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Outcomes with Bridging Radiation Therapy Prior to CAR-T Cell Therapy in Pts with Aggressive B Cell Lymphomas. Int J Radiat Oncol Biol Phys 2023; 117:e483-e484. [PMID: 37785529 DOI: 10.1016/j.ijrobp.2023.06.1708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Select patient (pts) with relapsed/refractory aggressive B cell lymphoma may benefit from bridging radiation (bRT) prior to anti-CD19-directed chimeric antigen receptor T cell therapy (CART). Here, we examined pt and treatment factors associated with outcome after bRT and CART. MATERIALS/METHODS We retrospectively reviewed adults with DLBCL who received bRT prior to axicabtagene ciloleucel 11/2017-12/2022. Clinical/treatment characteristics, response, and toxicity were extracted. Progression free survival (PFS), disease specific survival (DSS) and overall survival (OS) were modeled using Kaplan-Meier for events distributed over time, or binary logistic regression for disease response. Fisher's Exact Test or Mann-Whitney U methods were used. RESULTS Among 40 pts, 11 (28%) had limited stage disease at apheresis, and 14 (35%) received bRT in addition to bridging systemic therapy. Thirty-two (80%) pts received bRT post-leukapheresis. bRT was delivered with a median dose of 30 Gy (range: 4-46) in 10 fractions (range: 2-23). Eighteen (45%) pts received <30 Gy. Twenty-two pts (55%) received bRT comprehensively to all sites of disease, including 9 pts who had limited stage. Eleven pts had bulky disease (≥ 10 cm) at the time of bRT. After CART, 4 pts (10%) experienced Grade ≥3 cytokine release syndrome (CRS), 16 (40%) had Grade ≥2 CRS, and 16 (38%) had Grade ≥3 neurotoxicity. Twenty-three pts (57.5%) had CR at 30 days post-CART infusion. Nine had PR (22.5%), of whom 2 pts eventually developed CR at three months and 1 at nine months. Eight pts (20%) had either PD or SD. Of 23 pts who experienced CR, 11 relapsed-6 at three months and 5 at six months. At a median follow up of 9.6 months (95% CI: 6.6-16.2), 22 pts relapsed: 6 (27.3%) in-field, 10 (5.5%) out-of-field, 4 (18.2%) both, and 2 (9.1%) unknown. The median PFS was 8.87 months and median OS was 22 months. PFS at 1 year was 70% (53-82) and at 2 years was 42% (27-57). OS at 1 and 2 years was 72.5% (56-84) and 51% (34-65), respectively. Seventeen pts (42.5%) remain alive at last follow-up, 13 (76.5%) of whom have no evidence of disease (NED). On univariate analysis, OS and PFS at 1 year were 67% (43-83) and 49% (27-68) for those who received RT comprehensively (n = 22), and 41.9% (19-64) and 33.3% (14-54) for those who did not (n = 18; both p≤0.03). Disease bulk (≥10 cm) was associated with significant decrement in DSS (p = 0.03), but not PFS (p = 0.16) or OS (p = 0.24). Among pts treated comprehensively with bRT (n = 22), there was no association of tumor bulk with OS, PFS, or DSS (p>0.2). IPI ≥3 was associated with worse DSS (p = 0.045) and trended towards worse PFS (p = 0.054), but not OS (p = 0.23). There was no difference in PFS, OS, or DSS between pts who received bRT or chemoRT (p>0.3). CONCLUSION bRT and CART is a good treatment strategy for select pts with aggressive B cell lymphoma. When feasible, and with a caveat that other variables influence patient disposition, bRT for CART is associated with improved outcomes after comprehensive RT to all sites of disease.
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Outcomes and Toxicities in Patients with Diffuse Large B-Cell Lymphoma of the Gastrointestinal Tract. Int J Radiat Oncol Biol Phys 2023; 117:e460. [PMID: 37785475 DOI: 10.1016/j.ijrobp.2023.06.1655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Diffuse large B-cell lymphoma (DLBCL) involving the gastrointestinal (GI) tract is rare and long-term outcomes are not well defined. Combined modality therapy (CMT) with radiotherapy (RT) in addition to systemic therapy in this setting is not commonly pursued. We aim to characterize outcomes in patients with GI DLBCL treated with systemic therapy, with or without RT. MATERIALS/METHODS Patients diagnosed with DLBCL of the GI tract (with or without mesenteric involvement) treated at a single institution from 1988-2022 were retrospectively reviewed on an IRB-approved protocol. Clinical and treatment data were collected including adverse events (AE; acute vs late defined as before or 4 weeks after therapy end). Kaplan-Meier and Cox regression models were used to estimate survival. RESULTS Of 207 patients, 62% were male and median age at diagnosis was 63 (IQR 52-73). Gastric involvement was most common (n = 130, 63%), followed by small intestines (n = 48, 23%) and colon/rectum (n = 24, 12%). Most presented with early-stage disease (n = 124, 60%), with a median IPI score of 1. All patients received chemotherapy. Of 182 treated with CHOP/EPOCH, 36 (20%) were treated in the pre-rituximab era while 146 (80%) received rituximab. 66 patients (32%) were treated with RT, 89% as part of first line CMT. 50 cases (76%) received consolidative RT, while 10 (15%) targeted residual gross disease and 4 (6%) targeted distant sites. Median dose and fractionation were 36Gy (IQR 30.6-39.6) in 18 fractions (IQR 17-22). Over half (n = 132, 64%) developed grade 3+ acute chemotherapy AEs, and the most common were anemia (n = 64), febrile neutropenia (n = 40), and neutropenia (n = 20). Grade 3+ late chemotherapy AEs occurred in 14 patients (7%). Acute grade 3+ radiation AEs were uncommon (n = 2, 3%; colitis, emesis). No grade 3+ late radiation AEs were noted. Median follow-up was 46 months (IQR 16-97). 169 (81.6%) had a complete response (CR), with 154 (91%) after first line chemotherapy, 9 (5%) after second line, and 6 (4%) after RT. CR was defined by PET (62%), endoscopy (22%), CT (9%), or other methods (7%). The 5-year progression-free survival for those treated with one line of chemotherapy with or without RT was 95%. Median overall survival (OS) was not reached. Improved OS was associated with early-stage disease (p = 0.003), low IPI (p = 0.001), fewer chemotherapy lines (p<0.001), and CR (p<0.001). OS did not differ by gender, age, immunophenotype, GI site, SUVmax, or RT. Patients with early stage DLBCL treated with RT in the post-rituximab era received fewer chemotherapy cycles compared to those treated without RT (p = 0.02; median of 4 (IQR 3-6) vs 6 cycles (IQR 4-6)), with no OS difference. CONCLUSION GI DLBCL patients have favorable outcomes after CMT with minimal late toxicity. CMT with RT to the GI tract is well tolerated with no OS difference compared to chemotherapy alone, and may mitigate risks from additional chemotherapy cycles for selected early-stage patients.
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Characterization of Lymphopenia during Bridging Radiation Therapy Prior to CAR-T Cell Therapy in Patients with Aggressive B Cell Lymphomas. Int J Radiat Oncol Biol Phys 2023; 117:S53-S54. [PMID: 37784520 DOI: 10.1016/j.ijrobp.2023.06.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Bridging RT (bRT) may be used as a strategy for disease control in patients with relapsed/refractory aggressive B cell lymphoma treated with anti-CD19-directed chimeric antigen receptor T-cell therapy (CART). The correlation of treatment-related lymphopenia with adverse outcomes in patients has been widely documented in several malignancies. Here, we assessed lymphocyte kinetics during bRT and impact on clinical outcome. MATERIALS/METHODS After IRB-approval, records were retrospectively reviewed for adults with DLBCL who received bRT for axicabtagene ciloleucel 11/2017-12/2022. Clinical/treatment characteristics, lab values, and outcomes were extracted. ALC Δ RT was computed by subtracting pre-RT ALC from post-RT ALC count. Survival was modeled using Kaplan-Meier for events distributed over time, or binary logistic regression for disease response. Fisher's Exact Test or Mann-Whitney U methods were used. RESULTS Forty patients met inclusion criteria. Fourteen (35%) received bRT with systemic therapy. Thirty-two (80%) patients received bRT that started post-leukapheresis. bRT was delivered with a median dose of 30 Gy (range: 4-46) in 10 fractions (range: 2-23). Twenty-three patients (57.5%) had CR at 30 days post-CART infusion. Nine had PR (22.5%), and 8 patients (20%) had PD or SD. Median PFS was 8.9 months and median OS was 22 months. The pre-RT ALC mean ± SD was 0.74 ± 0.49 K/µL, and post-RT was 0.43 ± 0.35 K/µL. The absolute ALC Δ RT was 0.31 ± 0.43 K/µL, and ratio post-RT/pre-RT was 0.74 ± 0.64. Stratifying by receipt of bRT alone or with systemic therapy, there was no statistically significant difference in ALC count post-RT (chemoRT: 0.33 ± 0.23 vs. RT: 0.48 ± 0.4, p = 0.2), but there was a lower ALC count pre-RT in the chemoRT group (0.5 ± 0.3 vs. 0.87 ± 0.52 for RT alone, p = 0.02). Post-RT ALC was not significantly associated with CR/PR vs. PD/SD, or with DSS, PFS, or OS. A greater drop in ALC Δ RT trended towards association with improved 90-day response (p = 0.066), without correlation with DSS, OS, or response at 30 days. Median dose per fraction was lower among patients that got pre-leukapheresis RT (2.25 vs. 2.5, p = 0.04), but total dose of bRT or number of fractions was not significantly different. Otherwise, the groups were similar in terms of stage, disease bulk, or comprehensive vs. focal bRT. The average decrease in ALC post-RT for patients who received bRT prior to apheresis was 0.215 K/µL, compared to 0.268 K/µL for patients who received bRT post-apheresis (p = 0.75). Treatment with pre-leukapheresis bRT or ALC Δ RT among these patients were not associated with worse DFS, PFS, or OS (p>0.15). CONCLUSION Post-bRT ALC and reduction in ALC during bRT is not associated with worse treatment response or survival outcomes after CAR-T cell treatment in aggressive B cell lymphoma. Pre-leukapheresis bRT did not appear to substantially impact ALC, and ALC Δ RT among these patients were not associated with worse outcomes.
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Radiotherapy in the Treatment of Primary Cutaneous CD4+ Small/Medium T-Cell Lymphoproliferative Disorder. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hygroscopic growth and CCN activity of secondary organic aerosol produced from dark ozonolysis of γ-terpinene. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 817:153010. [PMID: 35026240 DOI: 10.1016/j.scitotenv.2022.153010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/30/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
The hygroscopic growth factor (GF) and cloud condensation nuclei (CCN) activity of secondary organic aerosol (SOA) particles produced during dark ozonolysis of γ-terpinene under different reaction conditions were investigated. The SOA particles were produced in the presence or absence of cyclohexane, an OH scavenger; 1,3,5-trimethylbenzene, an anthropogenic volatile organic compound; and (NH4)2SO4 seed particles. A hygroscopicity tandem differential mobility analyzer was used to determine the GFs of the SOA particles at RHs ≤ 93%. For some experiments, a CCN counter was used for size-resolved measurement of CCN activation at supersaturation (S) in the range of 0.1 to 1%. The single hygroscopicity parameter κ was derived from both the GF and CCN measurements. Under subsaturated conditions, all the SOA (except those in the presence of the (NH4)2SO4 seeds) showed small GF values. These GFs demonstrated that SOA mass loading affected the GF. A decrease in the SOA mass loading led to increased GF and corresponding κGFvalues. However, in a supersaturation regime, the SOA mass loading and the size of the particles did not significantly alter the CCN activity of the SOA. Our CCN measurements showed higher κCCN values (κCCN = 0.20-0.24) than those observed in most monoterpene ozonolysis studies (κCCN = 0.1-0.14). This difference may have been due to the presence of the two endocyclic double bonds in the γ-terpinene structure, which may have affected the SOA chemical composition, in contrast to monoterpenes that contain an exocyclic double bond. Our comparisons of sub- and supersaturated conditions showed a larger range of κ values than other experiments. Average κCCN/κGF ratios of ~7 and 14 were obtained in the unseeded SOA experiments at low and high SOA mass loadings, respectively. The average κCCN of 0.23 indicated that the SOA produced during ozonolysis of γ-terpinene exhibited fairly high CCN activity.
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Concurrent Radiation Therapy With the Antibody-Drug Conjugates Brentuximab Vedotin and Polatuzumab Vedotin. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Limited Utility of PET-CT and CT Imaging Beyond Treatment Completion in Limited Stage Hodgkin Lymphoma Patients. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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COMBINATION OF IBRUTINIB WITH RITUXIMAB (IR) IS HIGHLY EFFECTIVE IN PREVIOUSLY UNTREATED ELDERLY (>65 YEARS) PATIENTS (PTS) WITH MANTLE CELL LYMPHOMA (MCL) - PHASE II TRIAL. Hematol Oncol 2019. [DOI: 10.1002/hon.11_2629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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PROGNOSTIC VALUE OF PRE-TREATMENT PET SCAN IN PATIENTS WITH FOLLICULAR LYMPHOMA RECEIVING FRONTLINE THERAPY. Hematol Oncol 2019. [DOI: 10.1002/hon.22_2629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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SMART START: RITUXIMAB, LENALIDOMIDE, AND IBRUTINIB ALONE PRIOR TO COMBINATION WITH CHEMOTHERAPY FOR PATIENTS WITH NEWLY DIAGNOSED DIFFUSE LARGE B-CELL LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.48_2629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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CLINICAL IMPLICATIONS OF CYTOPENIAS BEYOND DAY 30 AFTER AXI-CEL THERAPY IN PATIENTS WITH RELAPSED/REFRACTORY LARGE B-CELL LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.120_2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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VERY EARLY FDG PET/CT SCAN MAY PREDICT OUTCOMES IN RELAPSED OR REFRACTORY DLBCL PATIENTS TREATED WITH SALVAGE THERAPY. Hematol Oncol 2019. [DOI: 10.1002/hon.79_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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IBRUTINIB WITH RITUXIMAB (IR) AND SHORT COURSE R-HYPERCVAD/MTX IS VERY EFFICACIOUS IN PREVIOUSLY UNTREATED YOUNG PTS WITH MANTLE CELL LYMPHOMA (MCL). Hematol Oncol 2019. [DOI: 10.1002/hon.12_2629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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COMPREHENSIVE ANALYSIS OF PROGNOSTIC FACTORS, OUTCOMES AND MUTATION PROFILE IN PATIENTS WITH AGGRESSIVE HISTOLOGY (BLASTOID/PLEOMORPHIC) OR TRANSFORMED MANTLE CELL LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.49_2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gastrointestinal: Intragastric balloon: Gastric outlet obstruction or resting in the antrum? J Gastroenterol Hepatol 2019; 34:8. [PMID: 30084128 DOI: 10.1111/jgh.14380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/09/2018] [Indexed: 12/09/2022]
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A4 PERORAL ENDOSCOPIC MYOTOMY IS EFFECTIVE AND SAFE IN NON-ACHALASIA ESOPHAGEAL MOTILITY DISORDERS: AN INTERNATIONAL MULTICENTER STUDY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Adjuvant everolimus in high-risk diffuse large B-cell lymphoma: final results from the PILLAR-2 randomized phase III trial. Ann Oncol 2018; 29:707-714. [DOI: 10.1093/annonc/mdx764] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Radiation-related soft tissue sarcoma in a veterinary technician. Diagn Interv Imaging 2018; 99:181-182. [PMID: 29398573 DOI: 10.1016/j.diii.2017.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 11/27/2022]
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Primary Breast Diffuse Large B-Cell Lymphoma: Treatment Strategies and Patterns of Failure. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Adjuvant Therapy Improves Outcomes in Completely Resected, Limited-Stage Follicular Lymphoma. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Baseline PET-CT Does Not Predict Outcome in Localized, Low Tumor Burden Follicular Lymphoma. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Radiation As an Effective Salvage Therapy for Secondary CNS Lymphoma. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Consolidative Radiation Dose De-escalation in Primary CNS Lymphoma for Patients with an Incomplete Response to Methotrexate Based Chemotherapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Primary Extranodal Follicular Lymphoma: Characteristics, Management, and Outcomes. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Grade 3 Follicular Lymphoma Patients Can Experience Favorable Outcomes With Various Management Strategies. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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IBRUTINIB-RITUXIMAB FOLLOWED BY REDUCED CHEMO-IMMUNOTHERAPY CONSOLIDATION IN YOUNG, NEWLY DIAGNOSED MANTLE CELL LYMPHOMA PATIENTS: a WINDOW OF OPPORTUNITY TO REDUCE CHEMO. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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RITUXIMAB, LENALIDOMIDE, AND IBRUTINIB ALONE AND COMBINED WITH CHEMOTHERAPY FOR PATIENTS WITH NEWLY DIAGNOSED DIFFUSE LARGE B-CELL LYMPHOMA. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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TREATMENT WITH COMBINATION OF LENALIDOMIDE AND RITUXIMAB ACHIEVES DURABLE RESPONSES IN A LONG TERM FOLLOW UP OF PATIENTS WITH INDOLENT NON-HODGKIN'S LYMPHOMA. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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THE IMMUNOLOGIC DOUBLET OF LENALIDOMIDE PLUS OBINUTUZUMAB IS HIGHLY ACTIVE IN RELAPSED/REFRACTORY FOLLICULAR LYMPHOMA, RESULTS OF A PHASE I/II STUDY. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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LENALIDOMIDE AND OBINUTUZUMAB WITH CHOP FOR NEWLY DIAGNOSED DIFFUSE LARGE B-CELL LYMPHOMA: PHASE I/II RESULTS. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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31
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Does Skeletal Presentation Make a Difference in Outcomes of Diffuse Large B-cell Lymphoma? A Review of the 25-Year Experience With Treating Primary Bone Lymphoma. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The Role of Radiation Therapy in the Treatment of Primary Mediastinal B Cell Lymphoma Treated with Rituximab containing Regimens. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Significant Activity of the mTOR Inhibitor Sirolimus and HDAC Inhibitor Vorinostat in Heavily Pretreated Refractory Hodgkin Lymphoma Patients. KLINISCHE PADIATRIE 2014. [DOI: 10.1055/s-0034-1371153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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The Effect of HLA, IL2RA and IL7RA Alleles on the Risk of Multiple Sclerosis in HHV-6 Infected and Uninfected Lebanese Subjects. ACTA ACUST UNITED AC 2014. [DOI: 10.5171/2014.562663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Mid-therapy Positron Emission Tomography Scans Significantly Predict Outcome in Patients With Diffuse Large B-cell Lymphoma (DLBCL) Treated With Chemotherapy Alone But Not When Consolidation Radiation is Added. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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37
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Randomized phase II study of R-CHOP plus enzastaurin versus R-CHOP in the first-line treatment of patients with intermediate- and high-risk diffuse large B-cell lymphoma (DLBCL): Preliminary analysis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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38
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Clinical implications of PET-negative residual disease at the completion of chemotherapy for diffuse large B-cell Lymphoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e18516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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39
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High response rates with lenalidomide plus rituximab for untreated indolent B-cell non-Hodgkin lymphoma, including those meeting GELF criteria. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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40
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Phase II study of RCHOP with pegylated liposomal doxorubicin (DRCOP) for patients older than age 60 with untreated diffuse large B-cell lymphoma (DLBCL). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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41
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Outcomes of HIV-positive lymphoma patients treated in the highly active antiretroviral therapy (HAART) era. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e18528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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42
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Complete response rates with lenalidomide plus rituximab for untreated indolent B-cell non-Hodgkin's lymphoma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8036] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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43
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Diffuse large B-cell lymphoma (DLBCL) with bone marrow (BM) involvement. clinical presentation, central nervous system (CNS) relapses, and outcomes of 121 patients treated at M. D. Anderson Cancer Center. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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44
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Prognosis and treatment of patients with peripheral T-cell lymphoma: The M. D. Anderson Cancer Center experience. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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45
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Rituximab, fludarabine, mitoxantrone, and dexamethasone (R-FND) for patients with relapsed indolent B-cell lymphoma (RIL). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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46
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Clinical features and treatment outcomes of angioimmunoblastic T-cell lymphoma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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47
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Outcome of Patients with Diffuse Large B Cell Lymphoma is Directly Related to Type of Chemotherapy and the use of Radiation. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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48
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A phase I/II trial of pixantrone (BBR2778), methylprednisolone, cisplatin, and cytosine arabinoside (PSHAP) in relapsed/refractory aggressive non-Hodgkin's lymphoma. Leuk Lymphoma 2009; 48:374-80. [PMID: 17325899 DOI: 10.1080/10428190601060496] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of the study was to evaluate the safety, efficacy, and pharmacokinetics of pixantrone (BBR2778) when substituted for etoposide in the ESHAP regimen in patients with aggressive relapsed or refractory non-Hodgkin's lymphoma. Nineteen patients received protocol therapy, consisting of pixantrone 80 mg/m2 over 1 h on day 1, methylprednisolone 500 mg on days 1 - 5, cisplatin 25 mg/m2 on days 1 - 4, and cytarabine 2000 mg/m2 on day 5. Cycles were repeated every 21 days, in the outpatient setting. Dose limiting toxicity, consisting of bone marrow suppression, occurred at the first dose level (80 mg/m2), which was defined as the recommended dose. Grade 3 and 4 toxicities were mainly hematologic. Only one patient had grade 4 febrile neutropenia. No significant decreases in ejection fraction greater than 20% occurred. Overall response rate was 58%, with 37% complete and 21% partial responses. Six of the 11 responders (55%) underwent stem cell transplant. Median time to progression and overall median survival were 5.7 months and 14.5 months, respectively. There is no significant interaction between pixantrone and the combined drugs. The recommended dose of pixantrone in combination with methylprednisolone, cytarabine, and cisplatin (PSHAP) is 80 mg/m2. PSHAP is an active salvage regimen and should be further evaluated as a pretransplant cytoreductive regimen.
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MESH Headings
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/pharmacokinetics
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cisplatin/administration & dosage
- Cytarabine/administration & dosage
- Female
- Humans
- Isoquinolines/administration & dosage
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/pathology
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/metabolism
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Methylprednisolone/administration & dosage
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/metabolism
- Prospective Studies
- Remission Induction
- Salvage Therapy
- Treatment Outcome
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Abstract
8548 Background: Despite advances in therapy and a better understanding of the natural history of indolent non-Hodgkins lymphomas (NHL), the optimal treatment for newly diagnosed patients (pts) has not been determined. While several combination chemotherapy regimens have response rates approaching 90%, toxicity is common with genotoxic drugs and secondary malignancies is a concern. Lenalidomide has been shown to have single agent activity in indolent NHL, and is approved for the treatment of multiple myeloma and myelodysplastic syndrome. Rituximab is effective as a single agent and in combination with chemotherapy for indolent NHL. The aim of this phase II, single arm study is to evaluate the efficacy and safety of lenalidomide and rituximab in pts with untreated, stage III, or IV indolent NHL. Methods: Pts with indolent NHL who were previously untreated, with measurable disease (>1.5 cm), were eligible for enrollment. Pts received 20mg of lenalidomide orally once daily on days 1–21 and rituximab 375mg/m2 intravenously on day 1 of each 28 day cycle. Pts could receive up to 6 cycles of therapy. Response was assessed after 3 cycles and at the end of therapy using the International Working Group Response Criteria. Results: At time of this report 17 pts have been enrolled and 14 are eligible for safety evaluation. The median age was 55 (33–77) years and 53% were male. Therapy was well tolerated with the following grade 3 adverse events (AE) reported; myalgia (1 pt), rash (1 pt), peripheral neuropathy (1pt). There were no grade 4 AEs. There have been no reported grade 3/4 hematologic AEs. There has been no tumor flare observed. In the 5 pts eligible for response assessment, 4 pts (80%) attained a complete response (CR), 1 patient (20%) had stable disease (SD). After 3 cycles, one patient had unconfirmed stable disease who also was previously treated with combination chemotherapy for Hodgkin's lymphoma. Updates for response will be presented. Conclusions: The combination of lenalidomide and rituximab has activity and is well tolerated with minimal toxicity in patients with newly diagnosed indolent lymphoma. [Table: see text]
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50
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Prospective trial of targeted radioimmunotherapy with Y-90 ibritumomab tiuxetan (Zevalin) for front-line treatment of early-stage extranodal indolent ocular adnexal lymphoma. Ann Oncol 2009; 20:709-14. [DOI: 10.1093/annonc/mdn692] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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