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Bastos-Oreiro M, Gutierrez A, Cabero A, López J, Villafuerte P, Jiménez-Ubieto A, de Oña R, De la Fuente A, Navarro B, Peñalver J, Martínez P, Alonso C, Infante M, Córdoba R, Perez-Montero B, Pérez de Oteyza J, González de Villambrosio S, Fernández-Caldas P, del Campo R, García Belmonte D, Diaz-Gálvez J, Salar A, Sancho JM. Comparing R-Bendamustine vs. R-CHOP Plus Maintenance Therapy as First-Line Systemic Treatment in Follicular Lymphoma: A Multicenter Retrospective GELTAMO Study. Cancers (Basel) 2024; 16:1285. [PMID: 38610963 PMCID: PMC11010804 DOI: 10.3390/cancers16071285] [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: 01/21/2024] [Revised: 03/08/2024] [Accepted: 03/15/2024] [Indexed: 04/14/2024] Open
Abstract
Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and R-bendamustine (R-B) are the most common frontline treatment strategies for advanced-stage follicular lymphoma (FL). After R-CHOP induction therapy, using rituximab for maintenance therapy notably improves outcomes; however, whether this can be achieved by using the same approach after R-B therapy is still being determined. This retrospective analysis compared 476 FL patients from 17 GELTAMO centers who received R-based regimens followed by rituximab maintenance therapy for untreated advanced-stage FL. The complete response rate at the end of induction was higher with R-B and relapses were more frequent with R-CHOP. During induction, cytopenias were significantly more frequent with R-CHOP and so was the use of colony-stimulating factors. During maintenance therapy, R-B showed more neutropenia and infectious toxicity. After a median follow-up of 81 months (95% CI: 77-86), the 6-year rates of progression-free survival (PFS) were 79% (95% CI: 72-86) for R-bendamustine vs. 67% (95% CI: 61-73) for R-CHOP (p = 0.046), and 6-year overall survival (OS) values were 91% (95% CI: 86-96) for R-B vs. 91% (95% CI: 87-94) for R-CHOP (p = 0.49). In conclusion, R-B followed by rituximab maintenance therapy in patients with previously untreated FL resulted in significantly longer PFS than R-CHOP, with older patients also benefiting from this treatment without further toxicity. Adverse events during maintenance were more frequent with R-B without impacting mortality.
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Affiliation(s)
- Mariana Bastos-Oreiro
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
| | | | | | | | | | | | - Raquel de Oña
- MD Anderson, 28033 Madrid, Spain; (R.d.O.); (A.D.l.F.)
| | | | | | - Javier Peñalver
- Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain; (J.P.); (P.M.)
| | - Pilar Martínez
- Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain; (J.P.); (P.M.)
| | | | | | - Raúl Córdoba
- Hospital Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | | | | | | | - Paula Fernández-Caldas
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
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Gonzalez Barca E, Tomás-Roca L, Esteve A, Rodriguez M, Gato L, Alonso-Alonso R, Martin Garcia-Sancho A, Cordoba R, Monter-Rovira A, Bastos-Oreiro M, Bergua Burgues JM, Sayas MJ, Viguria Alegria MC, Sanchez-Blanco JJ, Roig Pellicer M, Luzardo Henriquez HD, de Oña R, Cabezudo ME, Infante MS, Queizán Hernández JA, Sanz-Pamplona R, Blanco O, Mozos A, Climent F, Piris MA. Extranodal natural killer/T-cell lymphoma nasal type in a western population: Molecular profiling identifies new therapeutic targets. Am J Hematol 2023; 98:E134-E138. [PMID: 36882876 DOI: 10.1002/ajh.26904] [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] [Received: 11/16/2022] [Revised: 02/13/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
(A) Correlation matrix of unsupervised co-regulated genes, based on the 208 genes included in the NanoString platform. Some of the clusters of co-regulated genes corresponded to the following: Inflammatory cells; Epstein-Barr virus; B-cells; Cytotoxic T-cells; T-cells; and Proliferation. (B) Analysis of genomic alterations by targeted sequencing. Distribution of mutations in the 62 analyzed genes. Rows correspond to sequenced genes, columns represent individual patients. Color coding: green, missense; blue, synonymous; pink, frameshift; violet, Indel; red, stop gained; yellow, UTR.
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Affiliation(s)
- Eva Gonzalez Barca
- Hematology Department, Institut Català d'Oncologia Hospitalet, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Laura Tomás-Roca
- Pathology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | - Anna Esteve
- Unit of Biomarkers and Susceptibility, Oncology Data Analytics Program (ODAP), Medical Oncology Department, B-ARGO Badalona, Catalan Institute of Oncology, Barcelona, Spain
| | - Marta Rodriguez
- Pathology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), ISCIII, Madrid, Spain
| | - Lucía Gato
- Pathology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | - Ruth Alonso-Alonso
- Pathology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), ISCIII, Madrid, Spain
| | | | - Raul Cordoba
- Hematology Department, Fundación Jiménez Díaz, Madrid, Spain
| | - Anna Monter-Rovira
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Maria Jose Sayas
- Hematology Department, Hospital Universitario Dr. Peset, Valencia, Spain
| | | | | | | | | | - Raquel de Oña
- Hematology Department, MD Anderson Cancer Center, Madrid, Spain
| | - Maria Elena Cabezudo
- Hematology Department, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | | | | | - Rebeca Sanz-Pamplona
- Unit of Biomarkers and Susceptibility, Oncology Data Analytics Program (ODAP), Catalan Institute of Oncology, Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL) and CIBERESP, Barcelona, Spain
| | - Oscar Blanco
- Pathology Department, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Ana Mozos
- Pathology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Fina Climent
- Pathology Department, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet De Llobregat, Barcelona, Spain
| | - Miguel Angel Piris
- Pathology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
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Montalbán C, Díaz-López A, Dlouhy I, Rovira J, Lopez-Guillermo A, Alonso S, Martín A, Sancho JM, García O, Sánchez JM, Rodríguez M, Novelli S, Salar A, Gutiérrez A, Rodríguez-Salazar MJ, Bastos M, Domínguez JF, Fernández R, Gonzalez de Villambrosia S, Queizan JA, Córdoba R, de Oña R, López-Hernandez A, Freue JM, Garrote H, López L, Martin-Moreno AM, Rodriguez J, Abraira V, García JF. Validation of the NCCN-IPI for diffuse large B-cell lymphoma (DLBCL): the addition of β 2 -microglobulin yields a more accurate GELTAMO-IPI. Br J Haematol 2017; 176:918-928. [PMID: 28106247 DOI: 10.1111/bjh.14489] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [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: 07/20/2016] [Accepted: 10/10/2016] [Indexed: 12/18/2022]
Abstract
The study included 1848 diffuse large B-cell lymphoma (DLBCL)patients treated with chemotherapy/rituximab. The aims were to validate the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) and explore the effect of adding high Beta-2 microglobulin (β2M), primary extranodal presentation and intense treatment to the NCCN-IPI variables in order to develop an improved index. Comparing survival curves, NCCN-IPI discriminated better than IPI, separating four risk groups with 5-year overall survival rates of 93%, 83%, 67% and 49%, but failing to identify a true high-risk population. For the second aim the series was split into training and validation cohorts: in the former the multivariate model identified age, lactate dehydrogenase, Eastern Cooperative Oncology Group performance status, Stage III-IV, and β2M as independently significant, whereas the NCCN-IPI-selected extranodal sites, primary extranodal presentation and intense treatments were not. These results were confirmed in the validation cohort. The Grupo Español de Linfomas/Trasplante de Médula ósea (GELTAMO)-IPI developed here, with 7 points, significantly separated four risk groups (0, 1-3, 4 or ≥5 points) with 11%, 58%, 17% and 14% of patients, and 5-year overall survival rates of 93%, 79%, 66% and 39%, respectively. In the comparison GELTAMO IPI discriminated better than the NCCN-IPI. In conclusion, GELTAMO-IPI is more accurate than the NCCN-IPI and has statistical and practical advantages in that the better discrimination identifies an authentic high-risk group and is not influenced by primary extranodal presentation or treatments of different intensity.
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Affiliation(s)
- Carlos Montalbán
- Department of Haematology, MD Anderson Cancer Centre, Madrid, Spain
| | - Antonio Díaz-López
- Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain
| | - Ivan Dlouhy
- Department of Haematology, Hospital Clinic, Barcelona, Spain
| | - Jordina Rovira
- Department of Haematology, Hospital Clinic, Barcelona, Spain
| | | | - Sara Alonso
- Department of Haematology, Hospital Universitario and IBSAL, Salamanca, Spain
| | - Alejandro Martín
- Department of Haematology, Hospital Universitario and IBSAL, Salamanca, Spain
| | - Juan M Sancho
- Department of Haematology, Hospital Germans Trias i Pujol, ICO-IJC, Badalona, Spain
| | - Olga García
- Department of Haematology, Hospital Germans Trias i Pujol, ICO-IJC, Badalona, Spain
| | - Jose M Sánchez
- Department of Haematology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Mario Rodríguez
- Department of Haematology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Silvana Novelli
- Department of Haematology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Antonio Salar
- Department of Haematology, Hospital del Mar, Barcelona, Spain
| | - Antonio Gutiérrez
- Department of Haematology, Hospital Universitari Son Espases, Palma de Mallorca (IdISPa), Spain
| | | | - Mariana Bastos
- Department of Haematology, Hospital Gregorio Marañón, Madrid, Spain
| | - Juan F Domínguez
- Department of Haematology, Hospital Virgen del Rocío, Sevilla, Spain
| | - Rubén Fernández
- Department of Haematology, Hospital de Cabueñes, Gijón, Spain
| | | | - José A Queizan
- Department of Haematology, Hospital General de Segovia, Segovia, Spain
| | - Raul Córdoba
- Department of Haematology, Fundación Jimenez Díaz, Madrid, Spain
| | - Raquel de Oña
- Department of Haematology, MD Anderson Cancer Centre, Madrid, Spain
| | | | - Julian M Freue
- Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain
| | - Heidys Garrote
- Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain
| | - Lourdes López
- Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain
| | | | - Jose Rodriguez
- Department of Haematology, MD Anderson Cancer Centre, Madrid, Spain
| | - Víctor Abraira
- Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Juan F García
- Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain.,Department of Pathology, MD Anderson Cancer Centre, Madrid, Spain
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- Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain.,Department of Pathology, MD Anderson Cancer Centre, Madrid, Spain
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Panizo C, Rodríguez AJ, Gutiérrez G, Díaz FJ, González-Barca E, de Oña R, Grande C, Sancho JM, García-Álvarez MF, Sánchez-González B, Peñalver FJ, Cannata J, Espeso M, Requena MJ, Gardella S, Durán S, González AP, Alfonso A, Caballero MD. Evaluation of clinical and biological prognostic factors in relapsed or refractory diffuse large B-cell lymphoma patients after previous treatment with rituximab and chemotherapy: results of the PRO-R-IPI study. Clin Lymphoma Myeloma Leuk 2015; 15:398-403. [PMID: 25843416 DOI: 10.1016/j.clml.2015.02.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 02/26/2015] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous entity, showing a highly variable outcome. In patients with DLBCL relapsed/refractory to first-line treatment with rituximab the usefulness of the revised International Prognostic Index (R-IPI) as a prognostic tool remains unexplored. Some biological parameters (B-cell lymphoma 6 [Bcl-6], Bcl-2, p53, and multiple myeloma 1 [MUM1]) and blood populations (lymphocyte and monocyte counts) have been described as International Prognostic Index-independent prognostic factors. The objective was to evaluate the R-IPI to predict the outcome of DLBCL patients at the time of relapse after a front-line treatment with chemotherapy and rituximab and to establish in this population the relationship between biological parameters and outcome. PATIENTS AND METHODS We included patients with refractory/relapsed DLBCL after first-line treatment with rituximab-containing regimens; patients must have already finished a rescue treatment also including rituximab. Immunohistochemical assessment of Bcl-2, Bcl-6, p53, and MUM1 expression were undertaken in available biopsies. R-IPI factors were identified from the clinical data at diagnosis and at relapse. Response was assessed using National Cancer Institute-sponsored Working Group guidelines. RESULTS R-IPI prognosis at relapse was not significantly associated with overall response rate (ORR) after Rituximab-chemotherapy rescue therapy. None of the immunohistochemical parameters analyzed correlated with rescue therapy results. In contrast, patients with absolute lymphocyte count (ALC) ≥ 1 × 10(9)/L at relapse were more likely to respond than patients with ALC < 1 × 10(9)/L (P = .05). CONCLUSION The R-IPI score calculated at relapse could not predict the ORR to second-line treatment. Lymphopenia is a simple and useful predictor for outcome in relapsed/refractory DLBCL and the only prognostic factor that in our hands could predict the overall response to a second-line treatment with rituximab and chemotherapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ana Alfonso
- Clínica Universidad de Navarra, Pamplona, Spain
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Rivero A, Rapado I, Tomás JF, Montalbán C, de Oña R, Paz-Carreira J, Canales M, Martínez R, Sánchez-Godoy P, de Sevilla AF, de la Serna J, Martínez-López J. Relationship between deoxycytidine kinase (DCK) genotypic variants and fludarabine toxicity in patients with follicular lymphoma. Leuk Res 2011; 35:431-7. [DOI: 10.1016/j.leukres.2010.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 09/23/2010] [Accepted: 09/29/2010] [Indexed: 02/02/2023]
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