Silvia Rivas-Vera | Instituto Nacional de Cancerologia Mexico (original) (raw)
Papers by Silvia Rivas-Vera
Revista de la Facultad de Medicina, Jan 8, 1977
Blood, Dec 2, 2016
Introduction Autologous hematopoietic stem cell transplantation (ASCT) is a treatment option for ... more Introduction Autologous hematopoietic stem cell transplantation (ASCT) is a treatment option for long-term remission in patients with multiple myeloma and recurrent non-Hodgkin´s lymphoma (NHL). The eligibility for ASCT is based on a risk-benefit assesssment of the disease, age has not been considered an exclusion criteria for ASCT where treatment related mortality are relatively low. The treatment-related morbidity is associated with toxicity of condition regimen and infections associated with the degree of immune deficiency. Outcome in elderly patients with multiple myeloma and recurrence of Hodgkin´s lymphomas with chemosensitive illness in ≥ 60 years patients undergo ASCT are limited and contradictory. For this reason the aims of the present study was to reviewed to identify patient with multiple myeloma and non-Hodgkin lymphoma undergoing ASCT at 60 or greater and describe the clinical data and outcome. Method: This work was a retrospective transversal study, 24 patients older than 60 years was enrolled and all of them were undergo ASCT al Instituto Nacional de Cancerologia, Mexico from 2005 to 2015. We assessed previous comorbidities, treatment lines, response prior to transplantation, treatment response, relapse free-survived and global survival, it was considered from the transplantation day until last visit at the hospital. Results Twenty-four patients were assessed, all were ≥60 years at the transplant moment. 16 of them had diagnostic of multiple myeloma and 8 with Non-Hodgkin's lymphoma (NHL). For the multiple myeloma group the median of age was 66 years (60-70 years), the 81% was male. At the transplant moment, two people in that group had hypertension, one had diagnosis of Diabetes Mellitus Diabetes II and the another did not have any other illness. At the transplant moment 62.5% of the patients had been treated with only one line treatment and 37.5% had been received two treatment lines. On the other hand, at the transplant moment 50% of the patients had completed response, 12% had partial response, 31.26% had very good partial responses and 6.25% had illness progression. Multiple myeloma patient was conditioned with melphalan 200mg/m2 in 95%. Neutrophils recovery was at 12 days. Fourty-three percent of the patient required transfusion. Neutropenic fever was presented in 43% of the patient. Fifty percent got completed response after ASCT and 20% with progression disease. Relapse disease was in 31% and mortality was 6.25%, there was not mortality associated with the process and 44% is alive without illness (Table 1). In patients with multiple myeloma the OS at two year was 100% and at three years 86%; for NHL patients OS at one year was 67% and at two years 33%. . For the NHL group the median of age was 67 years (61-72 years), the 50% was male, one person in that group had HTA at transplant moment, another one had diagnosis of MDII, another one had rheumatology disease and another one had long disease, and the other four did not have any other diseases. At the transplant moment 37.5% of the patients had been treated with only one line treatment, 37.5% had been received two treatment lines and 25% had been received three treatment lines. On the other hand, at the transplant moment 87.5% of the patients had completed response and 12.5% had partial response. NHL patients were conditioned with PEAM (cisplatin, etoposide, cytosine arabinoside and melphalan) 25%, Rituximab-PEAM in 62.5% and one patient with fludarabine with cyclophosphamide (FLUCY). Neutrophils recovery was at 12 days. Fourty-three percent of the patient required transfusion. Neutropenic fever was presented in 43% of the patient. Fifty percent got completed response after ASCT and 20% with progression disease. Relapse disease was in 31% and mortality was 6.25%, there was not mortality associated with the process and 44% is alive without illness (Table 1) For lymphoma, the relapse-free survival at one year 48.6%. For patients with multiple myeloma, the free illness survival at one year was 85.7%, at two years 77.9% and at four year 58.4%. Conclusion Autologous stem cell transplantion in older people is a good option for treatment without mortality asociated at process. The complications like neutropenic fever and transfusional requirement are similar with younger patients. In our population, age is not a limit to offer a treatment with high dose of chemotherapy and autologous. Disclosures No relevant conflicts of interest to declare.
Revista de la Facultad de Medicina, Jan 8, 1976
Gaceta Medica De Mexico, 2003
Revista de hematología, 2010
El mieloma múltiple es una neoplasia de células plasmáticas malignas que pueden sintetizar inmuno... more El mieloma múltiple es una neoplasia de células plasmáticas malignas que pueden sintetizar inmunoglobulinas. Es incurable, poco frecuente y su tratamiento es heterogéneo en las diferentes instituciones y centros privados de nuestro país. En varias ocasiones se reunió un grupo de hematólogos mexicanos para revisar los criterios internacionales del diagnóstico y tratamiento de este padecimiento, con el fin de comparar y complementar los propios, los cuales incluirían diagnóstico, diagnóstico diferencial, terapia de inducción, evaluación de la respuesta a la terapia, etc. Las recomendaciones de este grupo se basaron en las guías americanas y europeas al respecto, y se adaptaron a la práctica médica de México. Palabras clave: guías mexicanas, mieloma múltiple, tratamiento del mieloma múltiple, imagenología, trasplante de células hematopoyéticas, quimioterapia.
Gaceta Medica De Mexico, Mar 28, 2023
El coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) y su traducción clínica, la e... more El coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) y su traducción clínica, la enfermedad por coronavirus 2019 (COVID-19), representan una enfermedad con manifestaciones respiratorias potencialmente fatales. Actualmente existen aproximadamente 12,700,000 personas afectadas por esta virus, el cual ha ocasionado 561,517 muertes en el mundo. Los pacientes con diagnóstico de linfoma, al igual que otros pacientes con cáncer activo, presentan compromiso inmunitario, ya sea por su propia patología o debido al tratamiento que reciben, por lo que son especialmente susceptibles a desarrollar cuadros graves de COVID-19. La transmisión comunitaria del SARS-CoV-2 dificulta el acceso al sistema de salud y, por ende, el seguimiento estricto que requieren lo pacientes bajo tratamiento oncológico. En la etapa en la que nos encontramos actualmente, la transmisión global de la infección por SARS-CoV-2 continúa en ascenso, por lo que un control epidemiológico cercano es poco probable. Ante este contexto, surge la necesidad de establecer guías de tratamiento de pacientes con neoplasias hematológicas.
American Journal of Hematology, 2006
We studied the effectiveness of a fludarabine/cyclophosphamide-based conditioning regimen without... more We studied the effectiveness of a fludarabine/cyclophosphamide-based conditioning regimen without anti-thymocyte globulin in 23 aplastic anemia patients who had no response to previous conventional pharmacologic treatment. Patients received oral busulphan 4 mg/ kg/day/2 days, IV cyclophosphamide 350 mg/m 2 /day/3 days, and fludarabine 30 mg/m 2 /day/ 3 days. For GVHD prophylaxis, patients received MTX 5 mg/m 2 days +1, +3, +6, and +11 and oral cyclosporin A (CyA) 5 mg/kg/day, starting on day-1. Peripheral blood stem cell products were used with a median dose of 5.5 • 10 6 CD34 + /kg. The patients were followed for an average of 25 months. By a median of day +11, an ANC > 0.5 • 10 9 /L was reached; and by day +12, the platelet count had reached >20,000 • 10 9 /L. Acute grade I-II GVHD occurred in 4 patients, whereas limited chronic GVHD presented in 6 cases. Twenty-one patients (91.3%) achieved engraftment. Two patients failed to engraft, and 4 developed late rejection; 2 of these individuals died, 2 have survived with high transfusion requirements, whereas 2 received a second peripheral blood stem cell infusion and achieved sustained engraftment. Currently 21 (91%) of the 23 patients are alive, whereas 19 of 21 (90%) remain in complete remission. The average cost was about USD 15,000 for this kind of reducedintensity allotransplant. Reduced-intensity stem cell transplantation represents an affordable alternative to traditional more cytotoxic conditioning for severe aplastic anemia (SAA) patients. Long-term effects however, remain to be evaluated. Am.
Blood, Nov 20, 2009
Abstract 2940 Poster Board II-916 Introduction. Nasal NK/T cell lymphoma (NNK/TCL) is a tumor wit... more Abstract 2940 Poster Board II-916 Introduction. Nasal NK/T cell lymphoma (NNK/TCL) is a tumor with a low prevalence but is more frequent in Asia and South America. There is no standard treatment for these patients, although radiotherapy is usually recommended. Few reports describe the frequency of central nervous system (CNS) involvement in this type of lymphoma and, in consequence, little is known about the benefit of carrying out screening procedures such as cerebrospinal fluid (CSF) cytology or image studies, nor it is known if prophylactic radiotherapy to the CNS or intrathecal chemotherapy improves the outcome of these patients. Patients and methods. We reviewed the clinical files of 63 patients of the National Cancer Institute in Mexico City with a diagnosis of angiocentric, centrofacial or NNK/TCL between january 1996 and december 2008. We excluded those patients who had a doubtful histopathological diagnosis, who were not completely studied or who did not received treatment in our institution. We collected the following variables: age, gender, histopathological diagnosis, localization of the tumor, clinical stage, symptoms at presentation, IPI score, CNS involvement, CSF cytology, image studies, LDH level, type of treatment and global response to treatment. Results. We found a total of 48 patients with a diagnosis of primary nasal lymphoma who met the inclusion and exclusion criteria. The mean age was 45.6 (range 16-81) years. The male to female ratio was 2:1. The most frequent localization and histopathological type was the nasal T cell lymphoma (58.3% and 43.8%, respectively). Thirty one percent of the tumors were classified as diffuse large cell and small cell lymphomas due to the lack of immunopathology at the time of diagnosis. Most of the patients were at stage I or II (81.3%) of the disease and had a low or low intermediate IPI score (85.4%). Of the 48 patients 89.6% recieved combined treatment with chemotherapy (CHOP) and radiotherapy, the other 10.4% recieved treatment with radiotherapy alone. Thirty nine point six percent and 23% of the patients had complete and partial response to the treatment, respectively. The remaining patients had either stable or progressive disease. Only 10.9% of the patients complained of neurologic symptoms and 85.4% had a spinal tap done. Nine patients had central nervous system infiltration (18.8%), 55.5% presented with neurological symptoms. Seven of the nine patients with CNS infiltration were diagnosed with a positive CSF cytology (77.8%). Two patients had a negative CSF cytology but had a positive MRI (22.2%). None of these patients had a positive CT scan for CNS involvement. Eight of the nine patients were treated with combined chemo and radiotherapy and 1 patient was treated with radiotherapy alone. Three patients achieved complete response (33.3%). Although there is a great difference in complete response between the patients with and without CNS involvement (6.25% vs 54.17% respectively, p= 0.07), this difference was not statistically significant. This can be due to the small number of patients with CNS involvement. There was no significant difference in the IPI score, LDH levels, stage of the disease or age between the groups. Conclusions. CNS involvement is present in a considerable proportion of patients with primary nasal lymphoma. Based on these data we think CSF cytology should be done in all patients. The results also suggest that the CT scan is not sensitive enough to detect CNS involvement. The treatment of these patients is an open question because there is virtually no data in the literature regarding therapy for this complication. Disclosures: No relevant conflicts of interest to declare.
Blood, Nov 13, 2019
Background: Defining the extent of disease is essential for determining the prognosis and managem... more Background: Defining the extent of disease is essential for determining the prognosis and management of patients with Hodgkin (HL) and non-Hodgkin lymphoma (NHL) as the presence of advanced disease, including involvement of an extralymphatic site, is associated with inferior outcomes (Cheson et al, 2014). 18F-fluorodeoxyglucose positron emission tomography (FDG PET-CT) has an excellent diagnostic performance for evaluation of bone marrow infiltration (BMI) in patients with lymphoma but it is expensive and not always available at low and middle-income health care facilities. Unilateral bone marrow biopsy (BMB) is a more accessible test and has been the standard to identify lymphomatous BMI. Unfortunately, it is an unpleasant procedure for the patient and can be limited by technical constraints. The aim of this single-center retrospective cohort study was to evaluate the diagnostic performance of FDG PET-CT for BMI in lymphoma patients, comparing it with BMB as the gold standard. Also, we evaluated for discordant results between both studies along with its effect on patient treatment. Methods: Newly diagnosed lymphoma patients evaluated at the National Cancer Institute between July 2017 and December 2018 were identified from our institutional lymphoma data base. Five hundred patient files were reviewed for bone marrow evaluation at diagnosis by BMB and FDG PET-CT as well as for other clinical characteristics. Only 355 patients had both FDG PET-CT and BMB performed and adequately reported, so the rest were excluded from the analysis. Fisher's exact and Pearson Chi-square tests were used to compare categorical variables. Comparisons of continuous variables were performed using Mann-Whitney U test. Setting BMB as the gold standard, diagnostic performance of FDG PET-CT for detecting BMI was evaluated. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratios (LR) and accuracy were calculated for the most common histological subtypes. Logistic regression model was used for univariate and multivariate analysis of predictors for positive BMB and positive FDG PET-CT for BMI. Results: The most common histologic type was diffuse large B-cell lymphoma (DLBCL) in 42.4% of cases, followed by HL in 20.4%, and follicular lymphoma (FL) in 11.2%. Median age was 53 years. B symptoms were present in 59.6% of cases and 71.4% debuted with advanced stage of disease (Ann Arbor III and IV). BMB was positive in 17% of all patients and 28% had a positive FDG PET-CT for BMI (Table 1). BMB was positive in 17.2% of HL, 12.3% of DLBCL, 29.8% of FL and 15.6% of other types of lymphoma patients. Overall, sensitivity of FDG PET-CT was 74.1%, specificity 80.1%, PPV 42.2%, NPV 94.1%, +LR 3.73, -LR 0.32 and accuracy 79.2%. The diagnostic performance of FDG PET-CT in patients with HL, DLBCL, FL and other types of lymphoma is shown in Table 2. As for predictors for BMB positivity, the presence of B symptoms, neutropenia and thrombocytopenia were independent factors for BMI with adjusted OR of 2.44, 95% CI (1.19, 4.99), 5.64, 95% CI (1.32, 24.08) and 4.12, 95% CI (1.66, 10.26), respectively. For positive FDG PET-CT, the presence of B symptoms, thrombocytopenia and advance stage remained significant with adjusted OR of 2.96, CI 95% (1.73, 5.05), 2.75, 95% CI (1.17, 6.48) and 19.22, 95% CI (5.90, 62.66), respectively. Seventy-four patients had discordant results between BMB and FDG PET-CT. The discrepancy in BMB and FDG PET-CT results did not have an effect on treatment. Conclusions: In addition to international clinical practice guidelines recommendations, in our center we recommend performing a BMB to those patients with HL and FDG PET-CT negative for BMI who present with cytopenias and B symptoms at the time of diagnosis. For patients with DLBCL our FDG PET-CT sensitivity was lower than expected, so we recommend a complementary BMB to all DLBCL patients with a positive FDG PET-CT for BMI (stage IV) that otherwise would be early stages (I and II) and would benefit from less aggressive therapy. In all other NHL including FL, we recommend performing a unilateral BMB with immunohistochemical analyses and flow cytometry, if available, for initial evaluation of BMI. Still in the absence of FDG PET-CT, a whole-body contrast-enhanced CT along with a unilateral posterior iliac crest BMB could adequately stage most types of lymphoma at low and middle-income health care facilities. No relevant conflicts of interest to declare.
Blood, Nov 29, 2018
Follicular lymphoma (FL) is the most common indolent lymphoma with a median survival approaching ... more Follicular lymphoma (FL) is the most common indolent lymphoma with a median survival approaching 20 years. However, there is significant clinical heterogeneity with subsets of patients experiencing transformation, early recurrence or refractory disease. Some authors found that progression of disease within 24 months of diagnosis, in patients treated with chemoimmunotherapy (POD24), is associated with poor overall survival (OS). OBJECTIVE Evaluate the POD24 as an early clinical endpoint in FL and evaluate FL international prognostic index (FLIPI), and other baseline risk factors at diagnosis for overall survival and relapse. METHODS We conducted a retrospective and observational study in which 160 patients with follicular lymphoma who received R-CHOP at National Institute of Cancerology, Mexico from 2011 to 2017. We analyze with Kaplan Meier curves, log rank test and logistic regression model. RESULTS We analyze 160 patients, median of age was 53 years (26- 88), with a female : male ratio of 1.17:1. In this group: 86% had hemoglobin >12 mg/dL, LDH was normal in 62%, 1-4 nodal areas were affected in 64%, 56% of patients had high FLIPI score, 27% had B symptoms and we found bone marrow infiltration in 30% of cases; grade 2 Follicular lymphoma was the most common histological subtype (40.5%). Most of patients achieved complete response (81%), 12% partial response after the first line therapy. Only 13 patients (8%) presents relapse. Sixty four percent received maintenance. Only 13 of patients relapsed, 10 after 24 months and only 3 in first 24 months from diagnostic (POD 24). Fig. 1 Overall survival in our population was 89% to 8 years, the factors with statistical significance in the bivariate analysis were the more nodal regions affected (1-4), high FLIPI score and POD 24 POD 24, adjusted to FLIPI score, was an independent predictor of survival in regression analysis (p<0.041, HR:35 IC 95% 1.15-1060.21). The bone marrow infiltration at diagnosis was the only independent predictor for relapse (p<0.007, HR: 6.9, IC 95% 1.7- 28.2). CONCLUSION: In our study group, POD 24, was an important predictor of overall survival, and bone marrow infiltration at diagnosis was the only predictor factor for relapse. Disclosures No relevant conflicts of interest to declare.
Blood, Nov 20, 2009
Abstract 5030 Introduction T cell Non/Hodgkin&amp... more Abstract 5030 Introduction T cell Non/Hodgkin's lymphomas (TCNHL) are a group of lymphomas characterized by an aggressive clinical course and resistance to the usual chemotherapy agents. Due to the limited availability of immunochemistry techniques the frequency and clinical presentation of these lymphomas are not well described in underdeveloped countries. Here we describe the experience with these diseases in a tertiary referral health center. Patients and methods We reviewed 520 cases with diagnosis of Non-Hodgkin's Lymphoma from the records of the Pathology Department of the Hospital General de Mexico, seen from January 2002 to July 2006. Results We found 80 cases with TCNHL (15.3%). In 62 cases the clinical information was available for review. We found a 1.45:1 male/female ratio, median age 32 years (range 17 to 83). Symptoms were present for a median of 6 months (range 1 to 120 months) before diagnosis. Regarding the pathological classification the Unspecified Peripheral T-cell lymphomas were more common (56%), followed by the anaplastic lymphoma (23%), T/NK (16%), Cutaneous lymphoma (3%) and angioimmunoblastic lymphoma (2%). In 56% the initial presentation was nodal and in 44% extranodal. The extranodal sites were: Nasal (34%), bone marrow (22%), pleura and lung (14%), parotid (5%), colon (5%), and liver (5%). Sixty seven percent of the patients had advanced clinical stages and 73% had at least 3 B symptoms. One quarter of patients had bulky disease at their first visit to our Hospital; the most frequent site was retroperitoneal (19%). The lactic dehydrogenase (LDH) was elevated in 89% of cases (range:97 U/L -3017 IU L, median 418 U/L); patients with anaplastic NHL had the highest values and NHL-TNK patients the lowest. HIV serology was performed in 41 of 62 patients. Ninety four percent of the patients had an ECOG between 1 and 3. We calculated the International Prognostic Index (IPI); it was low in 23 patients (37%), low-intermediate in 18 (29%), intermediate-high in 16 (26%) and high in just 5 patients (8%). When we classified the patients with the Prognostic Index for non-specific peripheral T-NHL (PIT or PTCL-L), we found that 79.4% of cases were in the high-risk group in contrast with 73.6% low group according to IPI. All patients were treated with CHOP chemotherapy. A complete response (CR) was achieved in 10 patients (16%); 13 patients (21%) were still on treatment at the end of the study, 4 patients (6.45%) did not respond to treatment and 14 patients (24.1%) had progressive disease. Ten patients discontinued treatment (16%) and 5 died (8.06%). At the end of the observation period 8 patients were alive without tumor activity, 2 patients were lost without tumor activity, 7 patients were alive with disease, 24 patients were missing with tumor activity, 9 patients were on treatment and 12 patients had died. Conclusions This study shows that in Mexico as in other populations, the TCNHL are less frequent than the B-cell lymphomas. It also confirms the poor response of the T-Cell lymphomas to CHOP. The population that attends our hospital is of a low socioeconomic stratum, and this fact explains the large abandonment of medical care. It is desirable the development of new drugs for these neoplasia. Disclosures No relevant conflicts of interest to declare.
Blood, Nov 5, 2021
Background: Positron emission tomography-computed tomography (PET-CT) is used for staging and res... more Background: Positron emission tomography-computed tomography (PET-CT) is used for staging and response assessment in classical Hodgkin lymphoma (cHL) and for evaluation and management of refractory/relapsed Hodgkin lymphoma (RRHL). According to the World Health Organization's Global Atlas of Medical Devices 2017 report, 92-95% of lower-middle and low-income countries have no PET/CT unit, and only 3% of upper-middle income countries have 1 PET scanner/million people, versus 29% of high-income countries. Real-world data on PET scan use in cHL and RRHL outside Europe and North America are limited. The B-CD30+ HOdgkin Lymphoma International Multi-center Retrospective Study of Treatment Pract Ices and Out Comes (B-HOLISTIC) study assessed real-world treatment practices and clinical outcomes in patients with stage IIB-IV cHL and RRHL in countries outside Europe and North America and imaging results are presented here. Methods: The B-HOLISTIC study retrospectively reviewed patients (≥18 years) with stage IIB-IV cHL or RRHL between 2010 and 2013. Patients initially diagnosed with cHL who progressed to RRHL during the study were included in both groups. Details of PET and CT scans at baseline and during/end of frontline/salvage treatment, were reported in both groups. Results: Overall, 1703 patients (cHL: 1598, RRHL: 426, both: 321) were enrolled (East Asia: 426, Latin America: 366, Middle East and South Africa: 694, Australia: 56, Russia: 161). Median follow-up was 5.4 and 4.4 years in the cHL and RRHL groups, respectively. PET and CT results for cHL and RRHL groups are shown in Tables 1 and 2, respectively. The proportion of patients with PET scan was 73.2% in the cHL group with a median (interquartile range [IQR]) frequency of 2.0 (2.0-4.0) and 72.3% in the RRHL group with a median (IQR) frequency of 3.0 (2.0-5.0). In both groups, the proportion of PET scans at baseline was lower (cHL: 54.4%; RRHL: 32.8%) than during/ end of frontline treatment (cHL: 85.8%; RRHL: 58.8%) and at relapse/refractory diagnosis (54.5%). In contrast, the proportion of CT scans was higher (cHL: 76.4%; RRHL: 79.1%), particularly at baseline (cHL: 66%; RRHL: 51.6%). The highest proportion of PET scans was reported in Australia and lowest in Russia. The highest proportion of CT scans was in Russia in the cHL group and in Australia and East Asia in the RRHL group, while the lowest was in Middle East and South Africa in both groups. The frequency of interim PET scans was low in both cHL and RRHL groups, and were rarely used in cHL surveillance. In the RRHL group, interim PET scans during the frontline therapy were higher after cycles 3-4 and 5-6 than after cycles 1-2. Deauville 5-point scale (5-PS) was used for PET assessment at interim treatment cycles, end of frontline/salvage treatment, relapse, and surveillance in both groups with increased scans reporting a 5-PS rating towards the end of treatment and surveillance. However, its overall use was suboptimal with a minority (<50%) reporting a specific Deauville score. Discussion and Conclusion: This study provides real-world evidence on PET use in cHL and RRHL outside Europe and North America, which is suboptimal. Although PET is part of standard care for cHL now, during 2010-2013 it was more commonly used only in RRHL, as reflected in the higher PET use in RRHL than cHL in this study. Lower overall PET use than CT and the regional differences may reflect the comparatively limited access and availability of PET, especially in low-income countries. Lower PET use at baseline may have been due to low accessibility of PET at the beginning of the study, which improved over time. Higher PET use at the end of frontline treatment in cHL is in line with the literature, and suggestive of its recognized benefits in guiding further treatment if used early in treatment. Lack of data on Deauville ratings could be because its use was uncommon during the time of the study. However, the increased Deauville score reporting towards the end of the study suggests a trend for its use. Overall, the low interim PET use, regional differences, and lack of data on use of Deauville rating in this study, suggest an existing gap in real-world practice and highlight the global inequities in access to PET. These findings suggest the need for upscaling numbers and access to PET scanners outside Europe and North America through careful planning and in-depth assessment of socioeconomic, demographic, and epidemiological circumstances of each country. Figure 1 Figure 1. Ferhanoglu: Takeda Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees. Zerga: Takeda: Honoraria; Sandoz: Honoraria; Bristol Myers Squib: Honoraria; Jansen: Honoraria; Roche: Honoraria. Kim: Bayer:…
Blood, Nov 5, 2020
Background: Despite therapeutic advances in classical Hodgkin lymphoma (cHL), only half of patien... more Background: Despite therapeutic advances in classical Hodgkin lymphoma (cHL), only half of patients with relapsed/refractory (R/R) cHL are cured with salvage chemotherapy followed by stem cell transplantation (SCT). Most studies to date have been undertaken in Europe or North America and data on treatment patterns and clinical outcomes from other regions are limited. We present the results from the B-CD30+ HOdgkin Lymphoma International Multi-center Retrospective Study of Treatment PractIces and OutComes (B-HOLISTIC), which assessed cHL treatment pathways, clinical outcomes and healthcare resource utilization across East Asia, Latin America, Middle East, South Africa, Australia and Russia (data as of 04 March 2020). Methods: Data were collected retrospectively for patients (≥18 years) diagnosed with stage IIB-IV cHL or R/R cHL between 01 January 2010 and 31 December 2013, until death or last follow-up (whichever occurred first) across 13 countries. Patients with initial diagnosis of cHL and subsequent progression to R/R cHL were included in both groups, provided R/R cHL was diagnosed within the study period. The primary endpoint was progression-free survival (PFS) in patients with R/R cHL. Secondary endpoints included overall survival (OS), best clinical response, and adverse events (AEs). Results: In total, 1703 patients were enrolled from East Asia (n=426), Latin America (n=366), Middle East and South Africa (n=694), Australia (n=56) and Russia (n=161): 1598 and 426 patients were eligible for the cHL and R/R cHL groups (321 patients in the cHL group progressed to R/R cHL and were included in both groups). Median study follow-up was 65.2 and 53.2 months for the cHL and R/R cHL groups. Baseline patient characteristics are shown in Table 1. All patients in the cHL group received first-line chemotherapy: the most common regimens were ABVD (1363/1598; 85.3%) and BEACOPP (104/1598; 6.5%). First-line radiotherapy was given to 357/1598 (22.3%) patients in the cHL group. For R/R cHL, intensive chemotherapy was used as first-line salvage in 372/426 (87.3%) patients: the most common regimens were ESHAP (98/372; 26.3%) and DHAP (65/372; 17.5%), with an overall response rate of 62.0% (complete remission in 30.8% and partial remission in 31.2%). Of the 426 patients with R/R cHL, 292 (68.5%) were eligible for SCT at relapse/refractory diagnosis; 10 patients who were initially ineligible for SCT subsequently became eligible. In total, 222/302 (73.5%) eligible patients underwent SCT; 63/222 (28.4%) patients relapsed after SCT. Median PFS (95% CI) for the R/R cHL group was 13.2 (9.9-20.2) months following initial therapy (Figure 1), with estimated 1-, 3- and 5-year PFS rates of 51.2%, 38.7%, and 33.9%, respectively (Table 2). Median PFS was not reached for the first-line cHL group. Factors for PFS in the R/R cHL group are shown in Table 3. Median OS was not reached for both groups. All-cause, any grade AEs were reported by 783/1598 (49.0%) patients with cHL and by 233/426 (54.7%) patients with R/R cHL. Serious AEs were reported by 303/1598 (19.0%) patients with cHL and by 103/426 (24.2%) patients with R/R cHL: the most common (≥2.0%) were febrile neutropenia, pneumonia and pyrexia for cHL, and febrile neutropenia and pyrexia for R/R cHL. Conclusion: Results from B-HOLISTIC show that PFS rates remain low in patients with R/R cHL receiving salvage therapy; the greatest risk was among patients with inadequate response to salvage chemotherapy. The low PFS rates highlight the importance of considering novel targeted therapies to address unmet medical needs. PFS rates in patients with cHL were comparable with previous studies from Italy, Spain, and Israel (Avigdor A et al. EHA 2020) and the ECHELON-1 study (Bartlett NL et al. ASH 2019). The higher OS rates compared to PFS rates may be related to the effect of modern salvage regimens. Approximately half of patients with R/R cHL underwent SCT which may support the use of targeted therapies. Overall, these results from 2010-2013 show that despite the differences in healthcare systems, ethnicities and treatment patterns in B-HOLISTIC, clinical outcomes remain consistent. The authors note that given that the management of high-risk cHL has changed dramatically since 2013, further investigation in diagnostic criteria, response assessment and treatment patterns is needed. Study support: Data analysis (IQVIA) and medical writing (Synergy Vision) funded by Takeda Pharmaceuticals. Disclosures Ferhanoglu: Takeda: Other: Advisory Board; Abbvie: Other: Advisory Board; Roche: Other: Advisory Board; Janssen: Other: Advisory Board. Kim:Novartis: Consultancy; AstraZeneca and Korea Health Industry Development Institute: Research Funding; Sanofi: Consultancy; F. Hoffmann-La Roche Ltd/Genentech, Inc.: Consultancy; Voronoi: Consultancy; Boryung: Consultancy; AstraZeneca: Consultancy; Takeda: Consultancy. Karduss:Takeda: Honoraria. Rivas-Vera:Takeda: Current Employment, Other: Steering Committee in…
Blood, Nov 29, 2018
Background: The cure rate for advanced classical Hodgkin lymphoma (cHL) is approximately 70%, whi... more Background: The cure rate for advanced classical Hodgkin lymphoma (cHL) is approximately 70%, which is calculated based on data from clinical trials performed in North American and/or European countries (Canellos GP, et al. N Engl J Med. 1992;327:1478-84; Carde P, et al. J Clin Oncol. 2016;34:2028-36; Gordon LI, et al. J Clin Oncol. 2013;31:684-91). However, there are limited outcome data available in other countries, apart from some small hospital-based studies (Ramirez P, et al. Rev Bras Hematol E Hemoter. 2015;37:184-9; Law MF, et al. Arch Med Sci. 2014;10:498-504; Jaime-Pérez JC, et al. Oncologist. 2015;20:386-92; Omer Al-Sayes FM, Sawan A. J Taibah Univ Med Sci. 2006;1:48-56). The B-HOLISTIC retrospective chart review study seeks to address the paucity of data on cHL treatment patterns, clinical outcomes, and healthcare resource utilization in 13 countries across Latin America, Africa, Middle East, and the Asia-Pacific region. Methods: The study will collect data from approximately 2,600 patients aged ≥18 years and newly diagnosed with stage IIB-IV cHL or relapsed/refractory cHL (RRHL) between 01 January 2010 and 31 December 2013, and will follow them until death or chart review, whichever occurs first. The primary objective is to describe progression-free survival (PFS) in patients with RRHL. Secondary objectives include describing demographic and clinical characteristics, clinical outcomes (overall survival, best clinical response after completion of treatment, response duration), key adverse events associated with each line of therapy, and cHL-related healthcare resource use. Results: As of 14 May 2018, a total of 165 patients from 12 sites have been included in the interim analysis, predominantly from Turkey and South Korea. At this time, 150 patients had cHL and 24 patients had RRHL, including 9 patients who were enrolled in the cHL group and had a documented relapse/progression during the study period. Here, we report the results of the newly diagnosed cHL group; data from the RRHL group will be reported in subsequent publications. At diagnosis, 64.7% of the cHL group were male, with a median age of 36.5 years (range, 18-89 years); 22.7% had stage IV disease, 30% had extranodal disease, 59.3% had &amp;#39;B&amp;#39; symptoms, and 34.9% had an International Prognostic Score (IPS) of ≥4. Patients were classified as 13.3% in stage I-IIA; 24% in stage IIB; 53.3% in stage IIIA-IVB; and 9.3% as unknown. Patients classified as stage I-IIA are a deviation from the clinical study protocol and will be removed from the final study analysis. The proportion of patients alive was 94%, with the cause of death reported as either HL-related (44.4%), due to an adverse event (11.1%), or other (44.4%). Positron emission tomography (PET) or PET-computed tomography (CT) imaging was performed in 58.5% of patients at baseline, 48% of patients at interim, and 36.6% at end-of-treatment; CT imaging was performed in 68.7% of patients at baseline, 83.6% of patients at interim, and 59.7% of patients at end-of-treatment. At frontline treatment, 95.3% of patients received chemotherapy (mostly doxorubicin, bleomycin, vinblastine, dacarbazine [ABVD], 92.3% [median number of cycles, 6; range, 2-8]), 22.7% of patients received radiotherapy, with 22% of patients receiving radiotherapy and chemotherapy (median total dose, 34.5 Gy; range, 24-45 Gy). The majority of patients received involved-field radiotherapy (53.1%), with other modalities including involved-node (21.9%), involved-site (18.8%), whole body (3.1%), or other (3.1%). The proportion of patients who achieved a complete or partial response to frontline treatment was 52.1% and 21.1%, respectively. The PFS for treatment in frontline cHL in the overall patient population at 48 months was 81% (95% CI, 73.1-86.7; Figure 1), with a median duration of follow-up of 58.9 months (range, 2.6-128.3 months). The PFS for treatment in frontline cHL excluding ineligible patients classified as stage I-IIA (13.3%) at 48 months was 78.9% (95% CI 69.7-85.6). Due to the retrospective nature of this study, adverse events were under-reported and will be presented once the data are mature. Conclusion: The B-HOLISTIC study is ongoing, with final patient enrolment anticipated in December 2018. These interim data provide real-world information on the incidence, treatment, and outcomes of cHL in countries where little is known about this patient population. Disclosures Ferhanoglu: Takeda: Membership on an entity&amp;#39;s Board of Directors or advisory committees; Roche: Membership on an entity&amp;#39;s Board of Directors or advisory committees; Janssen: Membership on an entity&amp;#39;s Board of Directors or advisory committees. Yeh:GNT Biotech &amp;amp;amp; Medicals Crop.: Research Funding. Brittain:Takeda: Membership on an entity&amp;#39;s Board of Directors or advisory committees. Karduss:Novartis: Membership on an entity&amp;#39;s Board of Directors or advisory…
Revista Iberoamericana De Micologia, Oct 1, 2010
Revista Medica De Chile, Feb 1, 2009
Histiocytic sarcoma of the small intestine. Report of one case Histiocytic sarcoma (HS) is a rare... more Histiocytic sarcoma of the small intestine. Report of one case Histiocytic sarcoma (HS) is a rare malignant neoplasm of the lymphohematopoietic system, that occurs in lymph nodes, skin and at extranodal sites, particularly the gastrointestinal tract. Although it shows characteristics histological and immunohistochemical features, it may be misdiagnosed. We report a 67 year-old female patient presenting with colicky abdominal pain and vomiting. A CT scan of the abdomen revealed a tumor in the ileum, that was surgically removed. On pathology, the neoplastic cells displayed large abundant eosinophilic cytoplasm, with bizarre-shaped nuclei, that expressed CD 45, CD 68 and lisozyme. The diagnosis of HS requires the use of a panel of immunohistochemical markers and may be supported by ultrastructural findings (Rev Méd Chile 2009; 137: 269-74).
Blood, Nov 16, 2005
Follicular lymphoma is frequently associated with the chromosomal rearrangement t(14;18)(q32;q21)... more Follicular lymphoma is frequently associated with the chromosomal rearrangement t(14;18)(q32;q21), which joints one of the JH segments of the heavy chains of immunoglobulins (IgH) gene in 14q32 with the Bcl-2 gene in 18q2, originating a chimeric protein. The frequency of this marker is unknown in the Mexican population. OBJECTIVE: To determine the incidence of the Bcl2-IgH rearrangement in Mexican patients with follicular lymphoma and its frequency as a marker of minimal residual disease after therapy. PATIENTS AND METHODS: 200 patients (102 male and 98 female) were evaluated; the analysis was made in peripheral blood samples (PB) in 64 cases (32%) or bone marrow (BM) in 136 (68%). Genomic DNA was obtained and the Bcl-2/IgH rearrangement was amplified by both PCR and nested PCR using primers for JH and exon-intron 3 region of Bcl-2 (MBR and MCR regions). The Bcl-2/IgH rearrangement was used as a marker to determine minimal residual disease (MDR) in 90 out of 200 patients in clinical remission, with a follow up ranging from 12 to 60 months; The incidence and tissue type analysis were compared using chi-square statistics. RESULTS AND DISCUSSION: We found a positive Bcl-2/IgH rearrangement in 80% of the Follicular NHL cases, with a breakage in the MBR region in 160 cases and in MCR in 10 cases, in the remaining 30 patients the Bcl-2/IgH was negative. We detected the Bcl-2/IgH rearrangement more frequently in the BM samples (86%) than in the PB (42%)…
Blood, Nov 20, 2009
Abstract 4767 Introduction Extranodal NK/T-cell lymphoma, nasal type is an entity of difficult di... more Abstract 4767 Introduction Extranodal NK/T-cell lymphoma, nasal type is an entity of difficult diagnosis. It is characterized by damage and vascular destruction, necrosis, cytotoxic phenotype and Epstein Barr virus association. It is prominent in Asia, Mexico, Central and South America, predominantly in men. Material and methods It is an observational, descriptive and retrospective study, based on medical records of NK/T-cell lymphoma patients of the General Hospital of Mexico between 1992-2009. Results Of 632 non-Hodgkin lymphomas (NHL), 113 had a T cell lymphoma. Only 32 cases (28.3%) were eligible for the study. The age range was 19-56 years with a media of 42. The male:female ratio was 2.2:1. The most frequent clinical presentation symptoms were nasal obstruction, facial swelling and pain. Central nervous system involvement was present only in two cases and bone marrow infiltration in one. Seventy eight percent were on clinical stages I or II and 56% had B symptoms. In 7/10 patients the Epstein Barr association was documented by hystopathological study. The treatment was completed in 31/32 individuals. Fifty five percent showed some response, regardless of the therapy used. The CHOP regimen was the first line treatment in 80.6% of cases and only 13% received fractionated radiotherapy as initial treatment. The CHOP arm had an overall response rate of 60% (complete remissions, unconfirmed complete remissions, partial remissions), and 100% of the patients in the radiotherapy arm presented complete response. Most patients of the radiotherapy arm were on stage IE. The overall survival rate was 63% at 36 months. The average follow-up was 40 months. There were no differences in overall survival rates between the two arms, but the radiotherapy arm had a higher rate of complete remissions. Conclusions In this study we report the clinical features and response to treatment of the patient population treated at the General Hospital of Mexico. The results are similar to other international reports. Although the incidence of NK/T-cell lymphoma is low, it is necessary to standardize its treatment and these preliminary data warrant further trial of radiotherapy as the initial treatment and chemotherapy as consolidation for advanced stages of the disease. Disclosures: No relevant conflicts of interest to declare.
Revista Médica del Hospital General de México, Jul 1, 2010
0185-1063/$ - see front matter © 2010 Sociedad Médica del Hospital General de México. Publicado p... more 0185-1063/$ - see front matter © 2010 Sociedad Médica del Hospital General de México. Publicado por Elsevier México. Todos los derechos reservados. ... Recibido: 29 de julio, 2010 Aceptado: 7 de septiembre, 2010 ... Langerhans cell sarcoma with intraocular infiltration: ...
Revista de la Facultad de Medicina, Jan 8, 1977
Blood, Dec 2, 2016
Introduction Autologous hematopoietic stem cell transplantation (ASCT) is a treatment option for ... more Introduction Autologous hematopoietic stem cell transplantation (ASCT) is a treatment option for long-term remission in patients with multiple myeloma and recurrent non-Hodgkin´s lymphoma (NHL). The eligibility for ASCT is based on a risk-benefit assesssment of the disease, age has not been considered an exclusion criteria for ASCT where treatment related mortality are relatively low. The treatment-related morbidity is associated with toxicity of condition regimen and infections associated with the degree of immune deficiency. Outcome in elderly patients with multiple myeloma and recurrence of Hodgkin´s lymphomas with chemosensitive illness in ≥ 60 years patients undergo ASCT are limited and contradictory. For this reason the aims of the present study was to reviewed to identify patient with multiple myeloma and non-Hodgkin lymphoma undergoing ASCT at 60 or greater and describe the clinical data and outcome. Method: This work was a retrospective transversal study, 24 patients older than 60 years was enrolled and all of them were undergo ASCT al Instituto Nacional de Cancerologia, Mexico from 2005 to 2015. We assessed previous comorbidities, treatment lines, response prior to transplantation, treatment response, relapse free-survived and global survival, it was considered from the transplantation day until last visit at the hospital. Results Twenty-four patients were assessed, all were ≥60 years at the transplant moment. 16 of them had diagnostic of multiple myeloma and 8 with Non-Hodgkin&#39;s lymphoma (NHL). For the multiple myeloma group the median of age was 66 years (60-70 years), the 81% was male. At the transplant moment, two people in that group had hypertension, one had diagnosis of Diabetes Mellitus Diabetes II and the another did not have any other illness. At the transplant moment 62.5% of the patients had been treated with only one line treatment and 37.5% had been received two treatment lines. On the other hand, at the transplant moment 50% of the patients had completed response, 12% had partial response, 31.26% had very good partial responses and 6.25% had illness progression. Multiple myeloma patient was conditioned with melphalan 200mg/m2 in 95%. Neutrophils recovery was at 12 days. Fourty-three percent of the patient required transfusion. Neutropenic fever was presented in 43% of the patient. Fifty percent got completed response after ASCT and 20% with progression disease. Relapse disease was in 31% and mortality was 6.25%, there was not mortality associated with the process and 44% is alive without illness (Table 1). In patients with multiple myeloma the OS at two year was 100% and at three years 86%; for NHL patients OS at one year was 67% and at two years 33%. . For the NHL group the median of age was 67 years (61-72 years), the 50% was male, one person in that group had HTA at transplant moment, another one had diagnosis of MDII, another one had rheumatology disease and another one had long disease, and the other four did not have any other diseases. At the transplant moment 37.5% of the patients had been treated with only one line treatment, 37.5% had been received two treatment lines and 25% had been received three treatment lines. On the other hand, at the transplant moment 87.5% of the patients had completed response and 12.5% had partial response. NHL patients were conditioned with PEAM (cisplatin, etoposide, cytosine arabinoside and melphalan) 25%, Rituximab-PEAM in 62.5% and one patient with fludarabine with cyclophosphamide (FLUCY). Neutrophils recovery was at 12 days. Fourty-three percent of the patient required transfusion. Neutropenic fever was presented in 43% of the patient. Fifty percent got completed response after ASCT and 20% with progression disease. Relapse disease was in 31% and mortality was 6.25%, there was not mortality associated with the process and 44% is alive without illness (Table 1) For lymphoma, the relapse-free survival at one year 48.6%. For patients with multiple myeloma, the free illness survival at one year was 85.7%, at two years 77.9% and at four year 58.4%. Conclusion Autologous stem cell transplantion in older people is a good option for treatment without mortality asociated at process. The complications like neutropenic fever and transfusional requirement are similar with younger patients. In our population, age is not a limit to offer a treatment with high dose of chemotherapy and autologous. Disclosures No relevant conflicts of interest to declare.
Revista de la Facultad de Medicina, Jan 8, 1976
Gaceta Medica De Mexico, 2003
Revista de hematología, 2010
El mieloma múltiple es una neoplasia de células plasmáticas malignas que pueden sintetizar inmuno... more El mieloma múltiple es una neoplasia de células plasmáticas malignas que pueden sintetizar inmunoglobulinas. Es incurable, poco frecuente y su tratamiento es heterogéneo en las diferentes instituciones y centros privados de nuestro país. En varias ocasiones se reunió un grupo de hematólogos mexicanos para revisar los criterios internacionales del diagnóstico y tratamiento de este padecimiento, con el fin de comparar y complementar los propios, los cuales incluirían diagnóstico, diagnóstico diferencial, terapia de inducción, evaluación de la respuesta a la terapia, etc. Las recomendaciones de este grupo se basaron en las guías americanas y europeas al respecto, y se adaptaron a la práctica médica de México. Palabras clave: guías mexicanas, mieloma múltiple, tratamiento del mieloma múltiple, imagenología, trasplante de células hematopoyéticas, quimioterapia.
Gaceta Medica De Mexico, Mar 28, 2023
El coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) y su traducción clínica, la e... more El coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) y su traducción clínica, la enfermedad por coronavirus 2019 (COVID-19), representan una enfermedad con manifestaciones respiratorias potencialmente fatales. Actualmente existen aproximadamente 12,700,000 personas afectadas por esta virus, el cual ha ocasionado 561,517 muertes en el mundo. Los pacientes con diagnóstico de linfoma, al igual que otros pacientes con cáncer activo, presentan compromiso inmunitario, ya sea por su propia patología o debido al tratamiento que reciben, por lo que son especialmente susceptibles a desarrollar cuadros graves de COVID-19. La transmisión comunitaria del SARS-CoV-2 dificulta el acceso al sistema de salud y, por ende, el seguimiento estricto que requieren lo pacientes bajo tratamiento oncológico. En la etapa en la que nos encontramos actualmente, la transmisión global de la infección por SARS-CoV-2 continúa en ascenso, por lo que un control epidemiológico cercano es poco probable. Ante este contexto, surge la necesidad de establecer guías de tratamiento de pacientes con neoplasias hematológicas.
American Journal of Hematology, 2006
We studied the effectiveness of a fludarabine/cyclophosphamide-based conditioning regimen without... more We studied the effectiveness of a fludarabine/cyclophosphamide-based conditioning regimen without anti-thymocyte globulin in 23 aplastic anemia patients who had no response to previous conventional pharmacologic treatment. Patients received oral busulphan 4 mg/ kg/day/2 days, IV cyclophosphamide 350 mg/m 2 /day/3 days, and fludarabine 30 mg/m 2 /day/ 3 days. For GVHD prophylaxis, patients received MTX 5 mg/m 2 days +1, +3, +6, and +11 and oral cyclosporin A (CyA) 5 mg/kg/day, starting on day-1. Peripheral blood stem cell products were used with a median dose of 5.5 • 10 6 CD34 + /kg. The patients were followed for an average of 25 months. By a median of day +11, an ANC > 0.5 • 10 9 /L was reached; and by day +12, the platelet count had reached >20,000 • 10 9 /L. Acute grade I-II GVHD occurred in 4 patients, whereas limited chronic GVHD presented in 6 cases. Twenty-one patients (91.3%) achieved engraftment. Two patients failed to engraft, and 4 developed late rejection; 2 of these individuals died, 2 have survived with high transfusion requirements, whereas 2 received a second peripheral blood stem cell infusion and achieved sustained engraftment. Currently 21 (91%) of the 23 patients are alive, whereas 19 of 21 (90%) remain in complete remission. The average cost was about USD 15,000 for this kind of reducedintensity allotransplant. Reduced-intensity stem cell transplantation represents an affordable alternative to traditional more cytotoxic conditioning for severe aplastic anemia (SAA) patients. Long-term effects however, remain to be evaluated. Am.
Blood, Nov 20, 2009
Abstract 2940 Poster Board II-916 Introduction. Nasal NK/T cell lymphoma (NNK/TCL) is a tumor wit... more Abstract 2940 Poster Board II-916 Introduction. Nasal NK/T cell lymphoma (NNK/TCL) is a tumor with a low prevalence but is more frequent in Asia and South America. There is no standard treatment for these patients, although radiotherapy is usually recommended. Few reports describe the frequency of central nervous system (CNS) involvement in this type of lymphoma and, in consequence, little is known about the benefit of carrying out screening procedures such as cerebrospinal fluid (CSF) cytology or image studies, nor it is known if prophylactic radiotherapy to the CNS or intrathecal chemotherapy improves the outcome of these patients. Patients and methods. We reviewed the clinical files of 63 patients of the National Cancer Institute in Mexico City with a diagnosis of angiocentric, centrofacial or NNK/TCL between january 1996 and december 2008. We excluded those patients who had a doubtful histopathological diagnosis, who were not completely studied or who did not received treatment in our institution. We collected the following variables: age, gender, histopathological diagnosis, localization of the tumor, clinical stage, symptoms at presentation, IPI score, CNS involvement, CSF cytology, image studies, LDH level, type of treatment and global response to treatment. Results. We found a total of 48 patients with a diagnosis of primary nasal lymphoma who met the inclusion and exclusion criteria. The mean age was 45.6 (range 16-81) years. The male to female ratio was 2:1. The most frequent localization and histopathological type was the nasal T cell lymphoma (58.3% and 43.8%, respectively). Thirty one percent of the tumors were classified as diffuse large cell and small cell lymphomas due to the lack of immunopathology at the time of diagnosis. Most of the patients were at stage I or II (81.3%) of the disease and had a low or low intermediate IPI score (85.4%). Of the 48 patients 89.6% recieved combined treatment with chemotherapy (CHOP) and radiotherapy, the other 10.4% recieved treatment with radiotherapy alone. Thirty nine point six percent and 23% of the patients had complete and partial response to the treatment, respectively. The remaining patients had either stable or progressive disease. Only 10.9% of the patients complained of neurologic symptoms and 85.4% had a spinal tap done. Nine patients had central nervous system infiltration (18.8%), 55.5% presented with neurological symptoms. Seven of the nine patients with CNS infiltration were diagnosed with a positive CSF cytology (77.8%). Two patients had a negative CSF cytology but had a positive MRI (22.2%). None of these patients had a positive CT scan for CNS involvement. Eight of the nine patients were treated with combined chemo and radiotherapy and 1 patient was treated with radiotherapy alone. Three patients achieved complete response (33.3%). Although there is a great difference in complete response between the patients with and without CNS involvement (6.25% vs 54.17% respectively, p= 0.07), this difference was not statistically significant. This can be due to the small number of patients with CNS involvement. There was no significant difference in the IPI score, LDH levels, stage of the disease or age between the groups. Conclusions. CNS involvement is present in a considerable proportion of patients with primary nasal lymphoma. Based on these data we think CSF cytology should be done in all patients. The results also suggest that the CT scan is not sensitive enough to detect CNS involvement. The treatment of these patients is an open question because there is virtually no data in the literature regarding therapy for this complication. Disclosures: No relevant conflicts of interest to declare.
Blood, Nov 13, 2019
Background: Defining the extent of disease is essential for determining the prognosis and managem... more Background: Defining the extent of disease is essential for determining the prognosis and management of patients with Hodgkin (HL) and non-Hodgkin lymphoma (NHL) as the presence of advanced disease, including involvement of an extralymphatic site, is associated with inferior outcomes (Cheson et al, 2014). 18F-fluorodeoxyglucose positron emission tomography (FDG PET-CT) has an excellent diagnostic performance for evaluation of bone marrow infiltration (BMI) in patients with lymphoma but it is expensive and not always available at low and middle-income health care facilities. Unilateral bone marrow biopsy (BMB) is a more accessible test and has been the standard to identify lymphomatous BMI. Unfortunately, it is an unpleasant procedure for the patient and can be limited by technical constraints. The aim of this single-center retrospective cohort study was to evaluate the diagnostic performance of FDG PET-CT for BMI in lymphoma patients, comparing it with BMB as the gold standard. Also, we evaluated for discordant results between both studies along with its effect on patient treatment. Methods: Newly diagnosed lymphoma patients evaluated at the National Cancer Institute between July 2017 and December 2018 were identified from our institutional lymphoma data base. Five hundred patient files were reviewed for bone marrow evaluation at diagnosis by BMB and FDG PET-CT as well as for other clinical characteristics. Only 355 patients had both FDG PET-CT and BMB performed and adequately reported, so the rest were excluded from the analysis. Fisher's exact and Pearson Chi-square tests were used to compare categorical variables. Comparisons of continuous variables were performed using Mann-Whitney U test. Setting BMB as the gold standard, diagnostic performance of FDG PET-CT for detecting BMI was evaluated. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratios (LR) and accuracy were calculated for the most common histological subtypes. Logistic regression model was used for univariate and multivariate analysis of predictors for positive BMB and positive FDG PET-CT for BMI. Results: The most common histologic type was diffuse large B-cell lymphoma (DLBCL) in 42.4% of cases, followed by HL in 20.4%, and follicular lymphoma (FL) in 11.2%. Median age was 53 years. B symptoms were present in 59.6% of cases and 71.4% debuted with advanced stage of disease (Ann Arbor III and IV). BMB was positive in 17% of all patients and 28% had a positive FDG PET-CT for BMI (Table 1). BMB was positive in 17.2% of HL, 12.3% of DLBCL, 29.8% of FL and 15.6% of other types of lymphoma patients. Overall, sensitivity of FDG PET-CT was 74.1%, specificity 80.1%, PPV 42.2%, NPV 94.1%, +LR 3.73, -LR 0.32 and accuracy 79.2%. The diagnostic performance of FDG PET-CT in patients with HL, DLBCL, FL and other types of lymphoma is shown in Table 2. As for predictors for BMB positivity, the presence of B symptoms, neutropenia and thrombocytopenia were independent factors for BMI with adjusted OR of 2.44, 95% CI (1.19, 4.99), 5.64, 95% CI (1.32, 24.08) and 4.12, 95% CI (1.66, 10.26), respectively. For positive FDG PET-CT, the presence of B symptoms, thrombocytopenia and advance stage remained significant with adjusted OR of 2.96, CI 95% (1.73, 5.05), 2.75, 95% CI (1.17, 6.48) and 19.22, 95% CI (5.90, 62.66), respectively. Seventy-four patients had discordant results between BMB and FDG PET-CT. The discrepancy in BMB and FDG PET-CT results did not have an effect on treatment. Conclusions: In addition to international clinical practice guidelines recommendations, in our center we recommend performing a BMB to those patients with HL and FDG PET-CT negative for BMI who present with cytopenias and B symptoms at the time of diagnosis. For patients with DLBCL our FDG PET-CT sensitivity was lower than expected, so we recommend a complementary BMB to all DLBCL patients with a positive FDG PET-CT for BMI (stage IV) that otherwise would be early stages (I and II) and would benefit from less aggressive therapy. In all other NHL including FL, we recommend performing a unilateral BMB with immunohistochemical analyses and flow cytometry, if available, for initial evaluation of BMI. Still in the absence of FDG PET-CT, a whole-body contrast-enhanced CT along with a unilateral posterior iliac crest BMB could adequately stage most types of lymphoma at low and middle-income health care facilities. No relevant conflicts of interest to declare.
Blood, Nov 29, 2018
Follicular lymphoma (FL) is the most common indolent lymphoma with a median survival approaching ... more Follicular lymphoma (FL) is the most common indolent lymphoma with a median survival approaching 20 years. However, there is significant clinical heterogeneity with subsets of patients experiencing transformation, early recurrence or refractory disease. Some authors found that progression of disease within 24 months of diagnosis, in patients treated with chemoimmunotherapy (POD24), is associated with poor overall survival (OS). OBJECTIVE Evaluate the POD24 as an early clinical endpoint in FL and evaluate FL international prognostic index (FLIPI), and other baseline risk factors at diagnosis for overall survival and relapse. METHODS We conducted a retrospective and observational study in which 160 patients with follicular lymphoma who received R-CHOP at National Institute of Cancerology, Mexico from 2011 to 2017. We analyze with Kaplan Meier curves, log rank test and logistic regression model. RESULTS We analyze 160 patients, median of age was 53 years (26- 88), with a female : male ratio of 1.17:1. In this group: 86% had hemoglobin &amp;gt;12 mg/dL, LDH was normal in 62%, 1-4 nodal areas were affected in 64%, 56% of patients had high FLIPI score, 27% had B symptoms and we found bone marrow infiltration in 30% of cases; grade 2 Follicular lymphoma was the most common histological subtype (40.5%). Most of patients achieved complete response (81%), 12% partial response after the first line therapy. Only 13 patients (8%) presents relapse. Sixty four percent received maintenance. Only 13 of patients relapsed, 10 after 24 months and only 3 in first 24 months from diagnostic (POD 24). Fig. 1 Overall survival in our population was 89% to 8 years, the factors with statistical significance in the bivariate analysis were the more nodal regions affected (1-4), high FLIPI score and POD 24 POD 24, adjusted to FLIPI score, was an independent predictor of survival in regression analysis (p&amp;lt;0.041, HR:35 IC 95% 1.15-1060.21). The bone marrow infiltration at diagnosis was the only independent predictor for relapse (p&amp;lt;0.007, HR: 6.9, IC 95% 1.7- 28.2). CONCLUSION: In our study group, POD 24, was an important predictor of overall survival, and bone marrow infiltration at diagnosis was the only predictor factor for relapse. Disclosures No relevant conflicts of interest to declare.
Blood, Nov 20, 2009
Abstract 5030 Introduction T cell Non/Hodgkin&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp... more Abstract 5030 Introduction T cell Non/Hodgkin&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s lymphomas (TCNHL) are a group of lymphomas characterized by an aggressive clinical course and resistance to the usual chemotherapy agents. Due to the limited availability of immunochemistry techniques the frequency and clinical presentation of these lymphomas are not well described in underdeveloped countries. Here we describe the experience with these diseases in a tertiary referral health center. Patients and methods We reviewed 520 cases with diagnosis of Non-Hodgkin&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Lymphoma from the records of the Pathology Department of the Hospital General de Mexico, seen from January 2002 to July 2006. Results We found 80 cases with TCNHL (15.3%). In 62 cases the clinical information was available for review. We found a 1.45:1 male/female ratio, median age 32 years (range 17 to 83). Symptoms were present for a median of 6 months (range 1 to 120 months) before diagnosis. Regarding the pathological classification the Unspecified Peripheral T-cell lymphomas were more common (56%), followed by the anaplastic lymphoma (23%), T/NK (16%), Cutaneous lymphoma (3%) and angioimmunoblastic lymphoma (2%). In 56% the initial presentation was nodal and in 44% extranodal. The extranodal sites were: Nasal (34%), bone marrow (22%), pleura and lung (14%), parotid (5%), colon (5%), and liver (5%). Sixty seven percent of the patients had advanced clinical stages and 73% had at least 3 B symptoms. One quarter of patients had bulky disease at their first visit to our Hospital; the most frequent site was retroperitoneal (19%). The lactic dehydrogenase (LDH) was elevated in 89% of cases (range:97 U/L -3017 IU L, median 418 U/L); patients with anaplastic NHL had the highest values and NHL-TNK patients the lowest. HIV serology was performed in 41 of 62 patients. Ninety four percent of the patients had an ECOG between 1 and 3. We calculated the International Prognostic Index (IPI); it was low in 23 patients (37%), low-intermediate in 18 (29%), intermediate-high in 16 (26%) and high in just 5 patients (8%). When we classified the patients with the Prognostic Index for non-specific peripheral T-NHL (PIT or PTCL-L), we found that 79.4% of cases were in the high-risk group in contrast with 73.6% low group according to IPI. All patients were treated with CHOP chemotherapy. A complete response (CR) was achieved in 10 patients (16%); 13 patients (21%) were still on treatment at the end of the study, 4 patients (6.45%) did not respond to treatment and 14 patients (24.1%) had progressive disease. Ten patients discontinued treatment (16%) and 5 died (8.06%). At the end of the observation period 8 patients were alive without tumor activity, 2 patients were lost without tumor activity, 7 patients were alive with disease, 24 patients were missing with tumor activity, 9 patients were on treatment and 12 patients had died. Conclusions This study shows that in Mexico as in other populations, the TCNHL are less frequent than the B-cell lymphomas. It also confirms the poor response of the T-Cell lymphomas to CHOP. The population that attends our hospital is of a low socioeconomic stratum, and this fact explains the large abandonment of medical care. It is desirable the development of new drugs for these neoplasia. Disclosures No relevant conflicts of interest to declare.
Blood, Nov 5, 2021
Background: Positron emission tomography-computed tomography (PET-CT) is used for staging and res... more Background: Positron emission tomography-computed tomography (PET-CT) is used for staging and response assessment in classical Hodgkin lymphoma (cHL) and for evaluation and management of refractory/relapsed Hodgkin lymphoma (RRHL). According to the World Health Organization's Global Atlas of Medical Devices 2017 report, 92-95% of lower-middle and low-income countries have no PET/CT unit, and only 3% of upper-middle income countries have 1 PET scanner/million people, versus 29% of high-income countries. Real-world data on PET scan use in cHL and RRHL outside Europe and North America are limited. The B-CD30+ HOdgkin Lymphoma International Multi-center Retrospective Study of Treatment Pract Ices and Out Comes (B-HOLISTIC) study assessed real-world treatment practices and clinical outcomes in patients with stage IIB-IV cHL and RRHL in countries outside Europe and North America and imaging results are presented here. Methods: The B-HOLISTIC study retrospectively reviewed patients (≥18 years) with stage IIB-IV cHL or RRHL between 2010 and 2013. Patients initially diagnosed with cHL who progressed to RRHL during the study were included in both groups. Details of PET and CT scans at baseline and during/end of frontline/salvage treatment, were reported in both groups. Results: Overall, 1703 patients (cHL: 1598, RRHL: 426, both: 321) were enrolled (East Asia: 426, Latin America: 366, Middle East and South Africa: 694, Australia: 56, Russia: 161). Median follow-up was 5.4 and 4.4 years in the cHL and RRHL groups, respectively. PET and CT results for cHL and RRHL groups are shown in Tables 1 and 2, respectively. The proportion of patients with PET scan was 73.2% in the cHL group with a median (interquartile range [IQR]) frequency of 2.0 (2.0-4.0) and 72.3% in the RRHL group with a median (IQR) frequency of 3.0 (2.0-5.0). In both groups, the proportion of PET scans at baseline was lower (cHL: 54.4%; RRHL: 32.8%) than during/ end of frontline treatment (cHL: 85.8%; RRHL: 58.8%) and at relapse/refractory diagnosis (54.5%). In contrast, the proportion of CT scans was higher (cHL: 76.4%; RRHL: 79.1%), particularly at baseline (cHL: 66%; RRHL: 51.6%). The highest proportion of PET scans was reported in Australia and lowest in Russia. The highest proportion of CT scans was in Russia in the cHL group and in Australia and East Asia in the RRHL group, while the lowest was in Middle East and South Africa in both groups. The frequency of interim PET scans was low in both cHL and RRHL groups, and were rarely used in cHL surveillance. In the RRHL group, interim PET scans during the frontline therapy were higher after cycles 3-4 and 5-6 than after cycles 1-2. Deauville 5-point scale (5-PS) was used for PET assessment at interim treatment cycles, end of frontline/salvage treatment, relapse, and surveillance in both groups with increased scans reporting a 5-PS rating towards the end of treatment and surveillance. However, its overall use was suboptimal with a minority (<50%) reporting a specific Deauville score. Discussion and Conclusion: This study provides real-world evidence on PET use in cHL and RRHL outside Europe and North America, which is suboptimal. Although PET is part of standard care for cHL now, during 2010-2013 it was more commonly used only in RRHL, as reflected in the higher PET use in RRHL than cHL in this study. Lower overall PET use than CT and the regional differences may reflect the comparatively limited access and availability of PET, especially in low-income countries. Lower PET use at baseline may have been due to low accessibility of PET at the beginning of the study, which improved over time. Higher PET use at the end of frontline treatment in cHL is in line with the literature, and suggestive of its recognized benefits in guiding further treatment if used early in treatment. Lack of data on Deauville ratings could be because its use was uncommon during the time of the study. However, the increased Deauville score reporting towards the end of the study suggests a trend for its use. Overall, the low interim PET use, regional differences, and lack of data on use of Deauville rating in this study, suggest an existing gap in real-world practice and highlight the global inequities in access to PET. These findings suggest the need for upscaling numbers and access to PET scanners outside Europe and North America through careful planning and in-depth assessment of socioeconomic, demographic, and epidemiological circumstances of each country. Figure 1 Figure 1. Ferhanoglu: Takeda Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees. Zerga: Takeda: Honoraria; Sandoz: Honoraria; Bristol Myers Squib: Honoraria; Jansen: Honoraria; Roche: Honoraria. Kim: Bayer:…
Blood, Nov 5, 2020
Background: Despite therapeutic advances in classical Hodgkin lymphoma (cHL), only half of patien... more Background: Despite therapeutic advances in classical Hodgkin lymphoma (cHL), only half of patients with relapsed/refractory (R/R) cHL are cured with salvage chemotherapy followed by stem cell transplantation (SCT). Most studies to date have been undertaken in Europe or North America and data on treatment patterns and clinical outcomes from other regions are limited. We present the results from the B-CD30+ HOdgkin Lymphoma International Multi-center Retrospective Study of Treatment PractIces and OutComes (B-HOLISTIC), which assessed cHL treatment pathways, clinical outcomes and healthcare resource utilization across East Asia, Latin America, Middle East, South Africa, Australia and Russia (data as of 04 March 2020). Methods: Data were collected retrospectively for patients (≥18 years) diagnosed with stage IIB-IV cHL or R/R cHL between 01 January 2010 and 31 December 2013, until death or last follow-up (whichever occurred first) across 13 countries. Patients with initial diagnosis of cHL and subsequent progression to R/R cHL were included in both groups, provided R/R cHL was diagnosed within the study period. The primary endpoint was progression-free survival (PFS) in patients with R/R cHL. Secondary endpoints included overall survival (OS), best clinical response, and adverse events (AEs). Results: In total, 1703 patients were enrolled from East Asia (n=426), Latin America (n=366), Middle East and South Africa (n=694), Australia (n=56) and Russia (n=161): 1598 and 426 patients were eligible for the cHL and R/R cHL groups (321 patients in the cHL group progressed to R/R cHL and were included in both groups). Median study follow-up was 65.2 and 53.2 months for the cHL and R/R cHL groups. Baseline patient characteristics are shown in Table 1. All patients in the cHL group received first-line chemotherapy: the most common regimens were ABVD (1363/1598; 85.3%) and BEACOPP (104/1598; 6.5%). First-line radiotherapy was given to 357/1598 (22.3%) patients in the cHL group. For R/R cHL, intensive chemotherapy was used as first-line salvage in 372/426 (87.3%) patients: the most common regimens were ESHAP (98/372; 26.3%) and DHAP (65/372; 17.5%), with an overall response rate of 62.0% (complete remission in 30.8% and partial remission in 31.2%). Of the 426 patients with R/R cHL, 292 (68.5%) were eligible for SCT at relapse/refractory diagnosis; 10 patients who were initially ineligible for SCT subsequently became eligible. In total, 222/302 (73.5%) eligible patients underwent SCT; 63/222 (28.4%) patients relapsed after SCT. Median PFS (95% CI) for the R/R cHL group was 13.2 (9.9-20.2) months following initial therapy (Figure 1), with estimated 1-, 3- and 5-year PFS rates of 51.2%, 38.7%, and 33.9%, respectively (Table 2). Median PFS was not reached for the first-line cHL group. Factors for PFS in the R/R cHL group are shown in Table 3. Median OS was not reached for both groups. All-cause, any grade AEs were reported by 783/1598 (49.0%) patients with cHL and by 233/426 (54.7%) patients with R/R cHL. Serious AEs were reported by 303/1598 (19.0%) patients with cHL and by 103/426 (24.2%) patients with R/R cHL: the most common (≥2.0%) were febrile neutropenia, pneumonia and pyrexia for cHL, and febrile neutropenia and pyrexia for R/R cHL. Conclusion: Results from B-HOLISTIC show that PFS rates remain low in patients with R/R cHL receiving salvage therapy; the greatest risk was among patients with inadequate response to salvage chemotherapy. The low PFS rates highlight the importance of considering novel targeted therapies to address unmet medical needs. PFS rates in patients with cHL were comparable with previous studies from Italy, Spain, and Israel (Avigdor A et al. EHA 2020) and the ECHELON-1 study (Bartlett NL et al. ASH 2019). The higher OS rates compared to PFS rates may be related to the effect of modern salvage regimens. Approximately half of patients with R/R cHL underwent SCT which may support the use of targeted therapies. Overall, these results from 2010-2013 show that despite the differences in healthcare systems, ethnicities and treatment patterns in B-HOLISTIC, clinical outcomes remain consistent. The authors note that given that the management of high-risk cHL has changed dramatically since 2013, further investigation in diagnostic criteria, response assessment and treatment patterns is needed. Study support: Data analysis (IQVIA) and medical writing (Synergy Vision) funded by Takeda Pharmaceuticals. Disclosures Ferhanoglu: Takeda: Other: Advisory Board; Abbvie: Other: Advisory Board; Roche: Other: Advisory Board; Janssen: Other: Advisory Board. Kim:Novartis: Consultancy; AstraZeneca and Korea Health Industry Development Institute: Research Funding; Sanofi: Consultancy; F. Hoffmann-La Roche Ltd/Genentech, Inc.: Consultancy; Voronoi: Consultancy; Boryung: Consultancy; AstraZeneca: Consultancy; Takeda: Consultancy. Karduss:Takeda: Honoraria. Rivas-Vera:Takeda: Current Employment, Other: Steering Committee in…
Blood, Nov 29, 2018
Background: The cure rate for advanced classical Hodgkin lymphoma (cHL) is approximately 70%, whi... more Background: The cure rate for advanced classical Hodgkin lymphoma (cHL) is approximately 70%, which is calculated based on data from clinical trials performed in North American and/or European countries (Canellos GP, et al. N Engl J Med. 1992;327:1478-84; Carde P, et al. J Clin Oncol. 2016;34:2028-36; Gordon LI, et al. J Clin Oncol. 2013;31:684-91). However, there are limited outcome data available in other countries, apart from some small hospital-based studies (Ramirez P, et al. Rev Bras Hematol E Hemoter. 2015;37:184-9; Law MF, et al. Arch Med Sci. 2014;10:498-504; Jaime-Pérez JC, et al. Oncologist. 2015;20:386-92; Omer Al-Sayes FM, Sawan A. J Taibah Univ Med Sci. 2006;1:48-56). The B-HOLISTIC retrospective chart review study seeks to address the paucity of data on cHL treatment patterns, clinical outcomes, and healthcare resource utilization in 13 countries across Latin America, Africa, Middle East, and the Asia-Pacific region. Methods: The study will collect data from approximately 2,600 patients aged ≥18 years and newly diagnosed with stage IIB-IV cHL or relapsed/refractory cHL (RRHL) between 01 January 2010 and 31 December 2013, and will follow them until death or chart review, whichever occurs first. The primary objective is to describe progression-free survival (PFS) in patients with RRHL. Secondary objectives include describing demographic and clinical characteristics, clinical outcomes (overall survival, best clinical response after completion of treatment, response duration), key adverse events associated with each line of therapy, and cHL-related healthcare resource use. Results: As of 14 May 2018, a total of 165 patients from 12 sites have been included in the interim analysis, predominantly from Turkey and South Korea. At this time, 150 patients had cHL and 24 patients had RRHL, including 9 patients who were enrolled in the cHL group and had a documented relapse/progression during the study period. Here, we report the results of the newly diagnosed cHL group; data from the RRHL group will be reported in subsequent publications. At diagnosis, 64.7% of the cHL group were male, with a median age of 36.5 years (range, 18-89 years); 22.7% had stage IV disease, 30% had extranodal disease, 59.3% had &amp;#39;B&amp;#39; symptoms, and 34.9% had an International Prognostic Score (IPS) of ≥4. Patients were classified as 13.3% in stage I-IIA; 24% in stage IIB; 53.3% in stage IIIA-IVB; and 9.3% as unknown. Patients classified as stage I-IIA are a deviation from the clinical study protocol and will be removed from the final study analysis. The proportion of patients alive was 94%, with the cause of death reported as either HL-related (44.4%), due to an adverse event (11.1%), or other (44.4%). Positron emission tomography (PET) or PET-computed tomography (CT) imaging was performed in 58.5% of patients at baseline, 48% of patients at interim, and 36.6% at end-of-treatment; CT imaging was performed in 68.7% of patients at baseline, 83.6% of patients at interim, and 59.7% of patients at end-of-treatment. At frontline treatment, 95.3% of patients received chemotherapy (mostly doxorubicin, bleomycin, vinblastine, dacarbazine [ABVD], 92.3% [median number of cycles, 6; range, 2-8]), 22.7% of patients received radiotherapy, with 22% of patients receiving radiotherapy and chemotherapy (median total dose, 34.5 Gy; range, 24-45 Gy). The majority of patients received involved-field radiotherapy (53.1%), with other modalities including involved-node (21.9%), involved-site (18.8%), whole body (3.1%), or other (3.1%). The proportion of patients who achieved a complete or partial response to frontline treatment was 52.1% and 21.1%, respectively. The PFS for treatment in frontline cHL in the overall patient population at 48 months was 81% (95% CI, 73.1-86.7; Figure 1), with a median duration of follow-up of 58.9 months (range, 2.6-128.3 months). The PFS for treatment in frontline cHL excluding ineligible patients classified as stage I-IIA (13.3%) at 48 months was 78.9% (95% CI 69.7-85.6). Due to the retrospective nature of this study, adverse events were under-reported and will be presented once the data are mature. Conclusion: The B-HOLISTIC study is ongoing, with final patient enrolment anticipated in December 2018. These interim data provide real-world information on the incidence, treatment, and outcomes of cHL in countries where little is known about this patient population. Disclosures Ferhanoglu: Takeda: Membership on an entity&amp;#39;s Board of Directors or advisory committees; Roche: Membership on an entity&amp;#39;s Board of Directors or advisory committees; Janssen: Membership on an entity&amp;#39;s Board of Directors or advisory committees. Yeh:GNT Biotech &amp;amp;amp; Medicals Crop.: Research Funding. Brittain:Takeda: Membership on an entity&amp;#39;s Board of Directors or advisory committees. Karduss:Novartis: Membership on an entity&amp;#39;s Board of Directors or advisory…
Revista Iberoamericana De Micologia, Oct 1, 2010
Revista Medica De Chile, Feb 1, 2009
Histiocytic sarcoma of the small intestine. Report of one case Histiocytic sarcoma (HS) is a rare... more Histiocytic sarcoma of the small intestine. Report of one case Histiocytic sarcoma (HS) is a rare malignant neoplasm of the lymphohematopoietic system, that occurs in lymph nodes, skin and at extranodal sites, particularly the gastrointestinal tract. Although it shows characteristics histological and immunohistochemical features, it may be misdiagnosed. We report a 67 year-old female patient presenting with colicky abdominal pain and vomiting. A CT scan of the abdomen revealed a tumor in the ileum, that was surgically removed. On pathology, the neoplastic cells displayed large abundant eosinophilic cytoplasm, with bizarre-shaped nuclei, that expressed CD 45, CD 68 and lisozyme. The diagnosis of HS requires the use of a panel of immunohistochemical markers and may be supported by ultrastructural findings (Rev Méd Chile 2009; 137: 269-74).
Blood, Nov 16, 2005
Follicular lymphoma is frequently associated with the chromosomal rearrangement t(14;18)(q32;q21)... more Follicular lymphoma is frequently associated with the chromosomal rearrangement t(14;18)(q32;q21), which joints one of the JH segments of the heavy chains of immunoglobulins (IgH) gene in 14q32 with the Bcl-2 gene in 18q2, originating a chimeric protein. The frequency of this marker is unknown in the Mexican population. OBJECTIVE: To determine the incidence of the Bcl2-IgH rearrangement in Mexican patients with follicular lymphoma and its frequency as a marker of minimal residual disease after therapy. PATIENTS AND METHODS: 200 patients (102 male and 98 female) were evaluated; the analysis was made in peripheral blood samples (PB) in 64 cases (32%) or bone marrow (BM) in 136 (68%). Genomic DNA was obtained and the Bcl-2/IgH rearrangement was amplified by both PCR and nested PCR using primers for JH and exon-intron 3 region of Bcl-2 (MBR and MCR regions). The Bcl-2/IgH rearrangement was used as a marker to determine minimal residual disease (MDR) in 90 out of 200 patients in clinical remission, with a follow up ranging from 12 to 60 months; The incidence and tissue type analysis were compared using chi-square statistics. RESULTS AND DISCUSSION: We found a positive Bcl-2/IgH rearrangement in 80% of the Follicular NHL cases, with a breakage in the MBR region in 160 cases and in MCR in 10 cases, in the remaining 30 patients the Bcl-2/IgH was negative. We detected the Bcl-2/IgH rearrangement more frequently in the BM samples (86%) than in the PB (42%)…
Blood, Nov 20, 2009
Abstract 4767 Introduction Extranodal NK/T-cell lymphoma, nasal type is an entity of difficult di... more Abstract 4767 Introduction Extranodal NK/T-cell lymphoma, nasal type is an entity of difficult diagnosis. It is characterized by damage and vascular destruction, necrosis, cytotoxic phenotype and Epstein Barr virus association. It is prominent in Asia, Mexico, Central and South America, predominantly in men. Material and methods It is an observational, descriptive and retrospective study, based on medical records of NK/T-cell lymphoma patients of the General Hospital of Mexico between 1992-2009. Results Of 632 non-Hodgkin lymphomas (NHL), 113 had a T cell lymphoma. Only 32 cases (28.3%) were eligible for the study. The age range was 19-56 years with a media of 42. The male:female ratio was 2.2:1. The most frequent clinical presentation symptoms were nasal obstruction, facial swelling and pain. Central nervous system involvement was present only in two cases and bone marrow infiltration in one. Seventy eight percent were on clinical stages I or II and 56% had B symptoms. In 7/10 patients the Epstein Barr association was documented by hystopathological study. The treatment was completed in 31/32 individuals. Fifty five percent showed some response, regardless of the therapy used. The CHOP regimen was the first line treatment in 80.6% of cases and only 13% received fractionated radiotherapy as initial treatment. The CHOP arm had an overall response rate of 60% (complete remissions, unconfirmed complete remissions, partial remissions), and 100% of the patients in the radiotherapy arm presented complete response. Most patients of the radiotherapy arm were on stage IE. The overall survival rate was 63% at 36 months. The average follow-up was 40 months. There were no differences in overall survival rates between the two arms, but the radiotherapy arm had a higher rate of complete remissions. Conclusions In this study we report the clinical features and response to treatment of the patient population treated at the General Hospital of Mexico. The results are similar to other international reports. Although the incidence of NK/T-cell lymphoma is low, it is necessary to standardize its treatment and these preliminary data warrant further trial of radiotherapy as the initial treatment and chemotherapy as consolidation for advanced stages of the disease. Disclosures: No relevant conflicts of interest to declare.
Revista Médica del Hospital General de México, Jul 1, 2010
0185-1063/$ - see front matter © 2010 Sociedad Médica del Hospital General de México. Publicado p... more 0185-1063/$ - see front matter © 2010 Sociedad Médica del Hospital General de México. Publicado por Elsevier México. Todos los derechos reservados. ... Recibido: 29 de julio, 2010 Aceptado: 7 de septiembre, 2010 ... Langerhans cell sarcoma with intraocular infiltration: ...