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https://www.readbyqxmd.com/read/27913512/walking-a-tightrope-clinical-use-of-ibrutinib-in-mantle-cell-lymphoma-in-the-elderly
#1
Marco Ruella, Pierre Soubeyran
Representative clinical case. A 74-year-old male patient was diagnosed with stage 3 mantle cell lymphoma in 2012. Because he was ineligible for intensive treatment (age, previous myocardial infarction [MI]), he received rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemoimmunotherapy for 6 cycles (reaching complete response) and then rituximab maintenance (RM) for 2 years. One year after the end of RM, he relapsed with disseminated disease. He was started on ibrutinib 560 mg/day...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27913491/prognostic-factors-in-follicular-lymphoma-new-tools-to-personalize-risk
#2
Carla Casulo
Follicular lymphoma (FL) is the most common indolent lymphoma, and it has a long median overall survival (OS). However, the recent discovery of clinical and biological prognostic biomarkers in FL is shedding light on FL heterogeneity and the need for a precise and risk-stratified individual approach at diagnosis and relapse. Many FL patients who are asymptomatic with indolent disease can be vulnerable to the toxicity, emotional distress, and financial burden of overtreatment. Yet a subset of FL patients develop chemoresistance to standard chemoimmunotherapy, experience transformation to aggressive lymphoma and rapid progression, and represent the population most in need of novel therapies and curative approaches...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27913474/prognostication-of-chronic-lymphocytic-leukemia-in-the-era-of-new-agents
#3
Barbara Eichhorst, Michael Hallek
The prognosis of chronic lymphocytic leukemia (CLL) is very heterogeneous. Therefore, a plethora of prognostic factors has been identified to allow a better prediction of the individual prognosis of a given patient. The clinical staging systems by Rai and Binet have been the backbone of clinical management for several decades. The advent of genetic and biochemical markers, as well as next-generation sequencing has provided several markers that can predict the prognosis of patients with CLL. Using this knowledge, several scores have been created to improve predicting overall survival and/or treatment-free survival...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27913472/novel-agents-in-chronic-lymphocytic-leukemia
#4
Nicole Lamanna, Susan O'Brien
The advent of novel small-molecule inhibitors has transformed the treatment approaches for patients with chronic lymphocytic leukemia (CLL). These therapies are becoming increasingly used in patients with relapsed disease, patients with 17p deletion, and, as of recently, also in the frontline setting for previously untreated patients with CLL. Moreover, many of these are oral therapies that are significantly less myelosuppressive than chemoimmunotherapy. However, these agents have their own set of unique toxicities with which providers must gain familiarity...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27913457/treatment-of-blastic-plasmacytoid-dendritic-cell-neoplasm
#5
Jill M Sullivan, David A Rizzieri
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare myeloid malignancy with no defined standard of care. BPDCN presents most commonly with skin lesions with or without extramedullary organ involvement before leukemic dissemination. As a result of its clinical ambiguity, differentiating BPDCN from benign skin lesions or those of acute myeloid leukemia with leukemia cutis is challenging. BPDCN is most easily defined by the phenotype CD4(+)CD56(+)CD123(+)lineage(-)MPO(-), although many patients will present with variable expression of CD4, CD56, or alternate plasmacytoid markers, which compounds the difficulty in differentiating BPDCN from other myeloid or lymphoid malignancies...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27897411/skeletal-muscle-density-is-an-independent-predictor-of-diffuse-large-b-cell-lymphoma-outcomes-treated-with-rituximab-based-chemoimmunotherapy
#6
Michael P Chu, Jessica Lieffers, Sunita Ghosh, Andrew Belch, Neil S Chua, Amelie Fontaine, Randeep Sangha, Robert A Turner, Vickie E Baracos, Michael B Sawyer
BACKGROUND: While much cancer research focuses on tumours and their microenvironment, malignancies cause widespread physiologic changes. Cancer and treatment-related sarcopenia, measured with quantitative imaging or as a decrease in overall body mass, are indicative of poor prognosis in elderly diffuse large B-cell lymphoma (DLBCL) patients, skeletal muscle radiodensity (SMD) may be a better prognostic marker. SMD, a measure of muscle radiation attenuation on CT imaging, is more prognostic than sarcopenia or International Prognostic Index (IPI) scores in follicular lymphoma and multiple solid organ malignancies...
November 21, 2016: Journal of Cachexia, Sarcopenia and Muscle
https://www.readbyqxmd.com/read/27888883/transformed-lymphoma
#7
REVIEW
Mary Ann Anderson, Piers Blombery, John F Seymour
Transformed lymphoma is a complex syndrome that encompasses an array of different underlying low-grade lymphoproliferative conditions transforming into more aggressive disease as manifest by morphologic, clinical, and genetic features. Over the last decade, advances in chemoimmunotherapy have led to new options. Knowledge surrounding the genetic changes driving the process of transformation is leading to novel targeted therapies. This article focuses on the transformation of chronic lymphocytic leukemia and follicular lymphoma into diffuse large B-cell lymphoma...
December 2016: Hematology/oncology Clinics of North America
https://www.readbyqxmd.com/read/27888880/optimizing-outcomes-in-primary-mediastinal-b-cell-lymphoma
#8
REVIEW
Pier Luigi Zinzani, Alessandro Broccoli
Primary mediastinal B-cell lymphoma is characterized by a high chance of cure, and cured patients have a long disease-free life-expectancy; however, prognosis is severe in the case of relapsed or refractory disease. The initial use of the most effective chemoimmunotherapy regimen is therefore crucial. Understanding who will benefit from postinduction radiotherapy is also of paramount importance; positron emission tomography may be a reliable guide for physicians in determining which patients will require consolidation...
December 2016: Hematology/oncology Clinics of North America
https://www.readbyqxmd.com/read/27888872/state-of-the-art-therapy-for-advanced-stage-diffuse-large-b-cell-lymphoma
#9
REVIEW
Annalisa Chiappella, Alessia Castellino, Umberto Vitolo
Diffuse large B-cell lymphoma (DLBCL) represents the most common lymphoid malignancy in adults, with a median age of 60 to 70 years. Clinical behavior is usually rapidly aggressive, with extranodal involvement in 40% of cases. Chemoimmunotherapy administered every 21 days is still the standard of care in the advanced stage. Optimization of frontline therapy and the amelioration of salvage strategies remain the most important targets in the treatment of patients with DLBCL. Novel drugs directed to specific molecular targets have been introduced as single agents or in addition to standard chemoimmunotherapy for the treatment of DLBCL...
December 2016: Hematology/oncology Clinics of North America
https://www.readbyqxmd.com/read/27880984/diffuse-large-b-cell-lymphoma-with-primary-treatment-failure-ultra-high-risk-features-and-benchmarking-for-experimental-therapies
#10
Luciano J Costa, Kami Maddocks, Narendranath Epperla, Nishitha M Reddy, Reem Karmali, Elvira Umyarova, Veronika Bachanova, Christiana Costa, Martha Glenn, Julio Chavez, Oscar Calzada, Frederick Lansigan, Hossain Nasheed, Stefan Barta, Zheng Zhou, Michael Jaglal, Saurabh Chhabra, Francisco Hernandez-Ilizaliturri, Ana C Xavier, Amitkumar Mehta, Deniz Peker, Andreas Forero-Torres, Zeina Al-Mansour, Andrew M Evens, Jonathon B Cohen, Christopher R Flowers, Timothy S Fenske, Mehdi Hamadani
While a subset of patients with DLBCL relapsing after upfront chemoimmunotherapy can be cured with salvage therapy and autologous hematopoietic cell transplantation (auto-HCT), the outcome of patients with primary treatment failure (PTF) is less clear. For this study we analyzed 331 patients from 15 US institutions with DLBCL and PTF, defined as primary progression while on upfront chemoimmunotherapy (PP), residual disease at the end of upfront therapy (RD) or relapse < 6 months from end of therapy (early relapse; ER)...
November 23, 2016: American Journal of Hematology
https://www.readbyqxmd.com/read/27880061/the-safety-profile-of-monoclonal-antibodies-for-chronic-lymphocytic-leukemia
#11
Anna Korycka-Wołowiec, Dariusz Wołowiec, Tadeusz Robak
Monoclonal antibodies (MoAbs), non-chemotherapeutic agents targeting the antigens present on chronic lymphocytic leukemia (CLL) lymphocytes, are being implemented increasingly more often as treatment options. Areas covered: This article reviews the similarities and differences in the structure, mechanism of action, efficacy and safety profile of commercially-available MoAbs and prevents new agents potentially useful for CLL treatment. Publications in English before June 2016 were surveyed on the MEDLINE database for articles...
November 23, 2016: Expert Opinion on Drug Safety
https://www.readbyqxmd.com/read/27870563/economic-burden-of-chronic-lymphocytic-leukemia-in-the-era-of-oral-targeted-therapies-in-the-united-states
#12
Qiushi Chen, Nitin Jain, Turgay Ayer, William G Wierda, Christopher R Flowers, Susan M O'Brien, Michael J Keating, Hagop M Kantarjian, Jagpreet Chhatwal
Purpose Oral targeted therapies represent a significant advance for the treatment of patients with chronic lymphocytic leukemia (CLL); however, their high cost has raised concerns about affordability and the economic impact on society. Our objective was to project the future prevalence and cost burden of CLL in the era of oral targeted therapies in the United States. Methods We developed a simulation model that evaluated the evolving management of CLL from 2011 to 2025: chemoimmunotherapy (CIT) as the standard of care before 2014, oral targeted therapies for patients with del(17p) and relapsed CLL from 2014, and for first-line treatment from 2016 onward...
November 21, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/27862308/alemtuzumab-consolidation-in-chronic-lymphocytic-leukaemia-a-phase-i-ii-multicentre-trial
#13
Othman Al-Sawaf, Kirsten Fischer, Carmen D Herling, Matthias Ritgen, Sebastian Böttcher, Jasmin Bahlo, Thomas Elter, Stephan Stilgenbauer, Barbara F Eichhorst, Raymonde Busch, Ute Elberskirch, Wolfgang Abenhardt, Michael Kneba, Michael Hallek, Clemens-Martin Wendtner
OBJECTIVE: Despite high rates of long-lasting remissions in patients with chronic lymphocytic leukaemia (CLL) treated with chemoimmunotherapy, none of the current therapeutic approaches is curative with the exception of allogeneic transplantation. One strategy to extend progression-free survival and long-term survival might be the establishment of consolidation therapies. METHODS: In this trial, patients with complete or partial second remission after fludarabine-based treatment received consolidation therapy with alemtuzumab...
November 9, 2016: European Journal of Haematology
https://www.readbyqxmd.com/read/27861736/real-world-clinical-experience-in-the-connect-%C3%A2-chronic-lymphocytic-leukaemia-registry-a-prospective-cohort-study-of-1494-patients-across-199-us-centres
#14
Anthony Mato, Chadi Nabhan, Neil E Kay, Mark A Weiss, Nicole Lamanna, Thomas J Kipps, David L Grinblatt, Ian W Flinn, Mark F Kozloff, Christopher R Flowers, Charles M Farber, Pavel Kiselev, Arlene S Swern, Kristen Sullivan, E Dawn Flick, Jeff P Sharman
The clinical course of chronic lymphocytic leukaemia (CLL) is heterogeneous, and treatment options vary considerably. The Connect(®) CLL registry is a multicentre, prospective observational cohort study that provides a real-world perspective on the management of, and outcomes for, patients with CLL. Between 2010 and 2014, 1494 patients with CLL and that initiated therapy, were enrolled from 199 centres throughout the USA (179 community-, 17 academic-, and 3 government-based centres). Patients were grouped by line of therapy at enrolment (LOT)...
December 2016: British Journal of Haematology
https://www.readbyqxmd.com/read/27861157/a-randomized-phase-ii-trial-comparing-chemoimmunotherapy-with-or-without-bevacizumab-in-previously-untreated-patients-with-chronic-lymphocytic-leukemia
#15
Neil E Kay, Paolo Strati, Betsy R LaPlant, Jose F Leis, Daniel Nikcevich, Timothy G Call, Adam M Pettinger, Connie E Lesnick, Curtis A Hanson, Tait D Shanafelt
Bevacizumab is a monoclonal antibody targeting vascular endothelial growth factor (VEGF) with in vitro pro-apoptotic and antiangiogenic effects on chronic lymphocytic leukemia (CLL) cells. As monotherapy in patients with CLL, it has no clinical activity. Here we report the results of an open-label, randomized phase II trial comparing the combination of pentostatin, cyclophosphamide and rituximab (PCR) either without or with bevacizumab (PCR-B) in previously untreated CLL patients. A total of 65 evaluable patients were enrolled, 32 receiving PCR and 33 PCR-B...
November 16, 2016: Oncotarget
https://www.readbyqxmd.com/read/27854102/the-next-generation-of-targeted-molecules-for-the-treatment-of-chronic-lymphocytic-leukemia
#16
REVIEW
Deepa Jeyakumar, Susan O'Brien
With the recent approval of several new targeted therapies for chronic lymphocytic leukemia (CLL), there are now multiple options for its treatment. Inhibitors of Bruton tyrosine kinase (with ibrutinib being the first-in-class US Food and Drug Administration-approved agent) and phosphoinositide 3-kinase (with idelalisib as the first-in-class approved agent) are promising because they are generally well tolerated and highly effective against this malignancy. These agents may be particularly important in the treatment of older patients who are less able to tolerate the myelosuppression (and subsequent infections) associated with chemoimmunotherapy...
November 15, 2016: Oncology (Williston Park, NY)
https://www.readbyqxmd.com/read/27831503/a-randomized-trial-of-tlr-2-agonist-cadi-05-targeting-desmocollin-3-for-advanced-non-small-cell-lung-cancer
#17
C P Belani, B Chakraborty, R Modi, B Khamar
BACKGROUND: Randomised controlled trial to evaluate synergy between taxane plus platinum chemotherapy and CADI-05, a TLR-2 agonist targeting desmocollin-3 as a first line therapy in advanced Non Small cell lung cancer (NSCLC). PATIENTS AND METHODS: Patients with advanced NSCLC (stage IIIB or IV) were randomized to Cisplatin-Paclitaxel (Chemotherapy group, N=112) or Cisplatin-Paclitaxel plus CADI-05 (Chemoimmunotherapy group, N=109). CADI-05 was administered a week prior to chemotherapy and on day 8 and 15 of each cycle and every month subsequently for 12 months or disease progression...
November 9, 2016: Annals of Oncology: Official Journal of the European Society for Medical Oncology
https://www.readbyqxmd.com/read/27808579/predictive-and-prognostic-biomarkers-in-the-era-of-new-targeted-therapies-for-chronic-lymphocytic-leukemia
#18
Davide Rossi, Bernhard Gerber, Georg Stüssi
Treatment options for chronic lymphocytic leukemia (CLL) have improved with the introduction of the B-cell receptor inhibitors ibrutinib and idelalisib, and of the BCL2 inhibitor venetoclax. While awaiting the results of head to head comparisons between novel agents and chemoimmunotherapy, predictive biomarkers can assist physicians in treatment tailoring. Though novel agents have modified the landscape of predictors at the time of treatment requirement, the usefulness of historical CLL prognostic biomarkers is still up-to-date when considering anticipation of time to first treatment...
November 3, 2016: Leukemia & Lymphoma
https://www.readbyqxmd.com/read/27807492/novel-brentuximab-vedotin-combination-therapies-show-promising-activity-in-highly-refractory-cd30-non-hodgkin-lymphoma-a-case-series-and-review-of-the-literature
#19
Wilfred Delacruz, Robert Setlik, Arash Hassantoufighi, Shyam Daya, Susannah Cooper, Dale Selby, Alexander Brown
Non-Hodgkin lymphomas (NHLs) are a heterogeneous group of hematologic malignancies which typically respond to standard first-line chemoimmunotherapy regimens. Unfortunately, patients with refractory NHL face a poor prognosis and represent an unmet need for improved therapeutics. We present two cases of refractory CD30+ NHL who responded to novel brentuximab vedotin- (BV-) based regimens. The first is a patient with stage IV anaplastic large cell lymphoma (ALCL) with cranial nerve involvement who failed front-line treatment with cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisone (CHOEP) and second line cyclophosphamide, vincristine, doxorubicin, dexamethasone alternating with high-dose methotrexate (MTX), and cytarabine (hyperCVAD) with intrathecal- (IT-) MTX and IT-cytarabine, but responded when BV was substituted for vincristine (hyperCBAD)...
2016: Case Reports in Oncological Medicine
https://www.readbyqxmd.com/read/27796157/management-of-elderly-and-unfit-patients-with-chronic-lymphocytic-leukemia
#20
Francesca R Mauro, Adriano Salaroli, Maria D Caputo, Gioia Colafigli, Luigi Petrucci, Melissa Campanelli, Antonietta Ferretti, Anna R Guarini, Robin Foà
About 75% of patients with chronic lymphocytic leukemia (CLL) are more than 65 years at the time of diagnosis. Treatment of the elderly remains complicated due to multiple factors, such as comorbidities, decline in functional reserve and fitness. Since chronological age by itself cannot properly predict life expectancy and treatment tolerance, an accurate assessment of the fitness status is of crucial importance for an optimal treatment choice. Areas covered: This review will discuss the most relevant aspects concerning the issues experienced in the management of elderly/unfit patients with CLL...
December 2016: Expert Review of Hematology
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