scholarly journals Bendamustine in chronic lymphocytic leukemia: Outcome according to different clinical and biological prognostic factors in the everyday clinical practice

2013 ◽  
Vol 88 (11) ◽  
pp. 955-960 ◽  
Author(s):  
Francesco Zaja ◽  
Michael Mian ◽  
Stefano Volpetti ◽  
Carlo Visco ◽  
Cinzia Sissa ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Clinical Practice ◽  
Chronic Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
Everyday Clinical Practice ◽  
The Everyday ◽  
Biological Prognostic Factors

What Is Known about the Clinical and Economic Burden of Refractory Chronic Lymphocytic Leukemia in Clinical Practice: A Review of the Literature.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4549-4549
Author(s):  
Gwilym J Thompson ◽  
Vincent Lévy ◽  
Krista Payne ◽  
Radek Wasiak ◽  
Yvonne Lis
Keyword(s):  
Prognostic Factors ◽  
Clinical Practice ◽  
Chronic Lymphocytic Leukemia ◽  
Conference Proceedings ◽  
Natural History ◽  
Clinical Outcomes ◽  
Economic Burden ◽  
Treatment Options ◽  
Lymphocytic Leukemia ◽  
Review Articles

Abstract Abstract 4549 Introduction Chronic lymphocytic leukemia (CLL) is the most common adult haematological malignancy in the Western world. It remains incurable and follows an extremely variable clinical course with survival ranging from months to decades. In those who become refractory to fludarabine based therapy, median survival is less than 1 year. Methods To identify data related to the clinical and economic sequelae of patients in routine clinical care diagnosed with refractory CLL, a systematic literature search of MEDLINE and EMBASE was conducted for the period January 1999-July 2009. The search terms used included incidence, prevalence, natural history, characteristics, clinical management, clinical outcomes, use of health care resources and was focused on patients with fludarabine refractory CLL also refractory to alemtuzumab (fludarabine and alemtuzumab refractory) or less suitable for alemtuzumab due to bulky lymph nodes (bulky fludarabine refractory). Supplementary checks were made of reference lists, particularly in review articles. Relevant conference proceedings for the period January 2006-July 2009 were also examined. Results The search of MEDLINE and EMBASE identified 102 articles of which 26 reported on the more general populations of patients with haematological malignancies, 61 on CLL and 15 on refractory CLL. Of those articles reporting data in relation to CLL (n=61), 49 described patient characteristics and outcomes, prognostic factors, diagnostic and treatment options, natural history of the disease, epidemiology, patient management and specific treatment outcomes and 12 review articles addressed areas such as prognostic factors and treatment options. Of those reporting on refractory CLL (n=15), one was a review article of novel agents and 14 were studies evaluating outcomes following salvage treatment with various pharmaceutical agents and other therapeutic interventions but mainly in patients refractory to fludarabine. Only one US study had evaluated patients who were refractory to both fludarabine and alemtuzumab or were bulky fludarabine refractory, examining response and survival following a variety of salvage treatments (Tam et al. Leukemia and Lymphoma 2007;48:1931-9). The search of conference proceedings identified 27 abstracts, 19 of which evaluated patients with CLL reporting on a range of topics including natural history and survival, prognostic factors and outcomes achieved with existing and experimental pharmaceutical interventions. Only two abstracts specifically reported on patients who were refractory to both fludarabine and alemtuzumab or were bulky fludarabine refractory, examining response rates following administration of a novel pharmaceutical agent (European Haematology Association Meeting 2009, abstracts 0494 and 0919). Conclusions There is very little data from clinical practice on clinical outcomes and none on economic sequelae for patients with double refractory or bulky nodal refractory disease. The lack of such data is likely to hinder the achievement of better outcomes for patients and the evaluation of cost effectiveness for newer agents. This lack of data to inform clinical practice and decision making has prompted the initiation of an observational study in five European countries with the objectives of characterising the current patterns of care, survival outcomes and resource utilization in double refractory and bulky nodal refractory CLL patients in Europe. The study, based on a retrospective chart review of approximately 250 patients, is currently underway in France, Germany, Italy, Spain and the UK. It is anticipated that the results, planned to be available by the end of 2009, will help to identify unmet clinical needs, quantify the clinical and economic burden in this particular population and contribute to the development of new treatment guidelines. Disclosures: Lévy: GlaxoSmithKline: Consultancy. Payne:GlaxoSmithKline: Consultancy. Wasiak:GlaxoSmithKline: Consultancy. Lis:GlaxoSmithKline: Consultancy.

scholarly journals <i>SEPT10</i> Expression in Chronic Lymphocytic Leukemia. Correlation with Clinical and Biological Prognostic Factors

2013 ◽  
Vol 03 (03) ◽  
pp. 11-16
Author(s):  
Ana Travella ◽  
Julieta Panero ◽  
Carmen Stanganelli ◽  
Raimundo Bezares ◽  
Irma Slavutsky
Keyword(s):  
Prognostic Factors ◽  
Chronic Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
Biological Prognostic Factors

Prospective study of clinical and biological prognostic factors at diagnosis in patients with early stage B-cell chronic lymphocytic leukemia

2011 ◽  
Vol 52 (3) ◽  
pp. 429-435 ◽  
Author(s):  
Ana C. Oliveira ◽  
Esmeralda de la Banda ◽  
Eva Domingo-Domenech ◽  
Maite Encuentra ◽  
Santiago Mercadal ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Chronic Lymphocytic Leukemia ◽  
Prospective Study ◽  
B Cell ◽  
Early Stage ◽  
Lymphocytic Leukemia ◽  
Cell Chronic Lymphocytic Leukemia ◽  
Biological Prognostic Factors

Practical considerations and questions in the treatment of chronic lymphocytic leukemia

2011 ◽  
Vol 152 (24) ◽  
pp. 958-963
Author(s):  
Béla Telek ◽  
László Rejtő ◽  
Péter Batár ◽  
Gyula Reményi ◽  
Róbert Szász ◽  
...  
Keyword(s):  
Overall Survival ◽  
Treatment Outcome ◽  
Clinical Practice ◽  
Chronic Lymphocytic Leukemia ◽  
Prognostic Markers ◽  
Lymphocytic Leukemia ◽  
Everyday Clinical Practice ◽  
The Past ◽  
Remission Rates ◽  
Molecular Biological Techniques

Understanding the pathogenesis and refine the treatment of chronic lymphocytic leukemia have been tremendously improved in the past decade. Treatment outcome and estimated prognosis have become more accurate due to the advanced molecular biological techniques and the classical prognostic markers. Incorporation of fludarabine and rituximab into the standard protocols fundamentally improved treatment outcome in chronic lymphocytic leukemia. Chemoimmunotherapy has improved not only the remission rates but had a significant impact on overall survival, as well. Eliminating residual leukemia and achieving complete hematological remissions at such high rates establish potential background for cure. Still, a great deal of dispute has been emerged regarding everyday clinical practice. Authors present their institutional experiences and review the literature. Orv. Hetil., 2011, 152, 958–963.

Complex analysis of prognostic factors in chronic lymphocytic leukemia

2007 ◽  
Vol 148 (16) ◽  
pp. 737-743
Author(s):  
Béla Kajtár ◽  
Pál Jáksó ◽  
László Kereskai ◽  
Ágnes Lacza ◽  
Gábor Méhes ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Chronic Lymphocytic Leukemia ◽  
Complex Analysis ◽  
Lymphocytic Leukemia

Bevezetés: Az utóbbi években felfedezett számos új prognosztikai faktor segítséget nyújthat a várható túlélés meghatározásához krónikus lymphocytás leukémia esetében. Célok: Jelen tanulmány célja e prognosztikai faktorok gyakoriságának, valamint egymással való összefüggésének meghatározása volt 419 beteg mintáin. Módszerek: 160 esetben végezték el az immunglobulin-nehézláncgén mutációs vizsgálatát. Eredmények: Az esetek 62%-ában nem mutált immunglobulin gént találtak, a nehézlánc géncsaládok használata különbözött a mutációs státusz függvényében. A CD38 expresszió 78%-os konkordanciát mutatott a mutációs státusszal, a ZAP-70-expresszió tekintetében korrelációt nem figyeltek meg. Citogenetikai abnormalitást 76%-ban láttak, a leggyakoribb eltérések a del(13q) (57%), a 12-es triszómia (15%), a del(11q) (12%) és a del(17p) (6%) voltak. A del(11q)-t hordozó esetek 95%-a nem mutált, az egyedül del(13q)-t hordozó esetek 74%-a mutált IgH-gént tartalmazott. Következtetések: A vizsgált paraméterek nem függetlenek egymástól, ezért alkalmazásuk a klinikai gyakorlatban gondos tervezést igényel.

Role of implantable loop recorder in the clinical diagnosis of syncope: Results of the introduction of an effective diagnostic tool

2015 ◽  
Vol 156 (15) ◽  
pp. 609-613
Author(s):  
Miklós Somlói ◽  
Emil Toldy-Schedel ◽  
Zoltán Nényei ◽  
Róbert Böszörményi ◽  
János Tomcsányi
Keyword(s):  
Clinical Practice ◽  
Diagnostic Yield ◽  
Diagnostic Algorithm ◽  
Definitive Treatment ◽  
Implantable Loop Recorder ◽  
Everyday Clinical Practice ◽  
Loop Recorder ◽  
Early Application ◽  
Electrocardiographic Monitoring ◽  
The Everyday

Introduction: Extension of electrocardiographic monitoring via loop recorder implantation may increase the diagnostic yield of syncope work-up. Aim: In this retrospective observational study, the authors wanted to evaluate the diagnostic performance of implantable loop recorder in the everyday clinical practice. Method: The authors analyzed the electronically stored data of all patients who underwent loop recorder implantation between 2005 and 2014 in their cardiology department because of recurrent syncope of undetermined origin. Results: There were 52 loop recorder implantations within the study period. During the 167 (±136) days of monitoring, 36 (69.2%) diagnostic events occurred. In two-thirds of events, (46.2% of all monitored patients) a specific arrhythmia diagnosis was reached, allowing definitive treatment in these cases. In this selected population, there was no correlation between age, presence of known high-risk predictors, or accompanying trauma, and the mechanism of syncope. Conclusions: The high diagnostic rate of implantable loop recorder in the everyday clinical practice is in accordance with the findings in prospective clinical studies. This observation supports the early application of loop recorder in the diagnostic algorithm of syncope. Orv. Hetil., 2015, 156(15), 609–613.

Survival and prognostic factors in chronic lymphocytic leukemia

2009 ◽  
Vol 38 (2) ◽  
pp. 123-130 ◽  
Author(s):  
Amos Pines ◽  
Isaac Ben-Bassat ◽  
Michaela Modan ◽  
Tzvia Blumstein ◽  
Bracha Ramot
Keyword(s):  
Prognostic Factors ◽  
Chronic Lymphocytic Leukemia ◽  
Lymphocytic Leukemia

scholarly journals Multivariable Model for Time to First Treatment in Patients With Chronic Lymphocytic Leukemia

2011 ◽  
Vol 29 (31) ◽  
pp. 4088-4095 ◽  
Author(s):  
William G. Wierda ◽  
Susan O'Brien ◽  
Xuemei Wang ◽  
Stefan Faderl ◽  
Alessandra Ferrajoli ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Chronic Lymphocytic Leukemia ◽  
Multivariable Analysis ◽  
Lymphocytic Leukemia ◽  
Cancer Center ◽  
Serum Lactate Dehydrogenase ◽  
Multivariable Model ◽  
Cervical Lymph Nodes ◽  
Mutation Status ◽  
Time To First Treatment

Purpose The clinical course for patients with chronic lymphocytic leukemia (CLL) is diverse; some patients have indolent disease, never needing treatment, whereas others have aggressive disease requiring early treatment. We continue to use criteria for active disease to initiate therapy. Multivariable analysis was performed to identify prognostic factors independently associated with time to first treatment for patients with CLL. Patients and Methods Traditional laboratory, clinical prognostic, and newer prognostic factors such as fluorescent in situ hybridization (FISH), IGHV mutation status, and ZAP-70 expression evaluated at first patient visit to MD Anderson Cancer Center were correlated by multivariable analysis with time to first treatment. This multivariable model was used to develop a nomogram—a weighted tool to calculate 2- and 4-year probability of treatment and estimate median time to first treatment. Results There were 930 previously untreated patients who had traditional and new prognostic factors evaluated; they did not have active CLL requiring initiation of treatment within 3 months of first visit and were observed for time to first treatment. The following were independently associated with shorter time to first treatment: three involved lymph node sites, increased size of cervical lymph nodes, presence of 17p deletion or 11q deletion by FISH, increased serum lactate dehydrogenase, and unmutated IGHV mutation status. Conclusion We developed a multivariable model that incorporates traditional and newer prognostic factors to identify patients at high risk for progression to treatment. This model may be useful to identify patients for early interventional trials.

scholarly journals Combination chemoimmunotherapy with pentostatin, cyclophosphamide, and rituximab shows significant clinical activity with low accompanying toxicity in previously untreated B chronic lymphocytic leukemia

Blood ◽  
2006 ◽  
Vol 109 (2) ◽  
pp. 405-411 ◽  
Author(s):  
Neil E. Kay ◽  
Susan M. Geyer ◽  
Timothy G. Call ◽  
Tait D. Shanafelt ◽  
Clive S. Zent ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Chronic Lymphocytic Leukemia ◽  
Minimal Residual Disease ◽  
Residual Disease ◽  
Lymphocytic Leukemia ◽  
Clinical Activity ◽  
Hematologic Toxicity ◽  
Color Flow ◽  
Significant Clinical Activity ◽  
Minimal Residual

Abstract Building on the prior work of use of pentostatin in chronic lymphocytic leukemia (CLL), we initiated a trial of combined pentostatin (2 mg/m2), cyclophosphamide (600 mg/m2), and rituximab (375 mg/m2) for 65 symptomatic, previously untreated patients. Of 64 evaluable patients, 34 (53%) were high Rai risk, 71% were nonmutated for the immunoglobulin heavy-chain variable region gene, 34% were CD38+, and 34% were ZAP-70+. Thirty patients (52%) had one anomaly detected by fluorescence in situ (FISH) hybridization, and 21 (36%) had complex FISH defects. Thirty-eight patients (58%) had grade 3+ hematologic toxicity but minimal transfusion needs and no major infections. Responses occurred in 58 patients (91%), with 26 (41%) complete responses (CRs), 14 (22%) nodular partial responses (nodular PRs), and 18 (28%) partial responses (PRs). Many patients with a CR also lacked evidence of minimal residual disease by 2-color flow cytometry. Examination of prognostic factors demonstrated poor response in the 3 patients with del(17p). In contrast, we found this regimen was equally effective in young versus older (> 70 years) patients and in del(11q22.3) versus other favorable prognostic factors. Thus, this novel regimen of pentostatin, cyclophosphamide, and rituximab for previously untreated patients with CLL demonstrated significant clinical activity despite poor risk-based prognoses, achievement of minimal residual disease in some, and modest toxicity.

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