Showing papers by "Monica Bellei published in 2017"

Early Positron Emission Tomography Response-Adapted Treatment in Stage I and II Hodgkin Lymphoma : Final Results of the Randomized EORTC/LYSA/FIL H10 Trial

Abstract: Purpose Patients who receive combined modality treatment for stage I and II Hodgkin lymphoma (HL) have an excellent outcome. Early response evaluation with positron emission tomography (PET) scan may improve selection of patients who need reduced or more intensive treatments. Methods We performed a randomized trial to evaluate treatment adaptation on the basis of early PET (ePET) after two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) in previously untreated-according to European Organisation for Research and Treatment of Cancer criteria favorable (F) and unfavorable (U)-stage I and II HL. The standard arm consisted of ABVD followed by involved-node radiotherapy (INRT), regardless of ePET result. In the experimental arm, ePET-negative patients received ABVD only (noninferiority design), whereas ePET-positive patients switched to two cycles of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPPesc) and INRT (superiority design). Primary end point was progression-free survival (PFS). Results Of 1,950 randomly assigned patients, 1,925 received an ePET-361 patients (18.8%) were positive. In ePET-positive patients, 5-year PFS improved from 77.4% for standard ABVD + INRT to 90.6% for intensification to BEACOPPesc + INRT (hazard ratio [HR], 0.42; 95% CI, 0.23 to 0.74; P = .002). In ePET-negative patients, 5-year PFS rates in the F group were 99.0% versus 87.1% (HR, 15.8; 95% CI, 3.8 to 66.1) in favor of ABVD + INRT; the U group, 92.1% versus 89.6% (HR, 1.45; 95% CI, 0.8 to 2.5) in favor of ABVD + INRT. For both F and U groups, noninferiority of ABVD only compared with combined modality treatment could not be demonstrated. Conclusion In stage I and II HL, PET response after two cycles of ABVD allows for early treatment adaptation. When ePET is positive after two cycles of ABVD, switching to BEACOPPesc + INRT significantly improved 5-year PFS. In ePET-negative patients, noninferiority of ABVD only could not be demonstrated: risk of relapse is increased when INRT is omitted, especially in patients in the F group.

Secondary malignant neoplasms, progression-free survival and overall survival in patients treated for Hodgkin lymphoma: a systematic review and meta-analysis of randomized clinical trials

Abstract: Treatment intensification to maximize disease control and reduced intensity approaches to minimize the risk of late sequelae have been evaluated in newly diagnosed Hodgkin lymphoma. The influence of these interventions on the risk of secondary malignant neoplasms, progression-free survival and overall survival is reported in the meta-analysis herein, based on individual patient data from 9498 patients treated within 16 randomized controlled trials for newly diagnosed Hodgkin lymphoma between 1984 and 2007. Secondary malignant neoplasms were meta-analyzed using Peto's method as time-to-event outcomes. For progression-free and overall survival, hazard ratios derived from each trial using Cox regression were combined by inverse-variance weighting. Five study questions (combined-modality treatment vs. chemotherapy alone; more extended vs. involved-field radiotherapy; radiation at higher doses vs. radiation at 20 Gy; more vs. fewer cycles of the same chemotherapy protocol; standard-dose chemotherapy vs. intensified chemotherapy) were investigated. After a median follow-up of 7.4 years, dose-intensified chemotherapy resulted in better progression-free survival rates (P=0.007) as compared with standard-dose chemotherapy, but was associated with an increased risk of therapy-related acute myeloid leukemia/myelodysplastic syndromes (P=0.0028). No progression-free or overall survival differences were observed between combined-modality treatment and chemotherapy alone, but more secondary malignant neoplasms were seen after combined-modality treatment (P=0.010). For the remaining three study questions, outcomes and secondary malignancy rates did not differ significantly between treatment strategies. The results of this meta-analysis help to weigh up efficacy and secondary malignancy risk for the choice of first-line treatment for Hodgkin lymphoma patients. However, final conclusions regarding secondary solid tumors require longer follow-up.

Pitfalls and major issues in the histologic diagnosis of peripheral T-cell lymphomas: Results of the central review of 573 cases from the T-Cell Project, an international, cooperative study

Abstract: Peripheral T-cell lymphomas (PTCLs) comprise a heterogeneous group of neoplasms that are derived from post-thymic lymphoid cells at different stages of differentiation with different morphological patterns, phenotypes and clinical presentations PTCLs are highly diverse, reflecting the diverse cells from which they can originate and are currently sub-classified using World Health Organization (WHO) 2008 criteria In 2006 the International T-Cell Lymphoma Project launched the T-Cell Project, building on the retrospective study previously carried on by the network, with the aim to prospectively collect accurate data to improve knowledge on this group of lymphomas Based on previously published reports from International Study Groups it emerged that rendering a correct classification of PTCLs is quite difficult because the relatively low prevalence of these diseases results in a lack of confidence by most pathologists This is the reason why the T-Cell Project requested the availability of diagnostic material from the initial biopsy of each patient registered in the study in order to have the initial diagnosis centrally reviewed by expert hematopathologists In the present report the results of the review process performed on 573 cases are presented Overall, an incorrect diagnosis was centrally recorded in 131% cases, including 85% cases centrally reclassified with a subtype eligible for the project and 46% cases misclassified and found to be disorders other than T-cell lymphomas; 21% cases were centrally classified as T-Cell disorders not included in the study population Thus, the T-Cell Project confirmed the difficulties in providing an accurate classification when a diagnosis of PTCLs is suspected, singled out the major pitfalls that can bias a correct histologic categorization and confirmed that a centralized expert review with the application of adequate diagnostic algorithms is mandatory when dealing with these tumours Copyright © 2016 John Wiley & Sons, Ltd

Pod24 and cr30 are promising surrogate endpoints for assessing the outcome of patients with advanced stage follicular lymphoma enrolled in the foll05 trial by fil.

Abstract: POD24 AND CR30 ARE PROMISING SURROGATE ENDPOINTS FOR ASSESSING THE OUTCOME OF PATIENTS WITH ADVANCED STAGE FOLLICULAR LYMPHOMA ENROLLED IN THE FOLL05 TRIAL BY FIL. S. Luminari* | L. Marcheselli | M. Manni | A. Anastasia | U. Vitolo | A. Chiarenza | L. Rigacci | E. Angelucci | A. Fama | A. Pulsoni | S. Rattotti | F. Angrilli | G. Gaidano | C. Stelitano | G. Bertoldero | N. Cascavilla | F. Salvi | A.J. Ferreri | V. Tarantino | M. Bellei | M. Federico Hematology, Azienda Ospedaliera Arcispedale Santa Maria Nuova‐ IRCCS, Reggio Emilia, Italy; Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy; Department of Hematology, ASST‐Spedali Civili di Brescia, Brescia, Italy; Hematology Unit, Città della Salute e della Scienza University and Hospital, Torino, Italy; Division of Hematology, AOU \"Policlinico‐Vittorio Emanuele\", University of Catania, Catania, Italy; Hematology, University of Florence, Florence, Italy; U.O. Ematologia, IRCCS AOU San Martino ‐ IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy; Hematology Department, Azienda Ospedaliera Arcispedale Santa Maria Nuova‐IRCCS, Reggio Emilia, Italy; Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy; Department of Hematology‐Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Hematology, Transfusion Medicine and Biotechnology, Spirito Santo Hospital, Pescara, Italy; Department of Translational Medicine, University of Eastern Piedmont, Division of Hematology, Novara, Italy; Division of Hematology, Grande Ospedale Metropolitano Bianchi‐Melacrino‐Morelli, Reggio Calabria, Italy; U O di Oncologia ed Ematologia Oncologica, Ospedale di Mirano, Mirano, Italy; Division of Hematology, IRCCS “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo, Italy; Department Hematology, Ospedale SS Antonio e Biagio, Alessandria, Italy; Unit of Lymphoid Malignancies, Department of Onco‐ Haematology, IRCCS San Raffaele Scientific Institute, Milan, Italy

Transformed Follicular Lymphoma: Not all fit in one

Abstract: Follicular Lymphoma (FL) is the second most frequent non-Hodgkin lymphoma accounting for approximately 10-20% of all lymphomas in Western Countries. Histologic transformation (HT) is a frequent event in the clini-cal course of patients with indolent lymphoma that is often accompanied by a dramatic change in the clinical fea-tures of the disease towards a more aggressive course. Although the transformation of Follicular Lymphoma (tFL) was described several decades ago, there is a strong need for a better understanding of both the dynamics of the tumor clonal evolution and the genetic events leading to ()transformation. In addition, the management of patients with tFL is challenged by the heterogeneity of the previous treatments. The present review describes the state of art of tFL, outlining recent advances in the understanding of genetic basis and the evolutionary pro-cess governing the initiation and persistence of tumor evolution. It will be also addressed the key questions pend-ing on this incurable disease, such as a lack of a standard therapeutic strategy for tFL patients as well as its out-come in the Rituximab (R) era.