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Martelli M, Zucca E, Botto B, Kryachok I, Ceriani L, Balzarotti M, Tucci A, Cabras MG, Zilioli VR, Rusconi C, Angrilli F, Arcaini L, Iwanicka AD, Ferreri A, Merli F, Zhao W, Hodgson D, Ionescu C, Fosså A, Cwynarski K, Mikhaeel G, Jerkeman M, Janikova A, Hüttmann A, Ciccone G, Metser U, Barrington S, Malkowski B, Versari A, Esposito F, Cozens K, Ielmini N, Ricardi R, Cavalli F, Johnson P, Davies A. IMPACT OF DIFFERENT INDUCTION REGIMENS ON THE OUTCOME OF PRIMARY MEDIASTINAL B CELL LYMPHOMA IN THE PROSPECTIVE IELSG 37 TRIAL. Hematol Oncol 2021. [DOI: 10.1002/hon.49_2879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Santi RM, Ceccarelli M, Catania G, Monagheddu C, Evangelista A, Bernocco E, Monaco F, Federico M, Vitolo U, Cortelazzo S, Cabras MG, Spina M, Baldini L, Boccomini C, Chiappella A, Bari A, Luminari S, Calabrese M, Levis A, Visco C, Contino L, Ciccone G, Ladetto M. PO-03 - Khorana score and histotype predict the incidence of early venous thromboembolism (VTE) in Non Hodgkin Lymphoma (NHL). A pooled data analysis of twelve clinical trials of Fondazione Italiana Linfomi (FIL). Thromb Res 2016; 140 Suppl 1:S177. [PMID: 27161692 DOI: 10.1016/s0049-3848(16)30136-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recent studies show that the risk of VTE in NHL pts is similar to that observed in high risk solid tumors (i.e. pancreatic, ovarian cancer). VTE in NHL occurs in most cases within three months from diagnosis and can have substantial impact on treatment delivery and outcome as well as on quality of life. However few data are available on potential predictors. AIMS To better clarify the epidemiology of early (within six months from treatment start) VTE in NHL we conducted a pooled data analysis of 12 clinical trials from FIL. Our analysis included basic demographic features, lymphoma-related characteristics as well the Khorana score (based on histology, BMI, platelets WBC and HB counts) which is extensively used in solid tumors to predict VTE risk. PATIENTS AND METHODS From Jan. 2010 to Dec. 2014, all pts with B-cell NHL enrolled in prospective clinical trials from FIL for frontline treatment were included. For 9 studies study period included the entire trial population was included. The analyses were conducted based on CRFs as well as pharmacovigilance reports. VTE definition and grading was stated according to standard criteria of toxicity (CTCAE V4.0). Cumulative incidence of VTE from the study enrollment was estimated using the method described by Gooley et al. accounting for death from any causes as a competing risk. The Fine & Gray survival model was used to identify predictors of VTE among NHL pts. Factors predicting the grade of VTE were investigated using an ordinal logistic regression model. This pooled data analysis was approved by local IRB. RESULTS Overall, 1,717 patients belonging to 12 studies were evaluated. Eight were phase I/II or II (25% of pts) and 4 phase III (75% of pts). M/F ratio was 1.41, Median age was 57, (IQ range (IQR) 49-66). Histologies were: DLCL-B 34%, FL 41%, MCL 18%, other 6%. Median BMI was 25 (IQR 22-28). Median Hb, WBC and platelets counts were 13g/dl) (IQR 11.5-14.2), 7.1*10^(9)/l (IQR 5.6-10.3), 224*10^(9)/l (IQR 169-298), respectively. 1189 pts were evaluable Khorana score: 58% low risk, 30% intermediate risk, 12% were high risk. Human erythropoetin support was given to 9% of patients. All pts received Rituximab. Planned therapeutic programs included ASCT in 27% of pts, conventional chemotherapy in 67% a conventional chemotherapy plus lenalidomide in 6%. Overall 59 any grade VTE episodes occurred in 51 pts (2.9%), including 21 grade III-IV VTE (18 pts). None was fatal. Median time from study enrolment to VTE was 63 days (IQR: 35-110). Considering death as a competitive event the 6 months cumulative incidence of VTE was 2,2% in low risk Khorana score, 4.5% (95%IC: 2.3-6.7) in intermediate and 6.6% (95%IC: 2.4-10.8) in high risk (p=0.012) (figure 1). Khorana score was predictive also for grade III-IV events as they were 0,7% (95% CI:0.1-1.4) in low risk and 2.0% (95% CI:0.8-3.3) in intermediate-high risk (p=0.048). The results were similar also after excluding lenalidomide containing studies. The Fine and Gray multivariate analyses, adjusted for age and stage, showed that Khorana score (intermediate risk adjHR=1.96; 95%IC: 0.84-4.56 and high risk adjHR=3.81; 95%IC: 1.51-9.58) and DLCL-B histotype (adjHR=2.58; 95% CI: 1.01-6.55) were independently associated to an increased risk of VTE. Moreover an ordinal logistical regression model indicated that the increase of one point in the Khorana score resulted in an increased risk of VTE (OR=1.85; 95% CI: 1.23-2.79). CONCLUSIONS Our results suggest that DLCL-B histotype and Khorana score are predictors of VTE in NHL. The latter might become a simple and effective tool to assess the risk of VTE in NHL. Prospective validation including also patients not eligible for clinical trials is needed.
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Affiliation(s)
| | - M Ceccarelli
- SCDU Epidemiologia dei Tumori-CPO Piemonte, Torino
| | - G Catania
- Division of Hematology, Az Osp SS Antinio e Biagio e Cesare Arrigo, Alessandria
| | - C Monagheddu
- SCDU Epidemiologia dei Tumori-CPO Piemonte, Torino
| | - A Evangelista
- Unit of Cancer Epidemiology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Torino
| | - E Bernocco
- Division of Haematology - SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandrio
| | - F Monaco
- Division of Hematology, AZ Osp SS Antonio e Biagio e Cesare Arrigo, Alessandria
| | - M Federico
- Oncologia Medica, Università di Modena e Reggio Emilia, Modena
| | - U Vitolo
- Hematology II, Azienda Ospedaliera Città della Salute, Torino
| | - S Cortelazzo
- Department of Haematology and Bone Marrow Transplantation, Regional Hospital, S. Maurizio, Bolzano/Bozen
| | - M G Cabras
- Division of Hematology, Ospedale Businco, Cagliari
| | - M Spina
- Division of Hematology, IRCCS CRO Aviano
| | - L Baldini
- Division of Hematology, Fondazione IRCCS Ospedale Maggiore Policlinico, Università degli Studi di Milano
| | - C Boccomini
- Division of Hematology II, AOU Citta della Salute e della Scienza, Torino
| | - A Chiappella
- Department of Hematology, Azienda Ospedaliera Città della Salute e della Scienza, Torino
| | - A Bari
- Program of Innovative Therapy in Oncology and Hematology, Department of Diagnostic, Clinical and Public Health Medicine University of Modena and Reggio Emilia, Modena
| | - S Luminari
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena
| | - M Calabrese
- Fondazione Italiana Linfomi Onlus, Alessandria
| | - A Levis
- Italian Lymphoma Foundation (FIL), Alessandria
| | | | | | - G Ciccone
- SCDU Epidemiologia dei Tumori-CPO Piemonte, Az Osp Citta della salute e della Scienza, Torino
| | - M Ladetto
- Division of Hematology, Az Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria; Italy
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Zinzani PL, Derenzini E, Pellegrini C, Rigacci L, Fabbri A, Gandolfi L, Argnani L, Casadei B, Pulsoni A, Gobbi M, Perotti A, Zaccaria A, Voso MT, Cabras MG, De Renzo A. Long-term efficacy and toxicity results of the FLUMIZ trial (fludarabine and mitoxantrone followed by yttrium-90 ibritumomab tiuxetan in untreated follicular lymphoma). Ann Oncol 2012; 23:805-807. [PMID: 22287683 DOI: 10.1093/annonc/mdr633] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Affiliation(s)
- P L Zinzani
- Department of Hematology and Medical Oncology "L. and A. Seràgnoli," S. Orsola-Malpighi Hospital, University of Bologna, Bologna.
| | - E Derenzini
- Department of Hematology and Medical Oncology "L. and A. Seràgnoli," S. Orsola-Malpighi Hospital, University of Bologna, Bologna
| | - C Pellegrini
- Department of Hematology and Medical Oncology "L. and A. Seràgnoli," S. Orsola-Malpighi Hospital, University of Bologna, Bologna
| | - L Rigacci
- Department of Hematology, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | - A Fabbri
- Department of Hematology, Azienda Ospedaliero-Universitaria Senese, Siena
| | - L Gandolfi
- Department of Hematology and Medical Oncology "L. and A. Seràgnoli," S. Orsola-Malpighi Hospital, University of Bologna, Bologna
| | - L Argnani
- Department of Hematology and Medical Oncology "L. and A. Seràgnoli," S. Orsola-Malpighi Hospital, University of Bologna, Bologna
| | - B Casadei
- Department of Hematology and Medical Oncology "L. and A. Seràgnoli," S. Orsola-Malpighi Hospital, University of Bologna, Bologna
| | - A Pulsoni
- Department of Cellular Biotechnology and Hematology, University La Sapienza, Rome
| | - M Gobbi
- Department of Hematology, Azienda Ospedaliero-Universitaria San Martino, Genova
| | - A Perotti
- Department of Hematology, S. Eugenio Hospital University "Tor Vergata," Rome
| | - A Zaccaria
- Department of Hematology, S. Maria delle Croci Hospital, Ravenna
| | - M T Voso
- Department of Hematology, La Cattolica University, Rome
| | - M G Cabras
- Division of Hematology, Cagliari Hospital, Cagliari
| | - A De Renzo
- Department of Hematology, Federico II University, Naples, Italy
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Zaja F, Tomadini V, Zaccaria A, Lenoci M, Battista M, Molinari AL, Fabbri A, Battista R, Cabras MG, Gallamini A, Fanin R. CHOP-rituximab with pegylated liposomal doxorubicin for the treatment of elderly patients with diffuse large B-cell lymphoma. Leuk Lymphoma 2009; 47:2174-80. [PMID: 17071492 DOI: 10.1080/10428190600799946] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [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: 10/24/2022]
Abstract
Thirty untreated patients, median age 69 years (range 60 - 75 years), with diffuse large B-cell lymphoma (B-DLCL) were treated with a pegylated liposomal doxorubicin (PL-doxorubicin) modified CHOP-rituximab regimen. PL-doxorubicin 30 mg/m2, was given in combination with standard dosage of prednisone, vincristine, cyclophosphamide, rituximab (according to CHOP-R regimen) every 21 days for six courses. Cardiac toxicity was evaluated by mean of echocardiography for left ventricular ejection fraction (LVEF) evaluations and serum troponin-I levels. Overall response and complete response rates were 76% and 59%. Projected two year event free survival and overall survival are 65.5% and 68.5%. No treatment-related mortality was documented. WHO grade III-IV neutropenia and thrombocytopenia were 86% and 3%. Extra-hematological III-IV toxicity was represented, respectively, by a single case of infection, mucositis, and bleeding. LVEF evaluations and the troponin levels did not show significant changes over the course of the treatment. One patient with a previous history of atrial fibrillation experienced a single episode of arrhythmia. None of the patients developed palmar-plantar erythrodysesthesia. This regimen appears an active regimen for the treatment of elderly patients with B-DLCL. The replacement of conventional doxorubicin with PL-doxorubicin seems to be associated with a negligible incidence of extra-hematological toxicity, in particular cardiac and infectious complications.
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Affiliation(s)
- F Zaja
- Division of Hematology, DIRM, University Hospital, Udine, Italy.
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Todeschini G, Secchi S, Morra E, Vitolo U, Orlandi E, Pasini F, Gallo E, Ambrosetti A, Tecchio C, Tarella C, Gabbas A, Gallamini A, Gargantini L, Pizzuti M, Fioritoni G, Gottin L, Rossi G, Lazzarino M, Menestrina F, Paulli M, Palestro M, Cabras MG, Di Vito F, Pizzolo G. Primary mediastinal large B-cell lymphoma (PMLBCL): long-term results from a retrospective multicentre Italian experience in 138 patients treated with CHOP or MACOP-B/VACOP-B. Br J Cancer 2004; 90:372-6. [PMID: 14735179 PMCID: PMC2409547 DOI: 10.1038/sj.bjc.6601460] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The optimal treatment of primary mediastinal large B-cell lymphoma (PMLBCL) is still undefined. In the absence of randomised studies, we retrospectively analysed: (a) the effectiveness of two chemotherapy regimens (CHOP vs MACOP-B/VACOP-B) in complete remission (CR) achievement and event-free survival (EFS) and (b) the role of mediastinal involved-field radiotherapy (IF-RT) as consolidation. From 1982 to 1999, 138 consecutive patients affected by PMLBCL were treated in 13 Italian institutions with CHOP (43) or MACOP-B/VACOP-B (95). The two groups of patients were similar as regard to age, gender, presence of bulky mediastinal mass, pleural effusion, stage and international prognostic indexes category of risk. Overall, 75.5% of patients in CR received IF-RT as consolidation. Complete remission was 51.1% in the CHOP group and 80% in MACOP-B/VACOP-B (P<0.001). Relapse occurred in 22.7% of CHOP- and in 9.2% of MACOP-B/VACOP-B-treated patients (n.s.). Event-free patients were 39.5% in CHOP and 75.7% in the MACOP-B/VACOP-B group (P<0.001). The addition of IF-RT as consolidation improved the outcome, irrespectively of the type of chemotherapy (P=0.04). At a multivariate analysis, achievement of CR (P<0.0001) and type of CT (MACOP-B/VACOP-B) retained the significance for OS (P=0.008) and EFS (P=0.03). In our experience, MACOP-B/VACOP-B appears to positively influence OS and EFS in patients affected by PMLBCL, as compared to CHOP. Consolidation IF-RT on mediastinum further improves the outcome of CR patients.
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Affiliation(s)
- G Todeschini
- Department of Hematology, Verona University, Italy.
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