Radioimmunotherapy in follicular lymphomas, a retrospective analysis of the Polish Lymphoma Research Group's (PLRG) experience

BACKGROUND: Ibritumomab is an 90Yttrium (90Y) labelled radioimmunoconjugate registered to treat follicular lymphoma relapsing or refractory after Rituximab therapy. Combining the specificity of anti CD20 monoclonal antibodies with the efficacy of radiotherapy, it is particularly effective in patients with advanced stages of disease with generalized lymphadenopathy. MATERIAL AND METHODS: Twenty-one patients with follicular lymphoma, after failing 2-5 lines of previous treatment, were subjected to radioimmunotherapy in three Polish Lymphoma Research Group (PLRG) centres. Ibritumomab infusion was followed by 2 doses of Rituximab (250 mg/m2 at day -7 and 0) to enhance its biodistribution. Radioimmunoconjugate was prepared in the Nuclear Medicine Departments of participating centres based on patient weight and full blood count results (14.8 MBq/kg, max 1200 MBq, reduced to 11.1 MBq/kg in cases with blood platelet 100 000-150 000 or leukocytes 1500-2000). 14.8 MBq/kg (0.4 mCi/kg) 100 thousand to 149 thousand/mm3 platelets 11.1 MBq/kg (0.3 mCi/kg) RESULTS: The primary endpoint of the study was the assessment of response rate and haematological toxicity. Objective responses were observed in all patients, with 10 partial and 12 complete regressions. Cytopenia, starting 3-4 weeks after radioimmunotherapy, reflected haematological toxicity - the only important side effect. Thrombocytopenia was more pronounced, with platelet counts of < 50,000/ul in every second patient. One patient developed myelodysplastic syndrome 21 months after the procedure. After the medium time of follow up over 2 years, 2 patients died. Median progression free survival (secondary study endpoint) was 15 months. CONCLUSIONS: Ibritumomab radioimmunotherapy is an efficient method of palliation treatment of heavily pre-treated follicular lymphoma patients, failing numerous previous treatment lines. Earlier application increases the number of complete responses and prolongs progression free survival

Primary immune thrombocytopenia in a patient with sarcoidosis

Sarkoidoza cechuje się zróżnicowanym obrazem klinicznym. Może współwystępować z różnorodnymi schorzeniami o immunologicznym podłożu, jednak rzadko towarzyszą jej choroby układu krwiotwórczego. W pracy przedstawiono przypadek współwystępowania pierwotnej małopłytkowości immunizacyjnej o nagłym początku i sarkoidozy. Częstość występowania pierwotnej małopłytkowości immunizacyjnej wśród chorych z sarkoidozą ocenia się na około 2%, a w grupie osób z małopłytkowością sarkoidozę rozpoznaje się u 1% chorych. Opisano 3 potencjalne patomechanizmy prowadzące do ujawnienia się małopłytkowości w sarkoidozie: 1) obecność autoprzeciwciał przeciwpłytkowych, 2) obecność ziarniniaków nabłonkowatokomórkowych w szpiku, 3) hipersplenizm. Pneumonol. Alergol. Pol. 2011; 79, 5: 371&#8211;376Sarcoidosis is a disease characterised by a highly variable clinical course. While it may be accompanied by various immune disorders, it is rarely accompanied by disorders of the haematopoietic system. We report a case of sudden-onset primary immune thrombocytopenia co-existing with sarcoidosis. The prevalence of primary immune thrombocytopenia in patients with sarcoidosis is estimated at about 2% and about 1% of patients with thrombocytopenia are diagnosed with sarcoidosis. Three potential pathomechanisms leading to the development of thrombocytopenia in sarcoidosis have been described, namely: (1) the presence of antiplatelet antibodies, (2) presence of epithelioid cell granulomas in the bone marrow and (3) hypersplenism. Pneumonol. Alergol. Pol. 2011; 79, 5: 371&#8211;37

Autologous stem cell transplantation as consolidation therapy for patients with peripheral T cell lymphoma in first remission : long-term outcome and risk factors analysis

This report is a retrospective analysis of 65 patients with peripheral T cell lymphoma (PTCL), who underwent high-dose therapy and autologous hematopoietic stem cell transplantation (autoHCT) as a consolidation of first response achieved with either induction or salvage chemotherapy. We intended to determine the prognostic factors that influenced outcome after autoHCT and to define the predictive value of the scoring systems most often applied for transplant outcomes. Nineteen patients in either complete or partial remission underwent autoHCT after induction chemotherapy. Forty-six patients received second-line chemotherapy as a consolidation of partial response after induction chemotherapy (n = 34) or as a salvage therapy after primary induction failure (n = 12), and thereafter proceeded to autoHCT. Finally, the 36 patients were in complete remission, and 29 in partial remission at autoHCT. The median follow-up of survivors was 53 months (range 7–157 months). The 5-year overall survival and progression-free survival for all patients were 61.5 % (95 % CI 47.0–74.2 %) and 59.4 % (95 % CI 46.1–71.5 %), respectively. In multivariate analysis, bone marrow involvement at diagnosis and less than partial remission after induction chemotherapy were factors independently predictive for overall survival and progression-free survival. The prognostic index for PTCL could reliably stratify the prognosis of PTCL in this analysis

Single Positive Commensal Blood Culture in hospital setting is associated with higher mortality after hematopoietic stem cell transplantation

BackgroundSingle positive staphylococcal blood culture in a hematopoietic stem cell transplantation (HSCT) recipient is generally regarded as contamination. Such a blood culture (BC) does not fill the criteria for Laboratory-Confirmed Bloodstream Infection (LCBI) and could be described as Single Positive Commensal Blood Culture. The aim of this retrospective cohort analysis was to determine the clinical significance of SPCBC in HSCT recipients.Methods206 patients transplanted between 2007 and 2013 were followed until January 2015.ResultsThe 100-day survival for patients without positive BC was 99.6% compared with 83.9% for LCBI and 82.8% for SPCBC (p=0.0036). The 5-year overall survival (5yOS) was 67.1% for patients without positive BC, 44.9% for LCBI, 34.0% for SPCBC (

Bendamustine in therapy of lymphoid malignancies

Bendamustyna jest cytostatykiem łączącym strukturalne i funkcjonalne cechy leków alkilujących i analogów purynowych. W wielu dotychczasowych badaniach klinicznych potwierdzono skuteczność tego leku w terapii nowotworów układu chłonnego. W artykule podsumowano dotychczasowe wyniki leczenia oraz bezpieczeństwa stosowania bendamustyny u chorych na chłoniaki nieziarnicze, przewlekłą białaczkę limfocytową oraz szpiczaka plazmocytowego. Hematologia 2011; 2, 3: 220&#8211;232Bendamustine is cytotoxic agent combining structural and functional features of alkylating agents and purine analogues. Many clinical trials confirmed efficacy of bendamustine in therapy of lymphoid malignancies. This article summarizes results, clinical data and safety of treatment with bendamustine in patients with non-Hodgkin lymphomas, chronic lymphocytic leukemia and plasma cell myeloma. Hematologia 2011; 2, 3: 220&#8211;23