scholarly journals A Case Report of Nongerminal Center B-Cell Type Diffuse Large B-Cell Lymphoma Treated to Complete Response with Rituximab and Ibrutinib

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Geoffrey Shouse ◽  
Miemie Thinn
Keyword(s):  
Elderly Patients ◽  
B Cell ◽  
Intracellular Signaling ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Cell Type ◽  
Large B Cell Lymphoma ◽  
Significant Toxicity ◽  
Large B Cell

Diffuse large B-cell lymphoma (DLBCL) is a molecularly heterogeneous disease consisting of different subtypes with varying clinical behaviors. For example, the activated B-cell-like (ABC) type of DLBCL has lower cure rates with traditional chemotherapy regimens. The molecular pathway promoting tumorigenic growth of the ABC type includes a dependence on intracellular signaling by Bruton’s agammaglobulinemia tyrosine kinase (BTK). This specific pathway has led to the investigation of the utility of ibrutinib in treatment of this type of lymphoma at relapse or in combination with standard chemotherapy. In elderly patients stricken with this disease, standard combination chemotherapy can pose significant toxicity. Some reduced intensity regimens have activity but significantly less favorable long-term outcomes and still pose significant toxicity to elderly patients. In the following case, we demonstrate induction of complete response in an elderly patient with significant comorbidities with nongerminal center B-cell type (NGCB) DLBCL treated with rituximab, ibrutinib, and prednisone. Toxicity included atrial fibrillation that ultimately led to heart failure as well as sepsis which ultimately led to the patient’s demise. Despite this fact, the response to treatment appeared durable. This case illustrates the utility and limitations of molecularly targeted therapies to treat aggressive lymphoma in frail elderly patients.

Rituximab in Combination with Cyclophosphamide, Mitoxantrone, Vincristine and Prednisone (R-CNOP) As First Line Regimen in Elderly Patients with Diffuse Large B-Cell Lymphoma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5390-5390
Author(s):  
Alma Aslan ◽  
Alev Turker ◽  
Ayse Kars ◽  
Ibrahim Barista ◽  
Evren Ozdemir
Keyword(s):  
Ejection Fraction ◽  
Elderly Patients ◽  
B Cell ◽  
Progressive Disease ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Hematological Toxicity ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Diffuse large B-cell lymphoma (DLBCL) is a treatable and potentially curable malignancy that is increasing in prevalence in the elderly. Because of geriatric considerations including functional status and comorbidities and increased toxicity concerns, older patients are sometimes given reduced dose therapy. Mitoxantrone has a broad anti-tumour activity including lymphoma with potentially less cardiotoxicity than doxorubicin, which may be of particular importance in the treatment of elderly aggressive lymphoma patients. This study's objective was to evaluate the efficacy and safety of R-CNOP (rituximab plus cyclophosphamide/mitoxantrone/vincristine/prednisone) combination regimen at standart doses in elderly patients with newly diagnosed diffuse large B-cell lymphoma. Mitoxantrone was given at the dose of 12 mg/m2. Twenty-four patients were enrolled. All patients had an ECOG performance status ≤ 2. Twenty-two patients (91.7%) had several comorbidities, the most common were cardiac diseases and hypertension (56%). Excluding one patient and with a borderline heart function (ejection fraction of 50%), all patients had an ejection fraction (EF) of ≥60%. The median age was 71 years (50-78) and 20 (83%) were female. Nineteen (79.2%) patients were stage III-IV and 15 (62.5%) patients had high-intermediate or high aa-IPI score. Thirteen patients (52%) had Ki-67 proliferation index > 80%. Three patients was myc positive. Twelve were non-germinal center phenotype. Median number of R-CNOP cycles administered to the patients was 6 (3-6). Treatment response was evaluated with PET-CT before and after the treatment. Of 24 patients, 19 (79.2%) had complete response, 3 (12.5%) had partial response, 2 (8.3%) had refractory/progressive disease. Two patients who had refractory/progressive disease received salvage chemotherapy and achieved complete response. The median follow-up was 18.78 (5.6-82.8) months. The median time to progression for responding patients (n=3) was was 14.3 (4.5-79.1) months. Median DFS and OS were not reached. Main toxicity was hematological. Grade ≥3 hematologic toxicity occurred in 13 patients: neutropenia (37.5%), thrombocytopenia (8.4%), and anemia (8.3%). Four (16.7%) patients developed febrile neutropenia and two patient developed pulmonary thromboembolism during therapy. Treatment cycle postponed in 11 (45.8%) patients without dose reduction because of hematological toxicity. Nineteen (79.2%) patients received G-CSF primary prophylaxis. After the treatment EF decreased (≤50%) only in two patients, who had coronary artery disease before the treatment. The patient who had borderline EF had stable EF after the treatment. R-CNOP was shown to be an effective and safe regimen in elderly patients with diffuse large B-cell lymphoma. The majority of the patients had long term disease control. Hematological toxicity was common. Disclosures No relevant conflicts of interest to declare.

Reduced-dose ICE chemotherapy ± rituximab is a safe and effective salvage therapy for fit elderly patients with diffuse large B-cell lymphoma

2015 ◽  
Vol 57 (7) ◽  
pp. 1633-1639 ◽  
Author(s):  
Nadav Sarid ◽  
Erel Joffe ◽  
Lili Gibstein ◽  
Irit Avivi ◽  
Aaron Polliack ◽  
...  
Keyword(s):  
Elderly Patients ◽  
B Cell ◽  
Salvage Therapy ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Reduced Dose ◽  
Large B Cell Lymphoma ◽  
Large B Cell

scholarly journals Role of anthracycline and comprehensive geriatric assessment for elderly patients with diffuse large B-cell lymphoma

Blood ◽  
2017 ◽  
Vol 130 (20) ◽  
pp. 2180-2185 ◽  
Author(s):  
Richard J. Lin ◽  
Madhusmita Behera ◽  
Catherine S. Diefenbach ◽  
Christopher R. Flowers
Keyword(s):  
Elderly Patients ◽  
B Cell ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Cell Lymphoma ◽  
Treatment Decision ◽  
B Cell Lymphoma ◽  
Treatment Decision Making ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Survival outcome for elderly patients with newly diagnosed diffuse large B-cell lymphoma remains suboptimal in the rituximab era. In this systematic review, we summarize available evidence relevant to the inclusion of anthracycline in upfront chemoimmunotherapy for these elderly patients and highlight the need of prospective clinical trials. With limited prospective data, we find that pretreatment comprehensive geriatric assessment accurately predicts survival and treatment-related toxicities, suggesting its potential role in guiding overall treatment decision-making.

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