Application of an adapted international prognostic index for aggressive non-Hodgkin's lymphomas: Good discrimination and lower survival rates in Rio de Janeiro, Brazil

2001 ◽  
Author(s):  
Irene Biasoli ◽  
Jose Morais ◽  
Patricia Soares de Jesus ◽  
Wolmar Pulcheri ◽  
Marcio Nucci ◽  
...  
Keyword(s):  
Rio De Janeiro ◽  
International Prognostic Index ◽  
Survival Rates ◽  
Prognostic Index ◽  
Good Discrimination ◽  
Lower Survival ◽  
Hodgkin's Lymphomas

Re-Assessment of the Prognostic Value of International Prognostic Index (IPI) and Revised IPI (R-IPI) in Patients with Diffuse Large B-Cell Lymphoma Treated with or without Rituximab in Chinese Populations: A Retrospective Multicenter Study by Shanghai Lymphoma Research Group

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2649-2649
Author(s):  
Honghui Huang ◽  
Fei Xiao ◽  
Fangyuan Chen ◽  
Ting Wang ◽  
Junmin Li ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Survival Rates ◽  
Prognostic Index ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Free Survival ◽  
Large B Cell Lymphoma ◽  
Prognostic Groups

Abstract Abstract 2649 Background: The International Prognostic Index (IPI) is a widely accepted prognostic factor system for diffuse large B cell lymphoma (DLBCL) patients treated with chemotherapy. However, the prognostic value of IPI has been a focal point of the debate in the era of immuno-chemotherapy. Recently, the study of British Columbia group suggested that a revised IPI (R-IPI) which redistributed the IPI factors into 3 distinct prognostic groups provided a more clinically useful prediction of outcome for patients with DLBCL. In order to reassess the value of IPI and R-IPI in unselected Chinese population, we conducted this study. Methods: A multicenter retrospective analysis of DLBCL patients treated with CHOP-like chemotherapy alone or plus rituximab was performed by Shanghai Lymphoma Research Group. In total, 438 patients of newly diagnosed DLBCL treated at 6 participated hospitals were included during the period of 1997–2008. The prognostic value of IPI and R-IPI at diagnosis with regards to overall survival (OS) and progression-free survival (PFS) was evaluated. Results: The median age at diagnosis was 50 years (range, 18–83 years), and the median follow-up was 34 months (range, 3–145 months). Among them, 241 patients received CHOP-like regimen, whereas 197 had rituximab (R)-CHOP-like regimen. While IPI remained predictive in CHOP-like group, it could not distinguish between each prognostic category in the R-CHOP-like group (Fig.1). Redistribution of the IPI factors into a R-IPI identified three distinct prognostic groups with significantly different outcomes both in the patients treated with and without rituximab. In R-CHOP-like arm, these three risk groups had distinctly different rates of 3-year progression-free survival rates of 96%, 84.3% and 67.5% (P<0.001), respectively, and 3-year overall survival rates of 96%, 87.6% and 71.1% (P<0.001), respectively (Fig.2). Conclusions: Our study underscores the power of R-IPI as a simplified and more clinically relevant predictor of the disease outcomes than the standard IPI in Chinese DLBCL populations in the rituximab era, and it deserves a further study in larger population-based prospective study. Disclosures: No relevant conflicts of interest to declare.

Dose Attenuation of R-CHOP for the Treatment of Elderly Patients with Diffuse Large B Cell Lymphoma.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4458-4458
Author(s):  
Young Jin Choi ◽  
Kyung Woo Lee ◽  
Ho-Jin Shin ◽  
Jooseop Chung ◽  
Goon-Jae Cho
Keyword(s):  
Elderly Patients ◽  
Response Rate ◽  
International Prognostic Index ◽  
Survival Rates ◽  
Prognostic Index ◽  
Stage Iv ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Hematologic Toxicity ◽  
Chop Regimen

Abstract Backgrounds: More than half of the patients with newly diagnosed aggressive lymphomas are older than 60 years. The addition of rituximab to the conventional CHOP regimen, administered every 21 days, has conclusively demonstrated to lead to a significant improvement of the outcome in elderly patients with DLBCL and surivival benefit. The aim of this study was to evaluate the efficacy and toxicity of dose attenuated CHOP with rituximab 3 weekly in untreated elderly DLBCL. Methods: CHOP regimen consisted of cyclophosphamide(600mg/m2), doxorubicin(30mg/m2), vincristine (1mg/m2) on day 1, and prednisolone (20mg bid) given on day 1 to 5 every 3 weeks. Rituximab (375mg/m2) was administered the same day as CHOP. Results: This study included 37 patients with DLBCL with a median age of 70 years (range:64–81). Seventy six percent had an international prognostic index score>1, 35% had stage IV disease. Toxicity was calculated over 192 cycles administered. Grade 4 neutropenia developed in 2.6% of cycles and no grade 4 non-hematologic toxicity didn’t developed except asthenia (1 person). The overall response rate was 83.3% (complete response rate: 72.2%). 2 year overall and event free survival rates were 79.8% and 67%, respectively. Conclusions: Dose attenuated R-CHOP is effective and tolerable for elderly patients with DLBCL.

Long-Term Follow-up of Rituximab and Infusional Cyclophosphamide, Doxorubicin, and Etoposide (CDE) In Combination with HAART In HIV-Related Non-Hodgkin's Lymphomas (NHL)

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 5072-5072
Author(s):  
Michele Spina ◽  
Ulrich Jaeger ◽  
Joseph A Sparano ◽  
Renato Talamini ◽  
Giuseppe Rossi ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Performance Status ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Disease Free Survival ◽  
High Grade ◽  
Long Term Follow Up ◽  
Hodgkin's Lymphomas

Abstract Abstract 5072 Background: The combination of Rituximab plus chemotherapy (CT) is more effective than CT alone in the treatment of high grade NHL. Objective: To report the long-term follow-up of CDE plus Rituximab in HIV-NHL. Methods: In June 1998, we started a phase II study using infusional CDE (Cyclophosphamide 187.5 mg/m2/day, Doxorubicin 12.5 mg/m2/day and Etoposide 60 mg/m2/day) administered by continuous intravenous infusion for 4 days every 4 weeks and Rituximab 375 mg/m2 i.v. on day 1. HAART was given concomitantly with CT. Results: Seventy-four patients (pts) have been enrolled. The median CD4+ cell count was 161 (range 3–691) and the median Performance Status was 1 (range 0–3). Diffuse large B-cell NHL was diagnosed in 72% of pts and Burkitt in 28%. Seventy per cent of pts had advanced stage (III-IV) disease and 57% of pts had an age-adjusted international prognostic index >2. Fifty-two out of 74 pts (70%) achieved a complete remission (CR), 4/74 (5%) had a partial remission and 18 pts progressed. With a median follow-up of 61 months, only 17% of CRs have relapsed and 41/74 pts are alive. The overall survival, disease free survival and time to treatment failure (TTF) at 5 years were 56%, 81% and 52%, respectively. Four cases of secondary tumors have been observed. No case of late pulmonary or cardiac toxicity has been reported. Conclusions: The combination of Rituximab and CDE in HIV-NHL treated concomitantly with HAART is very active. CR rate (70%) and TTF at 5 years (52%) are comparable to those observed in high grade NHL of the general population. Our data confirm that in HAART era a high proportion of HIV-NHL can be cured. Disclosures: No relevant conflicts of interest to declare.

Diabetes Mellitus Compromises Survival of Young Non Hodgkin Lmphoma Patients Treated with (R) CHOP Chemotherapy - a Retrospective Multicenter Analysis by Polish Lymphoma Study Group

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4844-4844
Author(s):  
Wojciech Jurczak ◽  
Joanna E Drozd-Sokolowska ◽  
Monika Joks ◽  
Justyna Dzietczenia ◽  
Tomasz Wrobel ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cause Of Death ◽  
Large Scale ◽  
Autoimmune Diabetes ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Diabetic Patients ◽  
Chop Chemotherapy ◽  
Co Morbidity ◽  
Hodgkin's Lymphomas

Abstract Abstract 4844 Introduction CHOP-based chemotherapy is a standard I line regimen for most non-Hodgkin's lymphomas (NHL). All prognostic indices, like international prognostic index (IPI) for DLBCL, follicular lymphoma IPI (FLIPI), mantle cell lymphoma IPI (MIPI) assess the risk associated both with lymphoma and the patient's performance status/age. No co-morbidity scale is used on a large scale in evaluation of younger patients. The effect of diabetes mellitus (DM) was assessed in a large, multicenter, retrospective analysis. Materials and methods 610 young NHL patients (median age 55 years, range 18–86) treated with (R)-CHOP chemotherapy, from 7 PLRG centers were assessed (427 DLBCL, 70 MCL, 45 FL, 22 MZL, 8 CLL/SLL and 38 PTCL). Medical records of all non-Hodgkin's lymphoma patients treated with first line CHOP-based therapy have been reviewed in order to collect data concerning the type of lymphoma, coexistence of DM, type and treatment of DM, modification of treatment during (immuno)-chemotherapy and finally overall survival and cause of death. Patients with impaired glucose tolerance and post-steroid hyperglycemia/ diabetes which developed only after initiation of treatment were classified as non-diabetic patients. Results There were 43/610 (7%) diabetic patients. Type 2 DM was diagnosed in 40 patients (6.5%), one patient (0.16%) had LADA (Latent Autoimmune Diabetes of Adulthood) and two patients had prior post-steroid diabetes. The median duration of diabetes prior to lymphoma diagnosis was 5 years (range 1–25 years). Body Mass Index (BMI) at the moment of diagnosis was calculated for 31 patients (median 28.1, range 20.3–42.8). Six patients (19.4%) had normal weight while 25 (80.6%) patients were either overweighed (16, 51.6%) or obese (9, 29%). Age and other risk factor distribution was similar between diabetic and non-diabetic patients. Diabetic patients had significantly shorter survival compared to those without DM, with median OS of 3.3 years versus not reached at average observation of 5 years (p=0.001, Figure 1). Diabetes treatment modification undertaken during chemotherapy did not influence survival (p=0.64). Lymphoma progression was the most common cause of death in both DM and non-DM patients (41% and 45.5% respectively), followed by cardiovascular diseases (29.5% and 31% respectively). In DM patients we observed doubling of fatalities due to complications (predominantly infectious): 23.5% compared to 12.5 % in non diabetic patients. Conclusions Diabetic patients had shorter survival than non-diabetic patients in the analyzed group (p=0.001). While diabetic and non-diabetic patients had similar mortality rate due to lymphoma or cardiovascular complications, deaths secondary to infection complications were twice as frequent in DM cases. It probably correlates with sustained immunosuppression, aggravated by (immuno)-chemotherapy. Disclosures: Jurczak: Pharmacyclics: Research Funding.

scholarly journals Proliferation in Non-Hodgkin’S Lymphomas and Its Prognostic Value Related to Staging Parameters

2004 ◽  
Vol 26 (1-2) ◽  
pp. 63-71
Author(s):  
Irene Lorand‐Metze ◽  
Fernanda Gonçalves Pereira ◽  
Flávia Pereira Silva Costa ◽  
Konradin Metze
Keyword(s):  
Prognostic Value ◽  
Dna Ploidy ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
S Phase ◽  
Dna Flow Cytometry ◽  
Histologic Type ◽  
Cytologic Examination ◽  
Dna Aneuploidy ◽  
Hodgkin's Lymphomas

In malignant lymphomas, cell kinetics has shown to be related with histologic type as well as with the clinical behaviour. The aim of our study was to investigate the relevance of cell proliferation parameters on overall survival in non‐Hodgkin's lymphomas as well as their relationship with prognostic factors such as International Prognostic Index (IPI). We performed DNA‐flow‐cytometry (S‐phase fraction and detection of DNA‐aneuploidy) as well as cytologic examination and the AgNOR technique in material obtained by fine needle aspiration of lymph nodes at diagnosis. The majority of the patients were stage IV by Ann Arbor and intermediate risk by IPI (42/55). When analyzing all patients together, histologic type by the WHO classification, IPI and the presence of a DNA‐aneuploid clone could not separate well patients with a different survival. For all patients, univariate Cox analysis revealed S‐phase (SPF) and AgNOR parameters to be of prognostic value. In the multivariate analysis, however, only SPF remained in the final model. Yet, when stratifying for DNA‐ploidy, only the total number of AgNORs/nucleus was an independent parameter. Looking only at the DNA‐diploid cases, the AgNOR pattern remained the most important parameter, whereas for the DNA‐aneuploid cases this was true for SPF. When studying patients with B large cell lymphoma separately, only DNA‐ploidy was a prognostic factor. In summary, cell kinetic parameters reveal important prognostic information in NHL patients. Furthermore, DNA‐aneuploidy seems to interfere with the analysis of the AgNOR pattern.

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

2020 ◽  
Vol 4 (9) ◽  
pp. 1906-1915 ◽  
Author(s):  
Sirpa Leppä ◽  
Judit Jørgensen ◽  
Anne Tierens ◽  
Leo Meriranta ◽  
Ingunn Østlie ◽  
...  
Keyword(s):  
High Risk ◽  
International Prognostic Index ◽  
Survival Rates ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
High Dose ◽  
Free Survival ◽  
Cns Prophylaxis ◽  
Phase 2 Trial ◽  
Dose Dense

Abstract 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.

scholarly journals VEGFandbFGFGene Polymorphisms in Patients with Non-Hodgkin's Lymphoma

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Tomasz Wróbel ◽  
Grzegorz Mazur ◽  
Justyna Dzietczenia ◽  
Katarzyna Gębura ◽  
Kazimierz Kuliczkowski ◽  
...  
Keyword(s):  
Growth Factor ◽  
Gene Polymorphisms ◽  
International Prognostic Index ◽  
Prognostic Significance ◽  
Prognostic Index ◽  
Vascular Endothelial ◽  
Healthy Individuals ◽  
Pcr Rflp ◽  
Hodgkin's Lymphomas ◽  
Endothelial Growth Factor

Angiogenesis and lymphangiogenesis are important in the proliferation and survival of the malignant hematopoietic neoplasms, including non-Hodgkin’s lymphomas (NHLs). Vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) play an important role in the initiation of angiogenesis. Both VEGF and bFGF have been reported to have prognostic significance in NHL. The present study aimed to determine an association between theVEGFandbFGFgene polymorphisms and disease susceptibility and progression.VEGF(rs3025039; 936 C>T) andbFGF(rs308395, −921 G>C) variants were determined in 78 NHL patients and 122 healthy individuals by PCR-RFLP technique. The presence of theVEGF 936Tallele was found to significantly associate with worse prognosis of the disease (expressed by the highest International Prognostic Index (IPI)) (0.41 versus 0.20, for IPI 4 among patients having and lacking theTallele). TheVEGF 936Tvariant was also more frequent among patients with IPI 4 than in controls (OR = 3.37, ). ThebFGF −921Gvariant was more frequently detected among patients with aggressive as compared to those with indolent histological subtype (0.37 versus 0.18, ) and healthy individuals (0.37 versus 0.19, OR = 2.51, ). These results imply that VEGF and bFGF gene polymorphisms have prognostic significance in patients with NHL.

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