Chemotherapeutic intensity and survival differences in young patients with diffuse large B‐cell lymphoma: a Swedish Lymphoma Registry study

Melén, Christopher M.; Enblad, Gunilla; Sonnevi, Kristina; Junlén, Henna Riikka; Smedby, Karin E.; Wahlin, Björn Engelbrekt

doi:10.1111/bjh.14399

Cited by 14 publications

(14 citation statements)

References 22 publications

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“…A variety of studies have been undertaken to improve upon outcome achieved with R-CHOP. More intensive chemotherapy regimens have been comparatively studied in younger cohorts, with variable results [17][18][19][20]. Advances beyond R-CHOP, with the addition of agents as bortezomib [21][22][23], everolimus [24], ibrutinib [25][26][27], and lenalidomide [28][29][30], have been limited to-date.…”

Section: Discussionmentioning

confidence: 99%

Treatment approaches for older and oldest patients with diffuse large B-cell lymphoma – Use of non-R-CHOP alternative therapies and impact of comorbidities on treatment choices and outcome: A Humedica database retrospective cohort analysis, 2007–2015

Morrison

Hamilton²,

Ogbonnaya³

et al. 2020

Journal of Geriatric Oncology

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a b s t r a c tIntroduction: We characterized real-world treatment patterns in older (65-74 years) and oldest (75-85 years) patients with diffuse large B-cell lymphoma (DLBCL) receiving initial therapy (R-CHOP, non-R-CHOP regimens). Impact of comorbidities on treatment choice, and overall and progression-free survival (OS, PFS) were assessed by age. Patients and Methods: Using the Humedica database, we identified 1436 newly diagnosed patients with DLBCL who received frontline therapy from 1/07-9/15. The 885 patients ≥65 years of age were further evaluated for baseline demographics, comorbidities, initial therapy, and PFS/OS. Results: Of 885 patients, 406 (45.9%) were age 65-74, and 479 (54.1%) age 75-85, years. First line therapy was R-CHOP (61.8%) or non-R-CHOP (38.2%). Although Charlson Comorbidity Index (CCI) scores were similar at baseline, congestive heart failure and myocardial infarction were more common in those receiving non-R-CHOP regimens. Survival outcomes were superior for those receiving initial R-CHOP, versus non-R-CHOP, therapy (median PFS 53.9 versus 27.8 months; two-year PFS 71.2% versus 51.6%, p b .0001; median OS not reached versus 45 months; two-year OS 81.3% versus 62.9%, p b .0001, respectively). Only 10.4% (R-CHOP) and 12.1% (non-R-CHOP) of patients received second line therapies. Two-year OS by age (65-74, 75-85 years) was 66.4% and 39.1%, respectively with R-CHOP (p = .0045), and 74.3% and 54.5%, respectively with non-R-CHOP (p = .004), therapy. Age ≥ 75 years and CCI of 2+ were associated with shorter OS and PFS. Conclusions: This study identified real-world first line treatment patterns for older patients with DLBCL. Our findings support the feasibility of administering standard R-CHOP therapy, even to oldest patients with DLBCL.

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Section: Discussionmentioning

confidence: 99%

Treatment approaches for older and oldest patients with diffuse large B-cell lymphoma – Use of non-R-CHOP alternative therapies and impact of comorbidities on treatment choices and outcome: A Humedica database retrospective cohort analysis, 2007–2015

Morrison

Hamilton²,

Ogbonnaya³

et al. 2020

Journal of Geriatric Oncology

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“…Consistent with our findings, recent retrospective studies have shown that addition of HD-Mtx to a CHOP/R-CHOP regimen improves the prognosis of patients with high-risk DLBCL, irrespective of their risk for CNS relapse. [31][32][33] Whether or to what extent the low number of CNS relapses observed in our study is a consequence of a systemic efficacy of early administration of HD-Mtx needs to be confirmed in a randomized study.…”

Section: Discussionmentioning

confidence: 82%

Patients with high-risk DLBCL benefit from dose-dense immunochemotherapy combined with early systemic CNS prophylaxis

et al. 2020

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Survival of patients with high-risk diffuse large B-cell lymphoma (DLBCL) is suboptimal, and the risk of central nervous system (CNS) progression is relatively high. We conducted a phase 2 trial in 139 patients aged 18 to 64 years who had primary DLBCL with an age-adjusted International Prognostic Index (aaIPI) score of 2 to 3 or site-specific risk factors for CNS recurrence. The goal was to assess whether a dose-dense immunochemotherapy with early systemic CNS prophylaxis improves the outcome and reduces the incidence of CNS events. Treatment consisted of 2 courses of high-dose methotrexate in combination with biweekly rituximab (R), cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP-14), followed by 4 courses of R-CHOP-14 with etoposide (R-CHOEP) and 1 course of high-dose cytarabine with R. In addition, liposomal cytarabine was administered intrathecally at courses 1, 3, and 5. Coprimary endpoints were failure-free survival and CNS progression rates. Thirty-six (26%) patients experienced treatment failure. Progression occurred in 23 (16%) patients, including three (2.2%) CNS events. At 5 years of median follow-up, failure-free survival, overall survival, and CNS progression rates were 74%, 83%, and 2.3%, respectively. Treatment reduced the risk of progression compared with our previous trial, in which systemic CNS prophylaxis was given after 6 courses of biweekly R-CHOEP (hazard ratio, 0.49; 95% CI, 0.31-0.77; P = .002) and overcame the adverse impact of an aaIPI score of 3 on survival. In addition, outcome of the patients with BCL2/MYC double-hit lymphomas was comparable to the patients without the rearrangements. The results are encouraging, with a low toxic death rate, low number of CNS events, and favorable survival rates. This trial was registered at www.clinicaltrials.gov as #NCT01325194.

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“…Ah andfulo fc ombinations of chemotherapeutic treatments is routinely appliedt ot he patientss uffering from DLBCL. [45] Amongt hese chemotherapeutic drugs, we have chosen three most commond rugsd oxorubicin, etoposide and prednisolone for our current study. [37,[46][47][48] Prednisolone is the active form of pro-drugp rednisone, after metabolism in the liver.…”

Section: Resultsmentioning

confidence: 99%

Selective Release of Doxorubicin from Cucurbit[8]uril Stabilized Gold Supra‐Pyramid Host at pH of Small Intestine

Saini

Ghosh

Kumar

et al. 2020

Chemistry A European J

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Gold supra-pyramid structures wereo btained by the addition of acidic solution of cucurbit[8]uril(CB[8]) to an aqueous solution of citrate stabilized gold nanoparticles (AuNP). The reactionr esulted in the precipitation of suprapyramid from the solution after just 1min of shaking. Microscopic images confirmed formation of the supra-pyramid. The stepwise structural transformation towards the suprapyramid was examined with variable concentrations of CB[8] to AuNP solution. Anionic counterp arts of thesea cids (Br À , NO 3 À ,S O 4 2À and Cl À)c ontrolled the size of the synthesized supra-pyramids. These supra-pyramid hosts showed uptake of three anticancer drugs:o ral drugs etoposide, prednisolone and intravenousd rug doxorubicin. Releases of drugs from these hosts were emulated at acidic stomach pH, basic small intestinal pH and in the presence of human serum albumin (HSA). The specific release of doxorubicin was confirmed at small intestinal pH 7.4. Poor release of drugs in presence of CB[8] specific guest 1-adamantanamine confirmed the role of the supra-pyramid as the exclusive host. The release of doxorubicin from the supra-pyramid at pH 7.4 was confirmed by fluorescencem icroscopici maging with prostate cancer DU-145 cell line.

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Chemotherapeutic intensity and survival differences in young patients with diffuse large B‐cell lymphoma: a Swedish Lymphoma Registry study

Cited by 14 publications

References 22 publications

Treatment approaches for older and oldest patients with diffuse large B-cell lymphoma – Use of non-R-CHOP alternative therapies and impact of comorbidities on treatment choices and outcome: A Humedica database retrospective cohort analysis, 2007–2015

Treatment approaches for older and oldest patients with diffuse large B-cell lymphoma – Use of non-R-CHOP alternative therapies and impact of comorbidities on treatment choices and outcome: A Humedica database retrospective cohort analysis, 2007–2015

Patients with high-risk DLBCL benefit from dose-dense immunochemotherapy combined with early systemic CNS prophylaxis

Selective Release of Doxorubicin from Cucurbit[8]uril Stabilized Gold Supra‐Pyramid Host at pH of Small Intestine

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