Caspofungin is an echinocandin with proven efficacy in invasive candidiasis (IC) and invasive aspergillosis (IA). This multicenter, prospective, non-comparative, observational ProCAS study was aimed to assess the effectiveness and safety of caspofungin in adult hematological patients with IC or IA under everyday clinical conditions. Favorable outcomes included complete and partial responses on the last day of caspofungin therapy. Safety was assessed up to 14 days post-caspofungin. A total of 115 patients (69 male) with a median age of 52 years (range, 23-78 years) were analyzed. Underlying disease was acute myeloid leukemia in 45 patients (39%), and 21 (18%) were allogeneic stem cell transplant recipients. Thirty-four (29.5%) patients had a diagnosis of IA and 26 (22.6%) had IC (candidemia). The median duration of caspofungin therapy was 14 days (range, 1-100). The overall favorable response rate was 77% (20/26) for patients with IC (69% first-line) and 79% (27/34) for those with IA. Antifungal therapy with caspofungin was generally well tolerated, only two (1.7%) patients having a non-serious drug-related adverse reaction. These results suggest that caspofungin, either alone or in combination, should be considered an effective and safe option for the treatment of invasive mycoses in patients with severe hematological disorders.
This retrospective study evaluated 66 patients diagnosed with relapsed and/or refractory mantle cell lymphoma (R/R MCL) treated with ibrutinib in Spain in routine clinical practice. At diagnosis, patients had a median age of 64.5 years, 63.6% presented with intermediate/high sMIPI (simplified prognostic index for advanced-stage mantle cell lymphoma), 24.5% had the blastoid variant, and 55.6% had a Ki67 > 30%. Patients had received a median of 2 prior lines of therapy (range 1–2; min–max 1–7). Overall response rate was 63.5%, with 38.1% of patients achieving complete response (CR). With a median duration of ibrutinib exposure of 10.7 months (range 5.2–19.6; min–max 0.3–36), the median progression-free survival (PFS) and overall survival (OS) were 20 months [95% confidence interval (CI) 8.8–31.1] and 32 months (95% CI 22.6–41.3), respectively, and were not reached in patients achieving CR. No grade ≥ 3 cardiovascular toxicity or bleeding was reported. This study supports that treatment with ibrutinib leads to high response rates and favorable survival outcomes in patients with R/R MCL.
Background Consensus is lacking regarding the optimal salvage therapy for patients with follicular lymphoma who relapse after or are refractory to immunochemotherapy. Methods This phase II trial evaluated the efficacy and safety of response‐adapted therapy with rituximab, bendamustine, mitoxantrone, and dexamethasone (RBMD) in follicular lymphoma patients who relapsed after or were refractory to first‐line immunochemotherapy. Sixty patients received three treatment cycles, and depending on their response received an additional one (complete/unconfirmed complete response) or three (partial response) cycles. Patients who responded to induction received rituximab maintenance therapy for 2 years. Results Thirty‐three (55%) and 42 (70%) patients achieved complete/unconfirmed complete response after three cycles and on completing induction therapy (4‐6 cycles), respectively (final overall response rate, 88.3%). Median progression‐free survival was 56.4 months (median follow‐up, 28.3 months; 95% CI, 15.6‐51.2). Overall survival was not reached. Progression‐free survival did not differ between patients who received four vs six cycles (P = .6665), nor between patients who did/did not receive rituximab maintenance after first‐line therapy (P = .5790). Median progression‐free survival in the 10 refractory patients was 25.5 months (95% CI, 0.6‐N/A) and was longer in patients who had shown progression of disease after 24 months of first‐line therapy (median, 56.4 months; 95% CI, 19.8‐56.4) than in those who showed early progression (median, 42.31 months; 95% CI, 24.41–NA) (P = .4258). Thirty‐six (60%) patients had grade 3/4 neutropenia. Grade 3/4 febrile neutropenia and infection were recorded during induction (4/60 [6.7%] and 5/60 [8.3%] patients, respectively) and maintenance (2/43 [4.5%] and 4/43 [9.1%] patients, respectively). Conclusions This response‐adapted treatment with RBMD followed by rituximab maintenance is an effective and well‐tolerated salvage treatment for relapsed/refractory follicular lymphoma following first‐line immunochemotherapy. Clinical trial registration http://clinicaltrials.gov # NCT01133158.
931 Purpose: Multicentre phase II study in newly diagnosed Mantle cell lymphoma patients to determine the feasibility, overall response (OR) and failure free survival (FFS) of intensive chemotherapy type Hyper-CVAD followed by in vivo purging with Rituximab previous peripheral stem-cell transplantation. Treatment scheme consisted in four cycles of Hyper-CVAD chemotherapy as is described by Romaguera et al. After chemotherapy four weekly Rituximab courses (375mg/m2) were administrated previously to peripheral stem-cell collection. Rituximab was not added at the same time as chemotherapy cycles; its role consisted in working as a purging agent previous stem-cell mobilization. After Rituximab administration peripheral blood progenitors were collected. Mobilization was performed using Cyclophosphamide plus G-CSF at dose of 10 μg/Kg/day. If the first mobilization was unsuccessful, a second scheme was used, using Ifosfamide (10 g/m2 in 72 hours infusion on day 1), Mesna (10 g/m2 days 1 and 2), VP16 (150 mg/m2 days 1 to 3) plus G-CSF at dose of 5 μg/Kg each 12 hours. The aim was obtain 2×106 CD34 cells/Kg. After mobilization peripheral autologous stem-cell transplantation (PASCT) was performed using BEAM (BCNU, Ethoposide, Ara-C and Melphalan) as conditioning regimen. .A week after platelet recovery (>50×109/L) another four weekly Rituximab courses (375mg/m2) were added. Patients were followed after treatment in each centre. Forty-four patients diagnosed of mantle cell lymphoma and previously not treated were enrrolled from fifteen Spanish Institutions from 2000 to 2006. The median age of the patients were 55.77 year old. Male/female rate was 3:1. Forty patients had an Ann-Arbor stage IV, and gastrointestinal involvement was present in twenty-nine. Marrow was infiltrated in 83.3% of the cases. Age IPI adjusted were ≥2 in 45% of the cases respectively (table 2). Blastic mantle cell lymphoma was diagnosed in 5 patients (11.9%). The median follow-up of the patients was 75,07 months. In the intention to treat, of the forty-four patients only 26 patients receive all the treatment (59%). Autologous peripheral stem-cell transplantation was not performed in 16 patients. The causes of not complete the treatment schedule was: three patients refuse to be transplanted; mobilization failure in four; death before ABMT in four patients and progression of the lymphoma during HyperCVAD treatment in five patients (table 2). Two patients have a compatible sibling and an allogenic bone marrow was performed; these patients are not included in the series, as protocol violation. Results: Median overall survival (OS) was 77.37 months. The OS of the patients who performed all the planned treatment was 73.6% and 61.96% at three and five years. At the end of the study 21 of the patients were alive. Univariate analysis showed that prolonged overall-free survival was associated to initial ECOG, response achieve (CR or uCR vs PR, non Remission or progression), non-blastic morphology, bone marrow infiltration and performing ASCT. The median FFS was 52.53 months. A plateau was observed in the FFS plot at 72 months. FFS was of 63% at three years of surveillance and 32% at six years for all the patients. For the patients who complete autologous stem-cell transplantation FFS at three and five years were 75.91% and 42.70%. The latest relapse occurred at 73 months after treatment. Nowadays four patients are in remission more than 82 months after diagnosis. Univariate analysis showed that factors that influence were: blastic subtype of MCL, achievements of CR or uCR., and if the patient complete ASCT. Recently two groups have published his results conducting protocols similar with our scheme of protocol. Disappointingly, our results contrast with the rather more optimistic of the Nordic Lymphoma Group with a shorter median follow up (median 3.9 years, 46,8 months) and with the recent up-date of the M.D. Anderson (Blood 2009). In both phase II essays, the 4 year FFS was of 63% and the 6 year PFS of 46% respectably. We noted that even though this prolonged relapse free survival we have relapses up to 6 years of surveillance. Differences with Nordic Lymphoma Group might be caused by not using Rituximab concomitantly with Hyper-CVAD regiment and perhaps increased toxicity of Hyper-CVAD regimen. Disclosures: Palomera: Janssen-Cilag: Honoraria; Celgene: Honoraria.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.