Surveillance investigations after high-dose therapy with stem cell rescue for recurrent follicular lymphoma have no impact on management

Background: The impact of active surveillance, comprising an annual CT scan and bone marrow biopsies, in the follow-up of patients after high-dose therapy (HDT) with autologous stem cell rescue for recurrent follicular lymphoma was analyzed.Design and Methods: Seventy-one of 99 patients who received HDT commenced on the surveillance program. Response duration, time-to-next-treatment and overall survival (OS) were compared, according to whether disease progression had been diagnosed on the basis of surveillance investigations or clinical grounds.Results: After a median follow-up of 16 years, progression was documented by surveillance in 16 patients and clinically in 18, the median response duration being 2.4 and 2.3 years, respectively (p=NS). Ten patients with a clinical relapse started treatment immediately contrasting with one patient who had a surveillance relapse. Five patients with relapses on surveillance investigations have not required treatment after a median follow-up of 18 years, whereas all but 2 patients with a clinical relapse have been treated. The median time-to-next-treatment was 7 years for patients with a surveillance relapse and 4 years for those with a clinical relapse (p=0.03). OS was not significantly different.Conclusions: Surveillance investigations have no impact on management and do not improve the outcome of this population

Quantitative PCR Analysis for Bcl-2/IgH in a Phase III Study of Yttrium-90 Ibritumomab Tiuxetan As Consolidation of First Remission in Patients With Follicular Lymphoma

PURPOSE The randomized First-Line Indolent Trial (FIT) was conducted in patients with advanced follicular lymphoma (FL), to evaluate the safety and efficacy of yttrium-90 ((90)Y) ibritumomab tiuxetan given as consolidation of complete or partial remission. This study of minimal residual disease was undertaken in parallel, to determine the rate of conversion from bcl-2 polymerase chain reaction (PCR) -detectable to -undetectable status and the corresponding effect on progression-free survival (PFS). PATIENTS AND METHODS Blood samples from 414 patients ((90)Y-ibritumomab, n = 208; control, n = 206) were evaluated using real-time quantitative polymerase chain reaction (RQ-PCR); 186 were found to have the bcl-2 rearrangement and were thus eligible for inclusion in the RQ-PCR analysis. Results Overall, 90% of treated patients converted from bcl-2 PCR-detectable to -undetectable disease status, compared with 36% in the control group. Treatment significantly prolonged median PFS in patients converting to bcl-2 PCR-undetectable status (40.8 v 24.0 months in the control group; P < .01, hazard ratio [HR], 0.399). In patients who had bcl-2 PCR-detectable disease at random assignment, treatment significantly prolonged median PFS (38.4 v 8.2 months in the control group; P < .01, HR, 0.293). CONCLUSION Eradication of PCR-detectable disease occurred more frequently after treatment with (90)Y-ibritumomab tiuxetan and was associated with prolongation of PF

Presentation serum selenium predicts for overall survival, dose delivery, and first treatment response in aggressive non-hodgkin’s lymphoma

Purpose: This study was undertaken to test the hypothesis that serum selenium concentration at presentation correlates with dose delivery, first treatment response, and overall survival in patients with aggressive B-cell non-Hodgkin’s lymphoma.Patients and Methods: The patients presented between July 1986 and March 1999 and received anthracycline-based chemotherapy, radiotherapy, or both. The total selenium content was retrospectively analyzed in 100 sera, frozen at presentation, using inductively coupled plasma mass spectrometry.Results: The serum selenium concentration ranged from 0.33 to 1.51 mol/L (mean, 0.92 mol/L; United Kingdom adult reference range, 1.07 to 1.88 mol/L). Serum selenium concentration correlated closely with performance status but with no other clinical variable. Multivariate analysis revealed that increased dose delivery, summarized by an area under the curve, correlated positively with younger age (P &lt; .001), advanced stage (P .001), and higher serum selenium concentration (P .032). Selenium level also correlated positively with response (odds ratio, 0.62; 95% confidence interval [CI], 0.43 to 0.90; P .011) and achievement of long-term remission after first treatment (log-rank test, 4.38; P .036). On multivariate analysis, selenium concentration was positively predictive of overall survival (hazard ratio [HR], 0.76 for 0.2 mol/L increase; 95% CI, 0.60 to 0.95; P .018), whereas age indicated negative borderline significance (HR, 1.09; 95% CI, 0.99 to 1.18; P .066).Conclusion: Serum selenium concentration at presentation is a prognostic factor, predicting positively for dose delivery, treatment response, and long-term survival in aggressive non-Hodgkin’s lymphoma. Unlike most existing prognostic factors in aggressive non-Hodgkin’s lymphoma, selenium supplementation may offer a novel therapeutic strategy in this frequently curable malignancy

Risk and clinical implications of transformation of follicular lymphoma to diffuse large B-cell lymphoma

To study the clinical significance of transformation to diffuse large B-cell lymphoma (DLBCL) in patients with follicular lymphoma (FL)