Surveillance investigations after high-dose therapy with stem cell rescue for recurrent follicular lymphoma have no impact on management

Gerlinger, Marco; Rohatiner, A. Z. S.; Matthews, Janet; Davies, Andrew; Lister, T. Andrew; Montoto, Silvia

doi:10.3324/haematol.2009.020115

Cited by 10 publications

(9 citation statements)

References 12 publications

(14 reference statements)

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“…This analysis concluded that detecting recurrence by imaging studies and CA-125 does not improve prognosis, even if recurrence is detected before symptoms develop. Studies involving cancers outside of gynecologic malignancies have also found no survival advantage to routine CT scan surveillance [23–28]. The present study found that CT scan did detect 15% of recurrences.…”

Section: Discussioncontrasting

confidence: 42%

Patterns and utility of routine surveillance in high grade endometrial cancer

Hunn

Tenney

Tergas

et al. 2015

Gynecologic Oncology

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Objective To evaluate surveillance methods and their utility in detecting recurrence of disease in a high grade endometrial cancer population. Methods We performed a multi-institutional retrospective chart review of women diagnosed with high grade endometrial cancer between the years 2000 and 2011. Surveillance data was abstracted and analyzed. Surveillance method leading to detection of recurrence was identified and compared by stage of disease and site of recurrence. Results Two hundred and fifty-four patients met the criteria for inclusion. Vaginal cytology was performed in the majority of early stage patients, but was utilized less in advanced stage patients. CA-125 and CT imaging were used more frequently in advanced stage patients compared to early stage. Thirty-six percent of patients experienced a recurrence and the majority of initial recurrences (76%) had a distant component. Modalities that detected cancer recurrences were: symptoms (56%), physical exam (18%), surveillance CT (15%), CA-125 (10%), and vaginal cytology (1%). All local recurrences were detected by symptoms or physical exam findings. While the majority of loco-regional and distant recurrences (68%) were detected by symptoms or physical exam, 28% were detected by surveillance CT scan or CA 125. One loco-regional recurrence was identified by vaginal cytology but no recurrences with a distant component detected by this modality. Conclusions Symptoms and physical examination identify the majority of high grade endometrial cancer recurrences, while vaginal cytology is the least likely surveillance modality to identify a recurrence. The role of CT and CA-125 surveillance outside of a clinical trial needs to be further reviewed

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Section: Discussioncontrasting

confidence: 42%

Patterns and utility of routine surveillance in high grade endometrial cancer

Hunn

Tenney

Tergas

et al. 2015

Gynecologic Oncology

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“…While it is obvious that patients should be encouraged to lead a healthy lifestyle and exercise and avoid/abandon smoking, it is unknown whether specific screening programs or preventive strategies should be recommended in patients with FL [18]. A restrictive use of surveillance imaging may be appropriate, given the lack of evidence in support of routine imaging [19,20] and the increased risk of cancer due to radiation exposure in these patients [21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Incidence of solid cancer in patients with follicular lymphoma

et al. 2019

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Introduction: Patients with follicular lymphoma (FL) have classically had a higher risk of solid cancers than the general population, but there is little data available in patients diagnosed and treated with modern day regimens. Material and methods: We conducted a retrospective multicenter study assessing the cumulative incidence of solid cancers other than nonmelanoma skin cancer in patients with FL between 1997 and 2016 and determined the standardized incidence ratio (SIR) to compare the incidence of solid cancers with that of the general population Results: Among 1002 FL patients with 7 years of median follow-up, we found 74 solid cancers (most common breast [n ¼ 19], lung and colon [n ¼ 9 each]). The cumulative incidence was 3.8% at 5 years (95%CI 2.6-5.2) from the time of diagnosis and 4.4% at 5 years (95%CI 3.1-5.9%) from the time of front-line treatment. Although a comparison of all front-line strategies did not reveal differences in the risk of solid cancers, patients treated with anthracycline-based regimens appeared to have a lower incidence than those treated with bendamustine-based strategies (2.8% vs. 6.9%). However, patients receiving the former regimen were younger than the latter. On multivariable analysis, older age was correlated with the incidence of solid cancer and bendamustine-based treatment was of borderline significance. SIR for any solid cancer was 1.22 (95%CI 0.91-1.64), indicating no increased risk of solid cancer in patients with FL over that of the general population. However, on subgroup analyses, female patients treated with bendamustine-based strategies appeared to have a greater risk (SIR 3.85 [95%CI 1.45-10.27]) Discussion: The incidence of solid cancer in this cohort of patients with FL was low and not greater than in the general population. However, the risk may be greater in female patients treated with bendamustine.

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“…Of course, a decade or more of follow-up may be required before the curative potential of brentuximab vedotin in the multiply relapsed/refractory setting can be confirmed. Although relapses are usually clinically symptomatic and patient-reported signs and symptoms appear reliable in the detection of lymphoma progression, [9][10][11][12][13][14][15] it is possible that progression based on CT assessment alone and in lieu of clinical symptoms may have been declared for some patients if the requirement for routine CT scanning had been maintained.…”

Section: Discussionmentioning

confidence: 99%

Durable remissions in a pivotal phase 2 study of brentuximab vedotin in relapsed or refractory Hodgkin lymphoma

Gopal

Chen

Smith

et al. 2015

Blood

200

139

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Key Points• A total of 47% of patients who achieved CR on brentuximab vedotin remain progression-free after being followed a median of 53 months.• Younger age, less functional impairment, and lower disease burden at baseline were associated with CR and prognostic for longer survival.We present response and survival outcomes of a pivotal phase 2 trial of the antibody-drug conjugate brentuximab vedotin in patients with relapsed/refractory Hodgkin lymphoma following autologous stem cell transplant (N 5 102) after a median observation period of approximately 3 years. Median overall survival and progression-free survival were estimated at 40.5 months and 9.3 months, respectively. Improved outcomes were observed in patients who achieved a complete remission (CR) on brentuximab vedotin, with estimated 3-year overall survival and progression-free survival rates of 73% (95% confidence interval [CI]: 57%, 88%) and 58% (95% CI: 41%, 76%), respectively, in this group (medians not reached). Of the 34 patients who obtained CR, 16 (47%) remain progression-free after a median of 53.3 months (range, 29.0 to 56.2 months) of observation; 12 patients remain progression-free without a consolidative allogeneic stem cell transplant. Younger age, good performance status, and lower disease burden at baseline were characteristic of patients who achieved a CR and were favorable prognostic factors for overall survival. These results suggest that a significant proportion of patients who respond to brentuximab vedotin can achieve prolonged disease control. The trial was registered at www.clinicaltrials.gov as #NCT00848926. (Blood. 2015;125(8):1236-1243

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Surveillance investigations after high-dose therapy with stem cell rescue for recurrent follicular lymphoma have no impact on management

Cited by 10 publications

References 12 publications

Patterns and utility of routine surveillance in high grade endometrial cancer

Patterns and utility of routine surveillance in high grade endometrial cancer

Incidence of solid cancer in patients with follicular lymphoma

Durable remissions in a pivotal phase 2 study of brentuximab vedotin in relapsed or refractory Hodgkin lymphoma

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