scholarly journals NCCN-IPI in Patients with Diffuse Large B CELL Lymphoma Treated with DA-R-EPOCH. Retrospective Analysis

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5401-5401
Author(s):  
Juan Miguel Bergua Burgues ◽  
Luis Lopez-Gomez ◽  
Fatima Ibañez ◽  
Sara Suarez-Varela ◽  
Julio Prieto-Fernandez ◽  
...  

Abstract We analyzed the value of new NCCN-IPI index in patients affected of Large B cell lymphoma (LBCL) treated with DA-EPOCH-R in order to assess the validity of this index in patients treated homogenously with dose adjusted R-EPOCH. Patients and protocol: We analyzed the use of NCCN-IPI (Zhou et al, 2014) index in a retrospective cohort of 98 DLBCL patients treated with -EPOCH. These patients were included in DA-EPOCH using IPI(Shipp M.A., 1993) as criteria of inclusion, including only patients (95 patients, 96%)with suspected bad prognosis based in IPI (2-5) and 3 patients with primary mediastinal large B cell lymphoma (PMLBCL). R-EPOCH was administered as reported previously(Wilson et al, 2013). Only 10 patients (10%) were Ann Arbor stage I or II. Results: The median age of the cohort was 57,13(15-82), 47 woman, 75 patients alived. The median follow-up of the patients alive is 6,7 years (1,3-11). Ann Arbor stage was IVB in 44 patients, and IVA in 21. Responses during treatment: Complete response (CR): 81 (82%), refractory during treatment: 7 (7%), death during treatment: 7 (7%). The number of patients who relapsed after treatment was 19 (20%). The median overall (OS) survival of all patients was not reached, (at 5 years, 0.669, CI: 0.562-0.798). The progression free survival (PFS) at 5 years is 0.62, CI: 0.483-0.795. We classify by the new NCCN-IPI the patients in Low-Intermediate risk (L-I)(3 patients, 3%), High-Intermediate risk (H-I)(38, 44%) and High risk (HR) (45, 52%). The OS at 5 years in H-I is 0.839 (CI: 0.73-0.96) and HR was 0.56 (CI: 0.421-0.754), p=0.025. The PFS at 5 years in H-I is 0.65 (CI: 0.518-0.826) and HR is 0.57 (CI: 0.43-0.755), p=0.4. Conclusions: NCCN-IPI discriminates well prognosis between HR/H-I patients with DLBCNHL treated with DA-EPOCH-R. The results of this retrospective analysis of high and intermediate high-risk patients compares better than the published in patients treated with R-CHOP. PFS were similar in H-I and HR; differences in OS could be explain by differences in outcome after salvage treatment with autologous stem cell Disclosures No relevant conflicts of interest to declare.

Praxis ◽  
2016 ◽  
Vol 105 (1) ◽  
pp. 47-52 ◽  
Author(s):  
Andreas Lohri

Zusammenfassung. Maligne Lymphome unterteilen sich zwar in über 60 Entitäten, das grosszellige B-Zell-Lymphom, das follikuläre Lymphom, der Hodgkin und das Mantelzell-Lymphom machen aber mehr als die Hälfte aller Lymphome aus. Im revidierten Ann Arbor staging system gelten die Suffixe «A» und «B» nur noch für den Hodgkin. «E» erscheint nur noch bei Stadien I und II. Eine Knochenmarksuntersuchung wird beim Hodgkin nicht mehr verlangt, beim DLBCL (Diffuse large B cell lymphoma) nur, falls das PET keinen Knochenmark-Befall zeigt. Der PET-Untersuchung, speziell dem Interim-PET, kommt eine entscheidende Bedeutung zu. PET-gesteuerte Therapien führen zu weniger Toxizität. Gezielt wirkende Medikamente mit eindrücklicher Wirksamkeit wurden neu zugelassen. Deren Kosten sind hoch. Eine strahlen- und chemotherapiefreie Behandlung maligner Lymphome wird in Zukunft möglich sein.


Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 11-11
Author(s):  
Bert Heyrman ◽  
Nikki Granacher ◽  
Ka Lung Wu

Introduction: The incidence and outcome of Waldenström's macroglobulinemia (WM) patients with transformation to diffuse large B-cell lymphoma (DLBCL) are unclear. We performed a retrospective analysis to determine the incidence, clinicopathological characteristics and treatment outcome of WM patient with histologic transformation to DLBCL in our centre. Methods: Single centre chart review of WM patients in the past 10 years. Patients with histologic diagnosis of DLBCL after the diagnosis WM were included in our analysis. Results: Three of the 79 WM patients had histological transformation to DLBCL, two male and one female. Mean age at DLBCL development was 76,6 years. The mean time to transformation since diagnosis of WM was 8,3 years (14, 8 and 3 years). All three patients received at least one prior line of treatment in relation to WM (2, 1 and 3 prior lines). Different regimens used were cyclophosphamide/dexamethasone, rituximab/bendamustin, chlorambucil monotherapy, fludarabine monotherapy, R-CVP and ibrutinib monotherapy. The patients were in clinical CR from WM at the time of transformation, two patients were still on treatment. All three patients presented with advanced disease (stage IIIB, IVB, and IVA) non-GCB subtype DLBCL with at least 2 extra nodal sites. R-IPI scores were 4,5 and 4. Two patients were treated with R-miniCHOP, one patient received R-CHOP. The first patient achieved a CR at the end of treatment and is now 1,5 years in follow-up. The second patient died from pneumonia one year after achieving a CR. The third patient is in follow op since 3 months after reaching a CR at the end of treatment. Conclusion: Over the past decade transformation of WM to DLBCL was 3.7% in our centre. This is in accordance with previous data suggesting an 2.4% risk of transformation over 10 years.Time to transformation varies and no association with prior WM therapy and response to treatment can be found.All patients presented with more aggressive DLBCL in an advanced stage.All three patients achieved a CR following treatment for DLBCL, one patient died from pneumonia, two others are now in follow-up 1,5 years and 3 months respectively. Disclosures Heyrman: Celgene:Research Funding.


2020 ◽  
Vol 31 (9) ◽  
pp. 1251-1259 ◽  
Author(s):  
A.K. McMillan ◽  
E.H. Phillips ◽  
A.A. Kirkwood ◽  
S. Barrans ◽  
C. Burton ◽  
...  

2019 ◽  
Vol 132 (15) ◽  
pp. 1807-1814
Author(s):  
Peng Liu ◽  
Ying Han ◽  
Shi-Yu Jiang ◽  
Xiao-Hui He ◽  
Yan Qin ◽  
...  

2014 ◽  
Vol 38 (12) ◽  
pp. 1446-1450 ◽  
Author(s):  
Francesca Merchionne ◽  
Giovanni Quintana ◽  
Francesco Gaudio ◽  
Carla Minoia ◽  
Giorgina Specchia ◽  
...  

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