Changes in Frequency of Surveillance Imaging of Survivors of Diffuse Large B-Cell Lymphoma After the American Society of Hematology Choosing Wisely Recommendations

2020 ◽  
pp. OP.20.00362
Author(s):  
Urshila Durani ◽  
Dennis Asante ◽  
Herbert C. Heien ◽  
Carrie A. Thompson ◽  
Thorvardur Halfdanarson ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Choosing Wisely ◽  
Aggressive Lymphoma ◽  
Large B Cell Lymphoma ◽  
Period 2 ◽  
Surveillance Imaging ◽  
American Society ◽  
Large B Cell

In 2013, the American Society of Hematology (ASH) published recommendations with Choosing Wisely to limit surveillance imaging in aggressive lymphoma. We studied surveillance imaging practice patterns for diffuse large B-cell lymphoma (DLBCL) before and after the ASH Choosing Wisely campaign. We used OptumLabs Data Warehouse, a national insurance claims database, to retrospectively study imaging frequency in survivors of DLBCL from 2008 to 2016. Three time periods were defined: Period 1 (2008 to 2010), Period 2 (2011 to 2013), and Period 3 (2014 to 2016). One thousand four hundred seventy-two patients were included. Median follow up was approximately 2 years. During the first and second years of surveillance, imaging remained stable between Period 1 (years 1 and 2: 199 [91%] and 137 [83%], respectively) and Period 2 (years 1 and 2: 257 [88%] and 172 [77%], respectively; P = .38), but decreased in Period 3 (years 1 and 2: 315 [78%] and 83 [61%], respectively; P < .01). In a multivariable logistic regression, year after 2012 was a significant predictor of decreased overuse (more than two scans per year in the first year of surveillance; [odds ratio, 0.49 for 2013 v 2008; P = .02]). Our study demonstrated the rate of surveillance scans—both computed tomography and positron emission tomography imaging—in DLBCL decreased after the ASH Choosing Wisely campaign. Multiple factors, such as changes in recommendations, reimbursement, and provider knowledge base, may have all contributed and should be studied further.

The Impact of Relative Dose Intensity of Rituximab-CHOP on Survival in Diffuse Large B-Cell Lymphoma Patients

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4931-4931
Author(s):  
Yoshiki Terada ◽  
Hirohisa Nakamae ◽  
Ran Moriguchi ◽  
Hiroshi Kanashima ◽  
Erina Sakamoto ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Dose Intensity ◽  
B Cell Lymphoma ◽  
Aggressive Lymphoma ◽  
Factors Influencing ◽  
Large B Cell Lymphoma ◽  
The Impact ◽  
Large B Cell ◽  
Significant Factors

Abstract Background. Recently several retrospective studies showed that relative dose intensity (RDI) in combination chemotherapy including CHOP significantly influences survival in aggressive lymphoma. Based on these data, maintaining high RDI in chemotherapy by, for example, prophylactic granulocyte colony-stimulating factor (G-CSF) administration has been attempted to obtain better outcome. Moreover, rituximab, a chimeric monoclonal anti CD20 antibody combined with CHOP chemotherapy (R-CHOP) has significantly ameliorated the outcome in patients with diffuse large B-cell lymphoma (DLBL). However, it is unclear if higher RDI even in combination with rituximab will improve outcome in B cell type aggressive lymphoma. Hence, in the current study, we retrospectively analyzed the impact of RDI in R-CHOP as an initial treatment on survival of patients with DLBL. Furthermore, we determined the factors influencing RDI. Patients and Methods. We studied 100 previously untreated DLBL patients who underwent more than 3 courses of R-CHOP chemotherapies at 5 institutions from December 2003 to February 2008. The median age of the patients was 60 years old (range 19–79). The median number of R-CHOP course was 6 (range, 3–8). In the current study, the RDI was calculated by averaging the delivered RDIs of cyclophosphamide (CY) and adriamycin (ADR) for all chemotherapy courses. Results. The median average RDI of CY and ADR (CY/ADR-RDI) in all patients was 87.9%. Twenty three of 100 patients were treated with RDI less than 75 %. With a median follow-up of 21.2 months, the probability of 4-year overall survival (OS) was significantly higher in patients with higher RDI (&gt;=75%) than that in patients with lower RDI (&lt;75%) (78.6 % vs. 60%; P = 0.01). In univariate Cox regression model to identify prognostic factors for OS, RDI [hazard ratio (HR) = 0.7 per 0.1 of RDI; 95% CI 0.6– 0.9; P = 0.02] and high/high-intermediate International Prognostic Index (IPI) (HR = 4.7; 95% CI 1.3–17; P = 0.04) were significant factors influencing OS. In multivariate model, RDI was only a significant factor influencing OS (HR = 0.8 per 0.1 of RDI; 95% CI 0.6–1.0; P = 0.04). In multivariate logistic analysis to determine factors influencing RDI, elderly patients (&gt;=51 ) [odds ratio (OR) = 0.2; 95% CI 0.1–0.7; P = 0.01] and high/high-intermediate IPI (OR = 0.3; 95% CI 0.1–1.0; P = 0.04) were significant factors for reduced RDI, whereas prophylactic G-CSF (OR = 3.2; 95% CI 1.1–9.3; P = 0.04) was found to be a significant factor for increased RDI. Conclusion. In newly diagnosed DLBL patients, the current results demonstrated that high RDI in CHOP even when combined with rituximab was significantly associated with better survival and higher RDI could be effectively maintained by G-CSF.

High rates of surveillance imaging for treated diffuse large B-cell lymphoma: findings from a large national database

2012 ◽  
Vol 53 (6) ◽  
pp. 1113-1116 ◽  
Author(s):  
Gregory A. Abel ◽  
Ann Vanderplas ◽  
Maria A. Rodriguez ◽  
Allison L. Crosby ◽  
Myron S. Czuczman ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
National Database ◽  
Large B Cell Lymphoma ◽  
Surveillance Imaging ◽  
Large National Database ◽  
Large B Cell

scholarly journals Primary treatment and Recent survival trends in patients with Primary Diffuse Large B-Cell Lymphoma of Central Nervous System,1995-2016: a population-based SEER analysis

2021 ◽  
Author(s):  
Cui Chen ◽  
Peng Sun ◽  
Xiaoqing Sun ◽  
Shaoyong Chen ◽  
Hang Yang ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
The Elderly ◽  
Primary Treatment ◽  
Large B Cell Lymphoma ◽  
Period 2 ◽  
Time Period ◽  
Time Periods ◽  
Large B Cell

Abstract This retrospective cohort study aimed to evaluate primary treatment and recent survival trends in patients with primary diffuse large B-cell lymphoma of CNS from 1995 to 2016.Using the SEER data, patients diagnosed with non-HIV associated PCNSL-DLBCL aged ⩾18 years between 1995 and 2016 were identified. The year of diagnosis was divided into the time periods-1(1995–2002), the time periods-2(2003–2012) and the time periods-3(2013–2016). We used Chi-square tests, the Kaplan–Meier method, log-rank test and Cox regression model in the analysis. Overall, 3760 patients were included. Both the use of radiotherapy alone and the application of combined chemoradiotherapy decreased significantly, following the wider use of chemotherapy alone during 1995–2016. There was a significant improvement in PCNSL cancer-specific survival (period-1: 13 months vs period-2: 19 months vs period-3: 41 months, P < 0.001). Survival of patients aged above 70 years did not change from the time period-1 to the time period-2 (P = 0.101). However, there was an increase in CSS from the time period-2 to the time period-3 in the elderly patients (period-2: 5 months vs period-3: 9 months, P < 0.001). On multivariable analyses, diagnosed in the time period-3 was significantly and independently associated with better CSS (HR 0.577, 95% CI 0.506–0.659). Our analysis shows the use of radiotherapy in the treatment of PCNSL has waned over the study span. There was a significant improvement in CSS during 1995–2016, which reflected developments in treatment over time. The elderly patient population also gained a significant CSS benefit in the most recent period.

scholarly journals Spontaneous Remission of Diffuse Large B Cell Lymphoma in the Stomach and the Continuation of Remission for 10 Years

2018 ◽  
Vol 12 (3) ◽  
pp. 699-703 ◽  
Author(s):  
Toshiro Sugiyama ◽  
Kotaro Arita ◽  
Eiji Shinno ◽  
Takahiko Nakajima
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Spontaneous Remission ◽  
Aggressive Lymphoma ◽  
Large B Cell Lymphoma ◽  
First Remission ◽  
Helicobacter Pylori Treatment ◽  
Large B Cell

According to the literature, spontaneous remission of aggressive lymphomas is extremely rare; gastric non-Hodgkin lymphomas, such as mucosa-associated lymphoid tissue lymphomas, often regress due to Helicobacter pylori treatment or no progression, even in a watch-and-wait strategy. Although spontaneous remission of diffuse large B cell lymphomas in the stomach was very rarely reported, the follow-up periods of the cases of spontaneous remission are within 2 years and most cases are likely to relapse after the first remission. Here, we report that a diffuse large B cell lymphoma in the stomach showed spontaneous remission within 2 months after the initial diagnosis and the remission is still continuing for 10 years without any specific treatments against this aggressive lymphoma.

Anaplastic Variant of Diffuse Large B-Cell Lymphoma: Re-Apprasial As Extra-Mediastinal Grey Zone Lymphoma Intermediate Between Diffuse Large B-Cell Lymphoma and Classical Hodgkin Lymphoma,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3660-3660 ◽  
Author(s):  
Nirmeen Ali Megahed ◽  
Seiichi Kato ◽  
Naoko Asano ◽  
Shigeo Nakamura
Keyword(s):  
B Cell ◽  
Hodgkin Lymphoma ◽  
Conflicts Of Interest ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Aggressive Lymphoma ◽  
Grey Zone ◽  
Female Ratio ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Abstract 3660 Background: Recently more light has been shed on the overlap in biologic and morphologic features between classic Hodgkin lymphoma (cHL) and B-cell non-Hodgkin lymphoma. This overlap was further substantiated by analyzing the neoplastic nature of the malignant cell of cHL, which was proven to be of B-cell origin in nearly all cases. In addition, the growing recognition of composite and metachronous Hodgkin and non-Hodgkin lymphomas provided a further evidence of such claim. This advocated the term Grey zone lymphoma, which was first introduced in 1998 in the ÔÔWorkshop on HodgkinÕs disease and related diseasesÕÕ. According to WHO classification 2008, the term Ògrey zone lymphomaÓ designates anterior mediatsinal involvement with lymphoma intermediate between DLBCL and cHL. This type of lymphoma is claimed to have a more aggressive course than either cHL or DLBCL. Although the optimum treatment regimen in such cases is not yet well established most authors go for administration of therapy appropriate for DLBCL with the addition of Rituximab. We present a reappraisal of anaplastic variant of diffuse large B-cell lymphoma as an extramediastinal grey zone lymphoma showing morphologic and phenotypic features intermediate between DLBCL and cHL. Methods and results: Clinical and pathological data of 13 cases were retrieved over 8-year period. The age of the patients ranged from 57 to 86 years old (mean= 75 yeas). Eight of our cases were males and 5 were females with slight male predominance (male: female ratio= 1.6:1). This runs in contradiction with cases of mediastinal grey zone lymphoma which show striking female predominance. All the cases were presented with extramediastinal lymphadenopathy. Six patients showed associated extranodal involvement (e.g. liver, stomach, forearm, bone). None of the cases was associated with EBV activity. Four cases were presented with stage IV disease, 3 cases with stage III and 4 cases with stage II. B symptoms were reported in 6 cases. Histopathologically, tumors showed sheet like growth of pleomorphic cells, some of them are Reed Sternberg like cells, admixed with inflammatory background formed of mature lymphocytes eosinophils and plasma cells. Fibrous strands and geographic necrosis were seen in all cases. B-cell immunophenotyping of the tumor cells was evidenced by positivity for CD20, CD79a and Pax 5 in all cases. On the other hand, Hodgkin-like immunophenotyping was evidenced by positivity for CD30 in 10 cases, positivity for CD15 in 2 cases, positivity for Mum1 in one case and positivity for fascin in 6 cases. All the cases were negative for ALK1, CD10, CD3, κ□Aλ and CD45 RO. Worth to be noted that 69% of the cases (9/13) showed positivity for p53 and 23% (3/13) showed positivity for BCL-6 which are both an unusual finding in cHL. Forty six percent of the cases (6/13) died within the first year of the disease course (mean=8.3 months). Six patients are still alive (46%), 5 of which showed complete remission and one patient showed partial remission. Conclusion: Anaplastic variant of diffuse large cell lymphoma shows phenotypic and immunotypic features intermediate between cHL and DLBCL. We here propose the term (Extramediastinal grey zone lymphoma) for such cases which represent a distinctive subgroup of aggressive lymphoma. Further future studies of this group could contribute more to unmasking the link between Hodgkin and Non-Hodgkin lymphomas. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Gene regulation and suppression of type I interferon signaling by STAT3 in diffuse large B cell lymphoma

2018 ◽  
Vol 115 (3) ◽  
pp. E498-E505 ◽  
Author(s):  
Li Lu ◽  
Fen Zhu ◽  
Meili Zhang ◽  
Yangguang Li ◽  
Amanda C. Drennan ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Cell Cycle Checkpoint ◽  
Aggressive Lymphoma ◽  
Type I ◽  
Type I Ifn ◽  
Large B Cell Lymphoma ◽  
And Migration ◽  
Large B Cell

STAT3 is constitutively activated in many cancers and regulates gene expression to promote cancer cell survival, proliferation, invasion, and migration. In diffuse large B cell lymphoma (DLBCL), activation of STAT3 and its kinase JAK1 is caused by autocrine production of IL-6 and IL-10 in the activated B cell–like subtype (ABC). However, the gene regulatory mechanisms underlying the pathogenesis of this aggressive lymphoma by STAT3 are not well characterized. Here we performed genome-wide analysis and identified 2,251 STAT3 direct target genes, which involve B cell activation, survival, proliferation, differentiation, and migration. Whole-transcriptome profiling revealed that STAT3 acts as both a transcriptional activator and a suppressor, with a comparable number of up- and down-regulated genes. STAT3 regulates multiple oncogenic signaling pathways, including NF-κB, a cell-cycle checkpoint, PI3K/AKT/mTORC1, and STAT3 itself. In addition, STAT3 negatively regulates the lethal type I IFN signaling pathway by inhibiting expression of IRF7, IRF9, STAT1, and STAT2. Inhibition of STAT3 activity by ruxolitinib synergizes with the type I IFN inducer lenalidomide in growth inhibition of ABC DLBCL cells in vitro and in a xenograft mouse model. Therefore, this study provides a mechanistic rationale for clinical trials to evaluate ruxolitinib or a specific JAK1 inhibitor combined with lenalidomide in ABC DLBCL.

The Gray Zone Between Burkitt's Lymphoma and Diffuse Large B-Cell Lymphoma From a Genetics Perspective

2011 ◽  
Vol 29 (14) ◽  
pp. 1835-1843 ◽  
Author(s):  
Itziar Salaverria ◽  
Reiner Siebert
Keyword(s):  
B Cell ◽  
Who Classification ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Burkitt’S Lymphoma ◽  
Burkitt's Lymphoma ◽  
Aggressive Lymphoma ◽  
Gray Zone ◽  
Large B Cell Lymphoma ◽  
Large B Cell

It has long been recognized that the border between classical Burkitt's lymphoma (BL) and classical diffuse large B-cell lymphoma (DLBCL) is hard to determine. Instead, both classical lymphoma entities seem to be the extreme ends of a spectrum of diseases that contains a group of lymphomas characterized predominately by the fact that they are hard to assign to the one or the other group. This gray zone has been recently termed “lymphoma, unclassifiable, with features intermediate between DLBCL and BL” by the updated WHO classification. The term “intermediate” resembles that from a recent gene-expression study of mature aggressive B-cell lymphomas, although, notably, it is used differently. Intermediate lymphomas according to the WHO classification clearly are a temporary container of different biologic subtypes of aggressive lymphoma, from which several might be associated with an unfavorable clinical outcome. The present review aims at describing the morphologic, clinical, and biologic heterogeneity of the intermediate lymphomas and, moreover, attempts to propose testable subgroups based on age and presence of genetic aberrations.

Are We Choosing Wisely in Lymphoma? Excessive Use of Surveillance CT Imaging in Patients With Diffuse Large B-cell Lymphoma (DLBCL) in Long-term Remission

2018 ◽  
Vol 18 (1) ◽  
pp. e27-e34 ◽  
Author(s):  
Matthew C. Cheung ◽  
Nicole Mittmann ◽  
Craig C. Earle ◽  
Farah Rahman ◽  
Ning Liu ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Ct Imaging ◽  
Choosing Wisely ◽  
Large B Cell Lymphoma ◽  
Large B Cell
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