Showing papers by "Pauline Brice published in 2016"
TL;DR: HT in patients with FL who previously responded to immunochemotherapy is an early event associated with a poor outcome that may deserve intensive salvage with autologous stem cell transplantation and the necessity for biopsy at the first recurrence of FL.
Abstract: PurposeTo study the outcome of histologic transformation (HT) in a large prospective cohort of patients with follicular lymphoma (FL) who previously responded to immunochemotherapy.Patients and MethodsAfter a median 6-year follow-up of 1,018 randomly assigned patients from the PRIMA trial, disease progression was observed in 463 patients, 194 of whom had histologic documentation.ResultsForty patients had histology consistent with HT, and 154 had untransformed FL (median time to recurrence, 9.6 v 22.8 months, respectively; P = .018). Thirty-seven percent of biopsies performed during the first year of follow-up showed HT corresponding to 58% of all HTs. Altered performance status, anemia, high lactate dehydrogenase level, “B” symptoms, histologic grade 3a, and high Follicular Lymphoma International Prognostic Index scores at diagnosis were identified as HT risk factors. Response (complete v partial) to immunochemotherapy or rituximab maintenance had no impact on the risk of HT. After salvage treatment, pati...
131 citations
TL;DR: ABVD8 and BEACopP4+4 resulted in similar EFS and OS in patients with high-risk advanced-stage HL, but BEACOPP4-4 did not demonstrate a favorable effectiveness or toxicity ratio compared with ABVD8, treatment burden, immediate and late toxicities, and associated costs must be considered.
Abstract: PurposeTo compare patients with high-risk stage III to IV Hodgkin lymphoma (HL) in the phase III European Organisation for Research and Treatment of Cancer 20012 Intergroup trial (Comparison of Two Combination Chemotherapy Regimens in Treating Patients With Stage III or Stage IV Hodgkin’s Lymphoma) who were randomly assigned to either doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) or to bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP).Patients and MethodsPatients with clinical stage III or IV HL, International Prognostic Score of 3 or higher, and age 60 years or younger received ABVD for eight cycles (ABVD8) or escalated-dose BEACOPP (BEACOPPescalated) for four cycles followed by baseline BEACOPP (BEACOPPbaseline) for four cycles (BEACOPP4+4) without radiotherapy. Primary end points were event-free survival (EFS), treatment discontinuation, no complete response (CR) or unconfirmed complete response (CRu) after eight cycles, progression, ...
96 citations
TL;DR: The authors meet criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE) and were fully responsible for all content and editorial decisions, and were involved at all stages of correspondence development.
Abstract: Writing assistance in the development of this manuscript was provided by Jim Kesslick and Nicholas C. Stilwell of Connexion Healthcare (Newtown, PA); editorial support provided by Tmirah Haselkorn, PhD of EpiMetrix (Los Altos, CA). Alexion Pharmaceuticals provided funding for these services. The authors meet criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE) and were fully responsible for all content and editorial decisions, and were involved at all stages of correspondence development.
45 citations
TL;DR: The results of this analysis support the previously reported brentuximab vedotin efficacy with manageable toxicity and suggest a high-dose therapy with stem cell transplantation for responders should be considered as quickly as possible.
Abstract: Brentuximab vedotin was reported to be effective and safe against refractory/relapsed Hodgkin lymphoma in cohorts of between 12 to 102 patients. Herein we report our retrospective analysis of the French experience with brentuximab vedotin used alone to treat 240 refractory/relapsed Hodgkin lymphoma patients enrolled in a named patient program between 2011 and 2013. All patients had histologically documented CD30+ Hodgkin lymphoma; 74% had refractory disease or early relapses. After a median of 3 lines of chemotherapy, brentuximab vedotin was infused intravenously (1.8 mg/kg every 3 weeks). The primary endpoint was best response. Response at the end of treatment, its duration, survival data and toxicity profile were secondary endpoints. Patients received a median of 6 cycles; 68 underwent a consolidation thereafter. The best response was observed after a median of 4 cycles in 145 (60.4%) patients: 33.8% complete response/unconfirmed complete response, 26.7% partial response. Objective responses were observed as decreased (39.3%) in the 28 patients >60 years. The median response duration was 8.4 months. With median follow-up at 16.1 months, median progression-free survival was 6.8 months and this was significantly longer for patients transplanted after brentuximab vedotin (a median of 18,8 months); median overall survival was not reached. No death has been linked to brentuximab vedotin toxicity. The most common adverse events were peripheral sensory neuropathy (29.3%) and hematological toxicity. The results of this analysis support the previously reported brentuximab vedotin efficacy with manageable toxicity. Because of the short-term responses in most patients, a high-dose therapy with stem cell transplantation for responders should be considered as quickly as possible.
34 citations
01 Jan 2016
TL;DR: Given the excellent results obtained with current therapies, the challenge now is to develop strategies aimed at reducing acute and long-term toxicity in most patients while maintaining high cure rates and to identify patients at high risk of failure requiring new strategies including more selective targeted therapies.
Abstract: Lymphomas are one of the commonest malignancies in adolescents and young adults (AYA) accounting respectively for 22% of all cancers in patients aged 15-24 years (16% for Hodgkin lymphoma (HL) and 6% for non-HL (NHL)). The distribution of NHL subtypes in this age group differs strikingly from the distribution in children and in older adults with 4 main subtypes accounting for the majority of the cases: diffuse large B-cell lymphoma (DLBCL) including primary mediastinal B-cell lymphoma, Burkitt lymphoma, lymphoblastic lymphoma or anaplastic large cell lymphoma. Age-related differences in tumor biology have been demonstrated mainly in DLBCL but there is still a need for biological studies to better understand age-related differences in this age group. AYA patients currently diagnosed with HL and NHL have 5-year survival expectations exceeding 90 and 75%, respectively. Different therapeutic strategies are often used in children and adult lymphoma and the dispersion of lymphoma care between adult and pediatric hematologist-oncologists results in heterogeneous strategies for each subgroup according to age. The impact of these different strategies on outcomes is not easy to evaluate given the paucity of population-based data focused on this age group, taking into account tumor biology and the lack of a uniform staging system. Given the excellent results obtained with current therapies, the challenge now is to develop strategies aimed at reducing acute and long-term toxicity in most patients while maintaining high cure rates and to identify patients at high risk of failure requiring new strategies including more selective targeted therapies.
30 citations
TL;DR: Brentuximab vedotin is an antibody-drug-conjugate directed against CD30 antigen, recently approved for the treatment of relapsed anaplastic large-cell lymphomas and it has been suggested that a significant proportion of peripheral T- cell lymphomas (PTCL) may be potential.
Abstract: Brentuximab vedotin (BV) is an antibody-drug-conjugate directed against CD30 antigen, recently approved for the treatment of relapsed anaplastic large-cell lymphomas (ALCL).[1][1] It has further been suggested that a significant proportion of peripheral T-cell lymphomas (PTCL) may be potential
27 citations
TL;DR: The TMTV assessed on the baseline FDG-PET is a novel approach of tumor burden measurement and has been reported to influence HL outcome in a retrospective series.
Abstract: 7509Background: The TMTV assessed on the baseline FDG-PET is a novel approach of tumor burden measurement It has been reported to influence HL outcome in a retrospective series (Kanoun, EJNM 2014)
17 citations
TL;DR: It is suggested that radiotherapy may be useful as a consolidation modality in PB-DLBCL and positron emission tomography/CT scan should be interpreted with caution due to a persistent [18F]fluorodeoxyglucose [18FDG] uptake of bone lesions even after remission in some patients.
Abstract: Primary bone diffuse large B-cell lymphoma (PB-DLBCL) is a rare DLBCL location variant. We treated 76 PB-DLBCL patients by immuno-chemotherapy, resulting in an 84% sustained complete remission rate and a 78.9% survival over a 4.7-year median follow-up period. Ann Arbor stage IV and high age-adjusted international prognostic index were predictive of adverse outcome in univariate analysis. In multivariate analysis using a Cox model, only aa-IPI predicted long-term survival. While based on a limited number of cases, we suggested that radiotherapy may be useful as a consolidation modality in PB-DLBCL. We also suggested that positron emission tomography/CT scan should be interpreted with caution due to a persistent [18F]fluorodeoxyglucose [18FDG] uptake of bone lesions even after remission in some in PB-DLBCL patients. Our study based on a homogeneous cohort of PB-DLBCL patients confirmed the favorable outcome of this DLBCL variant and support the implementation of prospective clinical trials in this disease.
14 citations
TL;DR: Outcome of patients older than 60 years with classical Hodgkin lymphoma treated with front line ABVD chemotherapy: frequent pulmonary events suggest limiting the use of bleomycin in the elderly.
Abstract: s), 116, 2812. Stamatoullas, A., Brice, P., Bouabdallah, R., Mareschal, S., Camus, V., Rahal, I., Franchi, P., Lanic, H. & Tilly, H. (2015) Outcome of patients older than 60 years with classical Hodgkin lymphoma treated with front line ABVD chemotherapy: frequent pulmonary events suggest limiting the use of bleomycin in the elderly. British Journal of Haematology, 170, 179–184. Swerdlow, S.H., Campo, E., Harris, N.L., Jaffe, E.S., Pileri, S.A., Stein, H., Thiele, J. & Vardiman, J.W., eds. (2008) Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, 4th edn. Lyon, France: International Agency for Research on Cancer. Wilder, R.B., Schlembach, P.J., Jones, D., Chronowski, G.M., Ha, C.S., Younes, A., Hagemeister, F.B., Barista, I., Cabanillas, F. & Cox, J.D. (2002) European organization for research and treatment of cancer and groupe d’Etude des Lymphomes de l’Adulte very favorable and favorable, lymphocyte-predominant Hodgkin disease. Cancer, 94, 1731–1738. Xing, K.H., Connors, J.M., Lai, A., Al-Mansour, M., Sehn, L.H., Villa, D., Klasa, R., Shenkier, T., Gascoyne, R.D., Skinnider, B. & Savage, K.J. (2014) Advanced-stage nodular lymphocyte predominant Hodgkin lymphoma compared with classical Hodgkin lymphoma: a matched pair outcome analysis. Blood, 123, 3567–3573. Correspondence a 2015 John Wiley & Sons Ltd 737 British Journal of Haematology, 2016, 175, 733–747
11 citations
TL;DR: FL pts > 70 yrs treated on trials have similar early disease outcomes to younger patients and age alone should not disqualify patients from standard treatments or RCTs.
4 citations
TL;DR: This is the first report of BV PRO data in R/R HL and sALCL and the majority of patients reported that their energy level, outlook on life, difficulties with daily activities, ability to participate in physical activities, and overall HRQoL improved compared to those before BV treatment.
Abstract: Background Patients with relapsed/refractory (R/R) Hodgkin lymphoma (HL) or R/R systemic anaplastic large-cell lymphoma (sALCL) treated with brentuximab vedotin (BV) experienced high remission rates in two Phase II trials. With increased response rates and survival times, patient-reported outcomes (PROs) and health-related quality of life (HRQoL) are becoming increasingly important and can help inform treatment decisions to enhance care of cancer patients. Objective The objective was to qualitatively assess HRQoL in long-term survivors treated with BV. Methods An eight-question survey assessing PRO-related aspects was developed and fielded to a subset of patients with HL or sALCL who remained in long-term follow-up after completing BV treatment in the two pivotal studies. Results The survey was completed by 25 of 38 patients (12 with HL, 13 with sALCL). The majority of patients reported that their energy level, outlook on life, difficulties with daily activities, ability to participate in physical activities, and overall HRQoL improved compared to those before BV treatment. Limitations Small sample size and lack of a baseline questionnaire or validated assessment instrument limit broad applicability of these findings to large populations of patients with HL or sALCL. Conclusion This is the first report of BV PRO data in R/R HL and sALCL. Given the patients' poor prognostic outcomes before stem cell transplant, these encouraging results warrant formal evaluation of PRO end points in BV trials.
TL;DR: Les lymphomes primitifs du mediastin, sous-type plus frequent chez les adultes jeunes sont globalement plus graves lorsqu’ils atteignent des enfants, anders selon des schemas pediatriques.
Abstract: Resume Les lymphomes figurent parmi les cancers les plus frequents chez les adolescents et jeunes adultes. Une guerison est obtenue dans plus de 90 % des lymphomes hodgkiniens. Les apports des protocoles adultes et pediatriques ont permis de reduire les toxicites gonadiques, cardiovasculaires et les cancers secondaires, grâce a la diminution des doses de chimiotherapie, en particulier les alkylants, et a la reduction des doses de radiotherapie. L’intensite du traitement est adaptee au risque de rechute et plus recemment a l’evaluation de la reponse metabolique par tomographie par emission de positons. Les approches adultes et pediatriques donnent des resultats globalement equivalents dans cette population. En revanche, la question est plus complexe concernant les lymphomes B diffus a grandes cellules. Les enfants ont une survie approchant les 90 % avec les protocoles pediatriques. Cependant, les adolescents de 15 a 18 ans, traites generalement selon des schemas pediatriques ont une moins bonne survie que les enfants plus jeunes, tandis que les jeunes adultes de plus de 18 ans ont une survie comparable aux adultes. Cette tranche d’âge necessite donc une attention particuliere et une bonne coordination entre oncologues adultes et pediatres. Les lymphomes primitifs du mediastin, sous-type plus frequent chez les adultes jeunes sont globalement plus graves lorsqu’ils atteignent des enfants. L’ensemble des lymphomes B beneficie des apports recents de l’immunotherapie (rituximab) et de l’adaptation des traitements a la reponse metabolique. Les lymphomes sont des pathologies pour lesquelles une prise en charge personnalisee dans des services specialises en onco-hematologie est necessaire.
TL;DR: It has been shown that in advanced stage Hodgkin lymphoma and Primary mediastinal B cell lymphoma, total metabolic tumor volume (TMTV) or total lesion glycolysis (TLG) predicted outcome better than the bulk.
TL;DR: A retrospective analysis evaluating the efficacy of mesna/ifosfamide, mitoxantrone, and etoposide with or without rituximab in relapsed/ refractory diffuse large B-cell lymphoma patients failing second-line treatment with R-DHAX in a single French center.
Abstract: Non-Hodgkin lymphoma (NHL) patients failing second-line regimens have three potential therapeutic avenues; a third-line regimen in the perspective of HDT/ASCT consolidation, a novel drug (if availa...
01 Jan 2016
TL;DR: The rapidity of the response supports the role of vinblastine instead of spontaneous regression in these patients with multifocal lesions and a long-term history of refractory C-ALCL, and its place as second-line treatment could be considered with failure of methotrexate and perhaps as first- line treatment in the case of contraindication to metotrexate.
Abstract: In our series, all patients had quick good-quality remission with a median progression-free survival of 6 months. The rapidity of the response supports the role of vinblastine instead of spontaneous regression in these patients with multifocal lesions and a long-term history of refractory disease. In our series, no patient had to discontinue use of the drug because of infection or severe toxic effects. Vinblastine should be studied in larger series to confirm its effectiveness and tolerance in disseminated or refractory C-ALCL. Its place as second-line treatment could be considered with failure of methotrexate and perhaps as first-line treatment in the case of contraindication to methotrexate, especially in older adults.