22 research outputs found
Response-Adapted Postinduction Strategy in Patients With Advanced-Stage Follicular Lymphoma: The FOLL12 Study
Purpose: We compared 2 years of rituximab maintenance (RM) with a response-adapted postinduction approach in patients with follicular lymphoma who responded to induction immunochemotherapy. Methods: We randomly assigned treatment-naïve, advanced-stage, high-tumor burden follicular lymphoma patients to receive standard RM or a response-adapted postinduction approach on the basis of metabolic response and molecular assessment of minimal residual disease (MRD). The experimental arm used three types of postinduction therapies: for complete metabolic response (CMR) and MRD-negative patients, observation; for CMR and MRD-positive (end of induction or follow-up) patients, four doses of rituximab (one per week, maximum three courses) until MRD-negative; and for non-CMR patients, one dose of ibritumomab tiuxetan followed by standard RM. The study was designed as noninferiority trial with progression-free survival (PFS) as the primary end point. Results: Overall, 807 patients were randomly assigned. After a median follow-up of 53 months (range 1-92 months), patients in the standard arm had a significantly better PFS than those in the experimental arm (3-year PFS 86% v 72%; P < .001). The better PFS of the standard vs experimental arm was confirmed in all the study subgroups except non-CMR patients (n = 65; P = .274). The 3-year overall survival was 98% (95% CI, 96 to 99) and 97% (95% CI, 95 to 99) in the reference and experimental arms, respectively (P = .238). Conclusion: A metabolic and molecular response-adapted therapy as assessed in the FOLL12 study was associated with significantly inferior PFS compared with 2-year RM. The better efficacy of standard RM was confirmed in the subgroup analysis and particularly for patients achieving both CMR and MRD-negative
Elotuzumab plus pomalidomide and dexamethasone in relapsed/refractory multiple myeloma: a multicenter, retrospective real-world experience with 200 cases outside of controlled clinical trials
In the ELOQUENT-3 trial, the combination of elotuzumab, pomalidomide and dexamethasone
(EloPd) proved a superior clinical benefit over Pd with a manageable toxicity profile, leading to its
approval in relapsed/refractory multiple myeloma (RRMM), who had received at least two prior
therapies, including lenalidomide and a proteasome inhibitor (PI).
We report here a real-world experience of 200 RRMMs treated with EloPd in 35 Italian centers
outside of clinical trials. In our dataset, the median number of prior lines of therapy was 2, with
51% of cases undergoing autologous stem cell transplant (ASCT) and 73% exposed to
daratumumab.
After a median follow-up of 9 months, 126 patients stopped EloPd, most of them (88.9%) because
of disease progression. The overall response rate (ORR) was 55.4%, in line with the pivotal trial
results. Regarding adverse events, our cohort experienced a toxicity profile similar to the
ELOQUENT-3 trial, with no significant differences between younger (<70 years) and older
patients. The median progression-free survival (PFS) was 7 months, shorter than that observed in
the ELOQUENT-3, probably due to the different clinical characteristics of the two cohorts.
Interestingly, the ISS stage III (HR:2.55) was associated with worse PFS. Finally, our series's
median overall survival (OS) was shorter than that observed in the ELOQUENT-3 trial (17.5 versus
29.8 months). In conclusion, our real-world study confirms EloPd as a safe and possible therapeutic
choice for RRMM who received at least two prior therapies, including lenalidomide and a PI
SARS-CoV-2 Infection in Patients with Waldenstrom's Macroglobulinemia: A Multicenter International Cohort Study
SARS-CoV-2 Infection in Patients With Waldenström's Macroglobulinemia: A Multicenter International Cohort Study
The coronavirus disease 2019 (COVID-19) pandemic has represented a huge challenge for vulnerable patients affected with hematological malignancies.1,2 So far, heterogeneous series on patients with lymphoma and COVID-19 have been published with mortality rates ranging from 25% to 40%,3–8 with only limited information about specific neoplasms.Peer reviewe
Cumulative radiation exposure from radiological imaging in patients with Hodgkin and diffuse large b-cell lymphoma not submitted to radiotherapy
Objective: To assess the cumulated exposure to radiation due to imaging in Hodgkin (HL) and diffuse large B-cell (DLBCL) lymphoma patients who were not submitted to radiotherapy. Methods: The study population included 51 and 83 adult patients with HL and DLBCL, with a follow-up duration >1 year. The cumulated exposure was expressed using patient-specific data as cumulated effective dose (CED). Results: Fifty-one HL patients (median age 47 years) were followed for a median of 3.5 years. The median total CED per subject was 104 mSv. CT and PET/CT examinations accounted for 75 and 25% of the total CED, respectively. 26 patients (49%) had a total CED ≥ 100 mSv and the maximum CED was 302 mSv. Eighty-three DLBCL patients (median age 66 years) were followed for a median of 3.7 years. The median total CED per subject over the study period was 134 mSv. CT and PET/CT for 86% and 13% of the total CED, respectively. 56 patients (67%) had a total CED ≥100 mSv. The maximum CED was 557 mSv. Conclusion: Our study demonstrated the large number of imaging procedures performed for patients with lymphoma. Overall, 61% of the patients accrued a CED ≥ 100 mSv. Imaging policies were only in a partial agreement with current international guidelines. Advances in knowledge: The cumulated exposure radiation exposure may be of concern in HL patients and the contribution of CT procedures to the total CED is significant. The standardisation of clinical guidelines for managing patients with lymphoma is warranted
New Frontiers in Monoclonal Antibodies for Relapsed/Refractory Diffuse Large B-Cell Lymphoma
Simple Summary Forty percent of patients with diffuse large B-cell lymphoma (DLBCL) have a refractory or relapsed (R/R) disease. In this setting, prognosis is poor, particularly for patients not eligible for autologous stem-cell transplantation or CAR-T-cell therapy, thus representing an unmet need in the field of hematological malignancies. Currently, the optimal treatment approach for these patients remains controversial. Over the last few decades, monoclonal antibodies (mAbs) have dramatically changed the therapeutic landscape for cancer patients. The aim of our review is focused on novel and emerging therapeutic strategies based on different types of mAbs, including monospecific and bispecific mAbs as well as antibody-drug conjugates and immune checkpoint inhibitors, in the challenging setting of R/R DLBCL.Abstract Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma. Approximately 60% of patients are cured with R-CHOP as a frontline treatment, while the remaining patients experience primary refractory or relapsed disease (R/R). The prognosis for R/R DLBCL patients who are neither eligible for autologous stem-cell transplantations nor CAR-T-cell treatment is poor, representing an important unmet need. Monoclonal antibodies (mAbs) have dramatically improved therapeutic options in anti-cancer strategies, offering new opportunities to overcome chemo-refractoriness in this challenging disease, even in cases of primary non-responder DLBCL. Several novel mAbs, characterized by different mechanisms of action and targets, are now available for R/R DLBCL. Unbound mAbs induce an immune response against cancer cells, triggering different mechanisms, including antibody-dependent cellular cytotoxicity (ADCC), activation of antibody-dependent cell-mediated phagocytosis (ADCP) and complement-dependent cytotoxicity (CDC). Antibody-drug conjugates (ADCs) and radioimmunotherapy (RIT), respectively, deliver a cytotoxic payload or a beta-emitter radionuclide to the targeted cells and nearby bystanders. Bispecific T-cell engagers (BiTes) and immune checkpoint inhibitors (ICIs) redirect and enhance the immune response against tumor cells. Here, we review therapeutic strategies based on monoclonal antibodies for R/R DLBCL
Outcome of patients older than 80\uc2\ua0years with diffuse large B-cell lymphoma (DLBCL) treated with \ue2\u80\u9cstandard\ue2\u80\u9d immunochemotherapy: A large retrospective study from 4 institutions
Early progression of disease predicts shorter survival in MALT lymphoma patients receiving systemic treatment
Early progression of disease (POD) within two years from diagnosis is linked with poor overall survival (OS) in follicular lymphoma but its prognostic role is less clear in extranodal marginal zone B-cell lymphoma (EMZL). We sought to identify prognostic factors associated with early POD and to determine whether is associated with inferior OS. We analyzed the impact of early POD in the IELSG19 clinical trial dataset (training set of 401 patients randomly assigned to chlorambucil or rituximab or chlorambucil plus rituximab). Reproducibility was examined in a validation set of 287 patients who received systemic treatment. In both sets, we excluded from the analysis the patients who, within 24 months from treatment start, died without progression or were lost to follow-up without prior progression. OS was calculated from progression in patients with early POD and from 24 months after start of treatment in those without (reference group). Early POD was observed in 69 of the 384 (18%) evaluable patients of the IELSG19 study. Patients with high-risk MALT-IPI were more likely to have early POD (p=0.006). The 10-year OS rate was 64% in the early POD group and 85% in the reference group (HR= 2.42, 95%CI, 1.35-4.34; log-rank P=0.002). This prognostic impact was confirmed in the validation set, in which early POD was observed in 64 out of 224 (29%) evaluable patients with 10-year OS rate of 48% in the early POD group and 71% in the reference group (HR= 2.15, 95%CI, 1.19-3.90; log-rank P=0.009). In patients with EMZL who received front-line systemic treatment, early POD is associated with poorer survival and may represent a useful endpoint in future prospective clinical trials
18F-FDG PET/CT Cannot Substitute Endoscopy in the Staging of Gastrointestinal Involvement in Mantle Cell Lymphoma. A Retrospective Multi-Center Cohort Analysis
The detection of gastrointestinal (GI) involvement in Mantle Cell Lymphoma is often underestimated and may have an impact on outcome and clinical management. We aimed to evaluate whether baseline 18F-FDG PET/CT presents comparable results to endoscopic biopsy in the diagnosis of GI localizations. In our retrospective cohort of 79 patients, sensitivity and specificity of 18F-FDG PET/CT were low for the stomach, with a fair concordance (k = 0.32), while higher concordance with pathologic results (k = 0.65) was detected in the colorectal tract. Thus, gastric biopsy remains helpful in the staging of MCL despite 18F-FDG PET/CT, while colonoscopy could be omitted in asymptomatic patients. The validation of our data in prospective cohorts is desirabl