Early chemotherapy de-escalation strategy in patients with advanced-stage Hodgkin lymphoma with negative positron emission tomography scan after 2 escalated BEACOPP cycles

Escalated BEACOPP (escBEACOPP: bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) significantly improves overall response rates (ORRs) and prolongs progression‑free survival (PFS) in patients with advanced‑stage Hodgkin lymphoma (HL). However, 6 to 8 cycles of escBEACOPP are associated with increased acute toxicity and late complications. We aimed to determine the role of early positron emission tomography-computed tomography (PET‑CT) response assessment in a de‑escalation strategy. We retrospectively analyzed 188 consecutive patients with advanced‑stage HL treated at diagnosis. Patients received 2 cycles of escBEACOPP followed by an early PET‑CT response assessment performed after 2 cycles of chemotherapy (PET2). Patients with an active disease continued therapy with escBEACOPP, while those with negative PET2 were de‑escalated to ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine). Radiotherapy was allowed in patients with stage IIBX. PET2 allowed for de‑escalation of therapy in 141 patients (75%). Their ORR was 92.2%, with a complete remission (CR) rate of 91.5%; 10‑year PFS and overall survival (OS) were 87.2% and 95%, respectively. In the whole cohort, ORR was 87.8% (CR, 85.6%), while the 10‑year PFS and OS were 79.3% and 89.4%, respectively. Hematological and thromboembolic complications were significantly more frequent in patients treated with 6 escBEACOPP cycles, including febrile neutropenia (25 patients, [53.2%] vs 7 [5%]), serious anemia (35 [74.5%] vs 11 [7.8%]), or thrombocytopenia (16 [34%] vs 7 [5%]) (P <0.001 for all comparisons with de‑escalation strategy) as well as pulmonary embolism (3 [6.4%] vs 0) (P = 0.02). The early de‑escalation strategy allows for effective treatment of advanced HL, with a comparable efficacy to that of 6 to 8 cycles of escBEACOPP, but with significantly reduced toxicity

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) with probable mesentery involvement with associated hemophagocytic syndrome (HPS) - how to treat it?

Subcutaneous panniculitis-like T-cell lymphoma (SPTL) is a rare, cutaneous lymphoma involving subcutaneous adipose tissue. SPTL is associated in less than 20% with hemophagocytic syndrome (HPS). A 5-year overall survival rate is inferior in patients with SPTL and HPS (46%) as compared with 91% in patients without HPS. No standardized therapy for SPTCL has yet been established. This is a case of 35-year-old Caucasian man with a one-month history of B symptoms with the suspicion of Still’s disease, at admission with leucopenia, high LDH, ferritin, sIl-R2, and triglycerides levels, hepatosplenomegaly, small right supraclavicular nodule, and irregular thickening of trunk subcutaneous tissue. The abdomen MRI showed generalized thickening of mesentery and colonic mucosa. In the patient, diagnosis of SPTCL was established with secondary HPS. CHOEP chemotherapy and modified HLH 2014 protocol were applied with subsequent high dose chemotherapy (BEAM) supported by autologous stem cells transplantation. Treatment was complicated by pancytopenia and pneumonia. The outcome of the disease treated by intensive protocol seems to be good

Rola rytuksymabu w leczeniu pierwszego rzutu chłoniaka rozlanego z dużych komórek B dużego ryzyka : analiza retrospektywna Polskiej Grupy Badawczej Chłoniaków

WPROWADZENIE Immunochemioterapia R‑CHOP (rytuksymab, cyklofosfamid, doksorubicyna, winkrystyna, prednizon) jest standardem leczenia pierwszego rzutu w przypadku chłoniaka rozlanego z dużych komórek B (diffuse large B‑cell lymphoma – DLBCL). Żadne z badań randomizowanych nie udowodniło istotnej statystycznie korzyści w zakresie całkowitego przeżycia (overall survival – OS) w podgrupie dużego ryzyka wg Międzynarodowego Wskaźnika Prognostycznego (International Prognostic Index, IPI). CELE Zbadaliśmy retrospektywnie rolę dodania rytuksymabu do chemioterapii opartej na antracyklinie u chorych z DLBCL dużego ryzyka wg IPI. PACJENCI I METODY 371 chorych z DLBCL dużego ryzyka leczonych w 15 polskich ośrodkach hematologicznych poddano retrospektywnie analizie w dwóch odrębnych grupach wiekowych: >60 i ≤60 rż. Porównywano i analizowano odsetki odpowiedzi na leczenie, OS i przeżycie wolne od progresji (progression‑free survival – PFS). WYNIKI Całkowity odsetek odpowiedzi (overall response rate – ORR) u chorych z DLBCL dużego ryzyka istotnie zwiększył się u chorych leczonych rytuksymabem w porównaniu z chorymi leczonymi bez rytuksymabu (76,7% vs 95,6%; p <0,05). Immunochemioterapia R‑CHOP wydłużyła przeżycie zarówno w młodszej, jak i starszej podgrupie chorych. 5‑letnie rzutowane OS i PFS młodszych chorych leczonych rytuksymabem vs samą chemioterapią wynosiły odpowiednio: 42% vs 38% i 46% vs 27% (p <0,05), natomiast 5‑letnie rzutowane OS i PFS starszych chorych leczonych rytuksymabem vs samą chemioterapią wynosiły odpowiednio: 82% vs 52% i 67% vs 45% (p <0,05). WNIOSKI Z uwzględnieniem wszystkich ograniczeń analizy retrospektywnej, przewaga dodania rytuksymabu do chemioterapii skojarzonej CHOP została wyraźnie wykazana odnośnie do ORR, OS i PFS w obu podgrupach wiekowych pacjentów z DLBCL dużego ryzyka.INTRODUCTION R-CHOP immunochemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) is a standard first-line treatment for diffuse large B-cell lymphoma (DLBCL). None of the randomized trials have proved a statistically significant overall survival (OS) benefit in high-risk subgroups according to the International Prognostic Index (IPI). OBJECTIVES We retrospectively investigated the role of adding rituximab to anthracycline-based chemotherapy in patients with high-risk DLBCL according to the IPI. PATIENTS AND METHODS A total of 371 patients with high-risk DLBCL treated at 15 Polish hematology centers were retrospectively analyzed in 2 distinct age groups: older than 60 years and 60 years old or younger. Response rates, OS, and progression-free survival (PFS) were compared and analyzed. RESULTS The overall response rate (ORR) of high-risk DLBCL patients significantly improved in rituximabtreated patients compared with patients treated without rituximab (76.7% vs 95.6%; P <0.05). The R-CHOP immunochemotherapy prolonged survival in both older and younger subgroups. The 5-year projected OS and PFS in younger patients treated with rituximab vs chemotherapy alone were 42% vs 38% and 46% vs 27%, respectively (P <0.05), while the 5-year projected OS and PFS in older patients treated with rituximab vs chemotherapy alone were 82% vs 52% and 67% vs 45%, respectively (P <0.05). CONCLUSIONS With all the limitations of a retrospective analysis, the superiority of adding rituximab to CHOP combination chemotherapy has been clearly demonstrated regarding ORR, OS, and PFS in both age subgroups of patients with high-risk DLBCL

Consolidation with 90Y ibritumomab tiuxetan radioimmunotherapy in mantle cell lymphoma patients ineligible for high dose therapy : results of the phase II multicentre Polish Lymphoma Research Group trial, after 8-year long follow-up

none16siPolish Lymphoma Research Group performed a phase-II trial to test whether (90)Y ibritumomab tiuxetan radioimmunotherapy (Y90) may constitute an alternative consolidation for mantle cell lymphoma patients unfit for high-dose therapy. Forty-six patients were consolidated with Y90 following response to the 1st (n = 34) or 2nd line (n = 12) (immuno)chemotherapy. Majority of the patients had advanced disease (stage IV and presence of B-symptoms in 85% and 70%, respectively) and high MIPI (5.8, range 4-7). Consolidation with Y90 increased the complete remission (CR) rate obtained by the 1st line therapy from 41% to 91% and allowed for median PFS of 3.3 and OS of 6.5 years. In the first relapse, CR rate increased from 16% to 75%, while median PFS and OS totaled 2.2 and 6.5 years, respectively. At 8 years, 30% of patients, consolidated in the 1st line CR were alive, without relapse. Toxicity associated with Y90 is manageable, more severe after fludarabine-based regimens.mixedJurczak, Wojciech; Gruszka, Alicja M; Sowa Staszczak, Anna; Dlugosz-Danecka, Monika; Szostek, Marta; Zimowska-Curylo, Dagmara; Giza, Agnieszka; Krawczyk, Katarzyna; Jakobczyk, Malgorzata; Hubalewska-Dydejczyk, Alicja; Szymczyk, Michal; Wróbel, Tomasz; Knopińska-Posłuszny, Wanda; Kisiel, Elżbieta; Skotnicki, Aleksander; Zinzani, Pier LuigiJurczak, Wojciech; Gruszka, Alicja M; Sowa Staszczak, Anna; Dlugosz-Danecka, Monika; Szostek, Marta; Zimowska-Curylo, Dagmara; Giza, Agnieszka; Krawczyk, Katarzyna; Jakobczyk, Malgorzata; Hubalewska-Dydejczyk, Alicja; Szymczyk, Michal; Wróbel, Tomasz; Knopińska-Posłuszny, Wanda; Kisiel, Elżbieta; Skotnicki, Aleksander; Zinzani, Pier Luig