Other Flashcards
Antibiotics for H pylori+ Gastric MALT
European, multi-institutional: Antibiotics in H pylori+ gastric MALT lead to excellent control.
Gastric MALT lymphoma Stage IE, H pylori+
Prospective. After H pylori eradication with amoxicillin and omeprazole (2nd line omeprazole, metronidazole, and clarithromycin if needed), patients get EGD and PCR
CR in 80%. Of those who achieved CR, EFS 98% (events: relapse, residual disease, death. 3/116 with relapse). Of 16 with residual disease, 100% with CR after 2nd line antibiotics. 7/120 deaths.
Nasal NKT cell lymphoma (Asian) RT+Chemo
RT concurrent with DeVIC leads to favorable outcomes.
Japan, multi-institutional:
“5-yr OS localized 68%, 5-yr OS advanced 24%
RT-DeVIC 5-yr OS 72% and 5-yr PFS 61%
IL-2 is prognostic factor for worse OS and PFS
RT-DeVIC most commonly used in localized, in 66%. L-asparaginase most commonly used for adv (in 30%)”
JCOG
“2-yr OS 78% (compared to historical control of RT alone 45%)
5-yr OS 70% (compared to historical control of RT alone 40%)
77% CR
5y PTV control rate 94% (Only 2 in field failures). “
Sungkyunkwan University , Seoul, Korea
“CR 80%
Overall response 100%
3-yr OS 86%, 3-yr PFS 85%”
Primary mediastinal B cell lymphoma: Post-chemo PET prognositication
IESLG-26: Despite low CR rate, 90% expected to be alive and progression free at 5 years.
R and anthracyline based chemo –> PET –> Consolidation RT optional (in 82%)
“CR (Deauville 1-2) in 47%, Deauville 3 in 23%
Deauville 4 in 21%, and 5 in 9%
Deauville 1-2 predicted 5-yr PFS (98% vs 92%) and 5-yr OS (100% vs. 91%)
Deauville 3 had equally good outcomes
Cutoff of liver uptake (i.e. Deauville 4-5) differentiated outcomes: 5-yr PFS 99% vs 68%, 5-yr OS 100% vs. 83% “
Primary mediastinal B cell lymphoma: RT benefit by Deauville score
IESLG-26: All patients with Deauville 1-3 after RT had no progression at 5 years in PMBCL. There were also no relapses in Deauville 4 after RT and anthracycline based chemo, suggesting additional therapy is not needed.
“A secondary analysis of RT effect in IESLG-26 based on Deauville score
R and anthracyline based chemo –> PET –> Consolidation RT optional (in 82%)
CR defined as Deauville Score ≤3
“CR (i.e. Deauville 1-3) improved from 74% without RT to 89% with RT
After RT, 11% had persistent Deauville score 4-5
At median f/u of 60 mos, no relapses in CR or Deauvile 4 after RT
All Deauville score 5 patients had progression in field and died”
Primary mediastinal B cell lymphoma: DA-EPOCH-R
NIH: DA-EPOCH-R led to excellent outcomes in PMBCL, suggesting routine RT is not needed.
Phase II: DA-R-EPOCH (dose-adjusted etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, rituximab) and filgastrim without RT
“5-yr EFS 93%, 5-yr OS 97%
At 10 mo -14 years follow-up, 2 patients (4%) relapsed and were disease free with RT salvage”
Primary mediastinal B cell lymphoma:R added to CHOP
MInT: Adding R to CHOP improves EFS.
PMBCL and DLBCL
“→RCHOP x6
vs.
→CHOP x6”
"In PMBCL patients (n=87): CRu 80% with R vs. 54% PD 2.4% vs. 25% 3-yr EFS 78% vs. 52% 3-yr OS 89% vs. 78%"
Primary mediastinal B cell lymphoma: RT benefit
UNFOLDER 21/14 DSHNHL: “In early bulky or extranodal NHL in ages 18-60, RT improves EFS. There is no benefit in OS or PFS. RT could be reserved for PR. There is no difference in RCHOP q14 days or q21 days.”
IPI 0-1, aggressive B-cell NHL, age 18-60 "→RCHOP-q21d x6 vs. →RCHOP-q21d x6 +39.6 Gy if CR vs. →RCHOP-q14d x6 G-CSF vs. →RCHOP-q14d x6 G-CSF +39.6 Gy if CR
- RT to bulky or extranodal sites only
- Bulky disease (>7.5 cm) or extranodal are randomized to all arms.
- Nonbulky patients are randomized in chemo only arms, not to RT arms. “
“•RT randomization
Closed early due to excess failures without RT
3-yr EFS 68% vs. 84% RT
(mostly due to PR triggering RT in no RT arm)
3-yr PFS 89% vs. 81%, p=0.221
3-yr OS 93% both arms, not different on MVA for LDH, Stage III/IV, B, and extranodal
•PMBCL subset 3-yr EFS 78% vs. 94% (mostly due to PR triggering RT in no RT arm) CR 84% vs. 94% PR 2% vs. 10% Progression 4% vs. 2% 3-yr PFS 90% vs. 95%, p=0.0253 3-yr OS 96-97%, not different
•Chemo randomization
No difference in EFS, PFS, or OS”
Mycosis Fungoides: Stanford Regimen
UK Cutaneous Lymphoma Group: The Standford regimen results in favorable outcomes and low toxicity.
Prospective. 12 Gy/ 8 fx in 2 weeks Standford regimen
“CR 18%, PR 69%, stable 8%, progression 5%
After CR, median time to replapse 7.3 mos
Median PFS 13.2 mos (26.5 for IB, 10-11 for Stave IIB-III)”
Mycosis Fungoides: 12vs 5fx
Johannesburg Hospital, South Africa: These twelve and five fraction regimens both produce favorable response rates and low toxicity.
“Prospective randomized
→24 Gy/12 fx
vs.
→20 Gy/5 fx”
“Response rates and LC not different
CR in n=28, PR in 19, stable in 3
1-yr OS 37%
acute and late skin toxicity not different”
