussou
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Panayiotis Panayiotidis
- First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Kostas Konstantopoulos
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Gerassimos A Pangalis
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.,Department of Hematology, Athens Medical Center, Psychikon Branch, Athens, Greece
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Vassilakopoulos T, Papageorgiou S, Michail M, Angelopoulou M, Kourti G, Kalpadakis C, Kotsopoulou M, Leonidopoulou T, Konstantinidou P, Kotsianidis I, Boutsis D, Michali E, Sachanas S, Terpos E, Karianakis G, Poziopoulos C, Vadikolia C, Pigaditou A, Vrakidou E, Anargyrou K, Symeonidis A, Stefanoudaki E, Hadjiharissi E, Papaioannou M, Gainaru G, Tsirogianni M, Katodritou E, Karmiris T, Variami E, Pappa V, Dimopoulos M, Roussou P, Panayitidis P, Konstantopoulos K, Pangalis G. PROGNOSTIC FACTORS (PFs) IN PRIMARY MEDIASTINAL LARGE B-CELL LYMPHOMA (PMLBCL) TREATED WITH RITUXIMAB-CHOP (RCHOP) ± RADIOTHERAPY (RT). Hematol Oncol 2019. [DOI: 10.1002/hon.76_2630] [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: 11/10/2022]
Affiliation(s)
- T.P. Vassilakopoulos
- Dept of Haematology; National & Kapodistrian University of Athens; Athens Greece
| | - S.G. Papageorgiou
- 2nd Department of Internal Medicine and Research Institute; University General Hospital "Attikon"; Haidari Greece
| | - M. Michail
- Hematology; General Hospital of Nicosia; Nicosia Cyprus
| | - M.K. Angelopoulou
- Dept of Haematology; National & Kapodistrian University of Athens; Athens Greece
| | - G. Kourti
- 3rd Dept of Internal Medicine; National and Kapodistrian University of Athens; Athens Greece
| | - C. Kalpadakis
- Dept of Haematology; University of Crete; Heraclion Crete Greece
| | - M. Kotsopoulou
- Dept of Haematology; Metaxa Anticancer Hospital; Piraeus Greece
| | | | - P. Konstantinidou
- Dept of Haematology; Theagenion Anticancer Hospital; Thessaloniki Greece
| | - I. Kotsianidis
- Dept of Haematology; Democritus University of Thrace; Alexandroupolis Greece
| | - D. Boutsis
- Dept of Haematology; Navy Hospital Athens; Athens Greece
| | - E. Michali
- Dept of Haematology; Athens General Hospital, “Gennimatas; Athens Greece
| | - S. Sachanas
- Dept of Haematology; Athens Medical Center, Psychikon Branch; Athens Greece
| | - E. Terpos
- Dept of Therapeutics; National and Kapodistrian University of Athens; Athens Greece
| | | | - C. Poziopoulos
- Dept of Haematology; Metropolitan Hospital; Piraeus Greece
| | - C. Vadikolia
- Dept of Haematology; 424 Army Hospital; Thessaloniki Greece
| | - A. Pigaditou
- Dept of Haematology; Athens Medical Center; Marousi Greece
| | - E. Vrakidou
- Dept of Haematology; HyGEIA Hospital; Athens Greece
| | - K. Anargyrou
- Dept of Haematology; 251 Air Force Hospital; Athens Greece
| | - A. Symeonidis
- Dept of Haematology; University of Patras; Patras Greece
| | | | - E. Hadjiharissi
- 1st Dept of Internal Medicine; AHEPA University Hospital; Thessaloniki Greece
| | - M. Papaioannou
- 1st Dept of Internal Medicine; AHEPA University Hospital; Thessaloniki Greece
| | - G. Gainaru
- Dept of Haematology; HYGEIA Hospital; Athens Greece
| | - M. Tsirogianni
- Dept of Haematology; AGIOS SAVVAS Anticancer Hospital; Athens Greece
| | - E. Katodritou
- Dept of Haematology; Theagenion Anticancer Hospital; Thessaloniki Greece
| | - T. Karmiris
- Dept of Haematology; Evangelismos Hospital; Athens Greece
| | - E. Variami
- 1st Dept of Internal Medicine; National & Kapodistrian University of Athens; Athens Greece
| | - V. Pappa
- 2nd Department of Internal Medicine and Research Institute; University General Hospital "Attikon"; Haidari Greece
| | - M. Dimopoulos
- Dept of Therapeutics; National and Kapodistrian University of Athens; Athens Greece
| | - P. Roussou
- 3rd Dept of Internal Medicine; National and Kapodistrian University of Athens; Athens Greece
| | - P. Panayitidis
- 1st Propedeutic Dept of Internal Medicine; National & Kapodistrian University of Athens; Athens Greece
| | - K. Konstantopoulos
- Dept of Haematology; National & Kapodistrian University of Athens; Athens Greece
| | - G.A. Pangalis
- Dept of Haematology; Athens Medical Center, Psychikon Branch; Athens Greece
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Katodritou E, Terpos E, Symeonidis AS, Pouli A, Kelaidi C, Kyrtsonis MC, Kotsopoulou M, Delimpasi S, Christoforidou A, Giannakoulas N, Viniou NA, Stefanoudaki E, Hadjiaggelidou C, Christoulas D, Verrou E, Gastari V, Papadaki S, Polychronidou G, Papadopoulou A, Giannopoulou E, Kastritis E, Kouraklis A, Konstantinidou P, Anagnostopoulos A, Zervas K, Dimopoulos MA. Clinical features, outcome, and prognostic factors for survival and evolution to multiple myeloma of solitary plasmacytomas: a report of the Greek myeloma study group in 97 patients. Am J Hematol 2014; 89:803-8. [PMID: 24757085 DOI: 10.1002/ajh.23745] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/19/2014] [Accepted: 04/21/2014] [Indexed: 12/22/2022]
Abstract
Solitary plasmacytoma (SP) is a rare plasma cell dyscrasia characterized by the presence of bone or extramedullary plasma cell tumors. The treatment of choice is local radiotherapy (R/T) ± surgical excision. The role of adjuvant chemotherapy (C/T) or novel agents (NA) is uncertain. Data related to prognostic factors are inconclusive. Herein, we describe the clinical features, survival and prognosis of 97 consecutive patients, 65 with bone SP (SBP), and 32 with extramedullary SP (SEP), diagnosed and treated in 12 Greek Myeloma Centers. Objective response rate (≥PR) and complete response (CR) was 91.8% and 61.9%, respectively, and did not differ between the 2 groups. Overall, 38 patients relapsed or progressed to multiple myeloma (MM). After a median follow-up of 60 months, 5 and 10-year overall survival (OS) probability was 92% and 89% in SEP and 86% and 69% in SBP, respectively (P = 0.2). The 5- and 10-year MM-free survival (MMFS) probability was 90% and 70% for patients with SEP vs. 59% and 50% for patients with SBP, respectively (P = 0.054). Overall, the 5- and 10-year OS probability, plasmacytoma relapse-free survival (PRFS), progression-free survival and MMFS was 84% and 78%, 72% and 58%, 58% and 43%, and 70% and 59%, respectively. In the multivariate analysis, prolonged PRFS and young age were positive predictors of OS. Achievement of CR was the only positive predictor of PRFS. Immunoparesis was the only negative predictor of progression to MM. The addition of C/T or NA-based treatment increased toxicity without offering any survival advantage over R/T.
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Dimopoulos MA, Kastritis E, Delimpasi S, Katodritou E, Hatzimichael E, Kyrtsonis MC, Repousis P, Tsirogianni M, Kartasis Z, Parcharidou A, Michael M, Michalis E, Tsatalas C, Stefanoudaki E, Hatjiharissi E, Gika D, Symeonidis A, Terpos E, Zervas K. Multiple myeloma in octogenarians: clinical features and outcome in the novel agent era. Eur J Haematol 2012; 89:10-5. [PMID: 22469521 DOI: 10.1111/j.1600-0609.2012.01784.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Multiple myeloma (MM) affects mainly elderly persons and because the population of octogenarians increases, it is common to treat patients ≥ 80 years of age. These patients are often not included in clinical trials; thus, there is limited data on their characteristics and treatment outcome. PATIENTS AND METHODS We retrospectively analyzed 682 consecutive, unselected patients with newly diagnosed symptomatic myeloma who started treatment between January 1, 2003 and December 31, 2010. RESULTS We identified 155 (23%) patients ≥ 80 years of age. Compared to patients <80 years, octogenarians had poorer performance status (P < 0.001), anemia (P = 0.006), low serum albumin (P = 0.001), and advanced ISS (P < 0.001). The median survival of patients ≥ 80 years was 22 months, and 14% died within 2 months from therapy initiation. The median survival of patients ≥ 80 years who received upfront novel agents was 26 vs. 17 months for those who did not. ECOG performance status ≤ 1 and frontline use of novel agents were independently associated with better survival. Response to first-line therapy was associated with improved survival (29 vs. 16 months, P = 0.017). CONCLUSIONS Patients ≥ 80 years of age present with features of advanced myeloma and impaired performance status. The addition of novel agents may improve their outcome, but careful assessment and prospective clinical trials targeting the population of elderly patients are needed.
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Affiliation(s)
- Meletios A Dimopoulos
- Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece.
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7
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Kastritis E, Kyrtsonis MC, Hatjiharissi E, Symeonidis A, Michalis E, Repoussis P, Tsatalas K, Michael M, Sioni A, Kartasis Z, Stefanoudaki E, Voulgarelis M, Delimpasi S, Gavriatopoulou M, Koulieris E, Gika D, Vervesou E, Konstantopoulos K, Kokkini G, Zomas A, Roussou P, Anagnostopoulos N, Economopoulos T, Terpos E, Zervas K, Dimopoulos MA. No significant improvement in the outcome of patients with Waldenström's macroglobulinemia treated over the last 25 years. Am J Hematol 2011; 86:479-83. [PMID: 21509798 DOI: 10.1002/ajh.22027] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Revised: 02/28/2011] [Accepted: 03/01/2011] [Indexed: 11/07/2022]
Abstract
The treatment of Waldenström's macroglobulinemia (WM) has changed over the last decades, mainly because of the introduction of nucleoside analogues and of rituximab while novel agents such as bortezomib have been recently introduced. We performed an analysis to investigate whether the outcome of patients with WM has improved over the last years, compared to that of patients who started treatment before new drugs became widely available, especially as part of the frontline treatment. We analyzed 345 symptomatic patients with WM: 130 who initiated treatment before and 215 who started treatment after January 1, 2000. Patients who started treatment in the latter group were older and had more often elevated beta2-microglobulin but the other characteristics were similar between the two groups. Most patients who started treatment before January 1, 2000 were treated upfront with alkylating agent-based regimens and most patients who started treatment after January 1, 2000 received rituximab-based regimens as initial treatment. Objective response (63 and 59%, respectively) and median overall survival, OS, (106.5 months for Group A and is estimated at 94 months for Group B, P = 0.327) were similar. There was also no difference regarding OS or cause specific survival (CSS) in each risk group according to IPSSWM. Our observation may be explained by the indolent course of WM in several patients and by the lack of profound cytoreduction in patients with high-risk disease. Possible differences in the 15- or 20-year survival rate between the two groups may be detected with further follow-up of these patients.
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Affiliation(s)
- Efstathios Kastritis
- Department of Clinical Therapeutics, University of Athens School of Medicine, 80 Vas Sofias Ave. 115 28, Athens, Greece
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Terpos E, Anargyrou K, Katodritou E, Kastritis E, Papatheodorou A, Christoulas D, Pouli A, Michalis E, Delimpasi S, Gkotzamanidou M, Nikitas N, Koumoustiotis V, Margaritis D, Tsionos K, Stefanoudaki E, Meletis J, Zervas K, Dimopoulos MA. Circulating angiopoietin-1 to angiopoietin-2 ratio is an independent prognostic factor for survival in newly diagnosed patients with multiple myeloma who received therapy with novel antimyeloma agents. Int J Cancer 2011; 130:735-42. [DOI: 10.1002/ijc.26062] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 02/04/2011] [Indexed: 01/24/2023]
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Kastritis E, Gavriatopoulou M, Kyrtsonis MC, Michael M, Hadjiharissi E, Symeonidis A, Michalis E, Repoussis P, Tsatalas K, Sioni A, Kartasis Z, Stefanoudaki E, Voulgarelis M, Delimpasi S, Gika D, Vervesou E, Konstantopoulos K, Kokkini G, Zomas A, Roussou P, Anagnostopoulos N, Economopoulos T, Terpos E, Zervas K, Dimopoulos MA. Prognostication of the high-risk WM patient. Clin Lymphoma Myeloma Leuk 2011; 11:127-9. [PMID: 21454212 DOI: 10.3816/clml.2011.n.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Waldenström's macroglobulinemia is characterized by a protracted course in most patients and the median survival may be long. However, a subset of patients may present with more aggressive disease that is associated with short survival. In order to better characterize these "poor-risk" patients, we identified patients who died within 2 years from the initiation of front-line treatment. These patients were older and had more often features of aggressive disease, such as elevated LDH and low serum albumin than the standard-risk population. Furthermore, only a minority of poor-risk patient had a response to initial therapy. However, conventional clinical factors or even the lack on response could not adequately identify poor-risk patients, indicating the need for novel molecular or other markers that would be able to effectively recognize patients at greatest need for aggressive therapies.
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