bluuebunny/crossref_metadata_2025_split huggingface dataset:
Non-Hodgkin lymphoma: The Indian scene.
Authors: Gogia Ajay , Nair Sukesh , Sharma Atul , Kumar Lalit , Mallick Saumyaranjan , Biswas Ahitagni , Gupta Ritu 
Published: May 2020

e20063 Background: There is a lack of data available regarding the distribution of Non-Hodgkin lymphoma (NHL) subtype, according to a recent WHO- 2016 classification and outcome of diffuse large B cell lymphoma (DLBCL) on the basis of cell of origin (COO) from developing country in Rituximab era. Methods: This is an ambispective study of newly diagnosed patients with NHL, treated in the Department of Medical Oncology, AIIMS, New Delhi. A total of 775 cases of adult ( > 18 years) lymphoma were registered over a period of 5 years (January 2014 to December 2018). Outcome of DLBCL patients who have received uniform RCHOP protocol separately analysed. The patients were classified as germinal center B-cell like (GCB) or activated B-cell (ABC) type using the Hans classification Results: NHL constituted 622 (80.26%) and Hodgkin's lymphoma 153 (19.74%) of the cases. B- cell constituted 553 (88.9%) among all NHL and rest 69 (11.1%) cases were T cell in origin.. Diffuse large B cell lymphoma (DLBCL) was the most common NHL 417(67%) followed by follicular lymphoma 60 (9.64%), mantle cell lymphoma 35 (5.62%), PTCL-NOS 25 (4.01%), ALCL 16 (2.57%),marginal zone lymphoma 14 (2.25%), T-LBL 13(2.1%) and the rest of the cases were rare NHL( < 1% cases each) for e.g. SLL, NK-T, BL, SLVL, AITL etc. Among the 417 cases of DLBCL, 262 (62.8%) cases received rituximab along with CHOP regimen. The median age of RCHOP treated patients was 47.6 years with male female ratio of 2.3:1. B symptoms were seen in 39% patients and bulky disease in 33%. ECOG performance status of 0-2 was present in 67% and 51% presented with advanced disease. GCB was seen in 42% and 44% were ABC. Low risk IPI was seen in 48 % and 40% were intermediate risk IPI. The overall response rate (ORR) was 82 % with a complete response rate (CR) of 75.6 %. Presence of bulky disease and non-radiotherapy treatment protocols were associated with inferior CR rate. After a median follow up of 30 months, the 3-year event free (EFS) survival and overall survival (OS) were 78 % and 88 % respectively. Low albumin ( < 4 gm/dl) and age > 60 years were associated with inferior EFS whereas high IPI risk score was associated with inferior OS. Pre-phase was used in 20% of cases. Grade III/ IV anaemia, neutropenia and thrombocytopenia were seen in 5%, 13% and 2% of patients respectively. Febrile neutropenia was seen in 7 % of patients and there were 3 treatment related death. Rituximab infusion related toxicity was seen in 7 patients. Conclusions: DLBCL is the most common NHL ( GC-42%, ABC-44%). The distribution according to COO dose not impact on CR rate and EFS and OS . RCHOP is well tolerated in our patients and results are comparable with the western data.
Older patients with mantle cell lymphoma (MCL): Practice patterns and predictors of survival in the rituximab era.
Authors: Karmali Reem , Switchenko Jeffrey M. , Goyal Subir , Bachanova Veronika , Gerson James , Barta Stefan K. , Danilov Alexey Valeryevich , Grover Natalie Sophia , Epperla Narendranath , Burkart Madelyn , Sawalha Yazeed , Ghosh Nilanjan , Bond David Alan , Maddocks Kami J. , Badar Talha , Fenske Timothy , Guo Jin , Malecek Mary-Kate , Martin Peter , Cohen Jonathon Brett 
Published: May 2020

e20064 Background: Therapeutic intensity poses a challenge for older or medically unfit pts with untreated MCL. We assessed clinical outcomes and predictors of survival in older MCL pts treated in the rituximab era. Methods: We included pts ≥ 65 yrs of age with newly diagnosed MCL treated between 2000 and 2015. The primary objective was to characterize practice patterns and survival outcomes in older pts and secondarily to assess predictive factors of survival. Results: Data were collected from 12 centers for 1168 pts. For 465 pts ≥ 65 yrs of age (median 70; range 65-100), variable denominators indicate missing data: 305 of 444 pts (69%) were male; 23 (8%), 110 (39%) and 148 (53%) of 281 pts had low, intermediate and high-risk MIPI respectively. Median time from diagnosis to first treatment was 31 days (range 0-2611 days). In 407 older pts with initial treatment data, 148 (36%) received BR, 65 (16%) a cytarabine containing regimen, 9 (2%) lenalidomide, and 92 (23%) other treatments that excluded BTK inhibitors (BTKi). 68 of 365 pts (19%) were enrolled on clinical trial for initial therapy, 88 of 369 pts (24%) received autologous transplant (AHCT) in first remission, and 155 of 351 pts (44%) received maintenance rituximab (MR). Median f/u was 2.7 yrs. 41 of 465 pts (9%) had primary refractory disease (POD6); 107 (23%) progressed within 24 months (POD24). Treatment data were available for 157 relapsing pts: 58 (37%) were treated with BTKi/BTKi combinations. PFS and OS rates were compared across young and older age cohorts: 2 yr PFS rates were 79%, 69%, and 66% and 2 yr OS rates were 92%, 87%, and 84% for age < 65, age 65-69, and age ≥ 70 respectively (p < 0.001). In the older cohort: on UVA, ECOG ≥2, BM involvement, blastoid histology, > 3 cytogenetic abnormalities and lack of MR were associated with inferior PFS and OS (p = 0.012 – < 0.001). POD6 and POD24 were associated with decreased OS (p < 0.001). AHCT in first remission did not impact PFS or OS. After MVA, MR remained significantly associated with improved PFS and OS (p < 0.001). 2 yr PFS rates were 81% and 58% and 2 yr OS rates were 96% and 80% with and without MR respectively (p < 0.001). Conclusions: In this large cohort of older pts in the rituximab era, survival outcomes remain inferior to younger pts. MR is associated with improved PFS and OS but AHCT does not yield better survival. A small number of pts received BTKi salvage therapy. As such, our data does not reliably reflect the potential advancements in survival achieved with the introduction of BTKis. Focused clinical trials are necessary to identify effective therapeutics in this population.
Age-related lymphoma patient experience: Results from the Lymphoma Coalition 2018 Global Patient Survey.
Authors: Cordoba Raul , Bolanos Natacha , Warwick Lorna , Dren Natalie 
Published: May 2020

e20071 Background: Over the past two decades, the incidence of lymphoma has increased by 8-10% per year in older adults. Despite the growing population of older cancer patients, there are a limited number of studies that focus on the experience of these patients. Lymphoma Coalition (LC) saw the need in the 2019 Report Card on Lymphomas to examine the age-related lymphoma patient experience. The objectives of this study were to identify: 1) informational needs and understanding levels, 2) physical conditions and medical issues, 3) psychosocial issues, and 4) barriers in patient-doctor communication. Methods: Using a subset of data from the LC 2018 Global Patient Survey on Lymphomas and CLL (LC 2018 GPS), this study will specifically examine the experiences of newly diagnosed lymphoma patients within the following age categories: 1) Young (18-59) (n = 1473); Mid (60-69) (n = 371); Old (70+) (n = 162). Results: From January to March 2018, 2,006 participants were included in this analysis from 47 countries. The majority of all three patient groups wanted additional medical information beyond what was provided at their diagnosis meeting with the doctor, with the greatest need for information in the young patient group (73%). The highest proportion of poor understanding was reported by the mid-age group (14%) and the highest proportion of very good understanding was reported by the old age group (53%). Across all three age groups, fatigue was the top reported physical condition affecting well-being. Regarding older patients, hair loss was reported in 36% vs 54% in younger patients (p = 0.01), and muscle weakness was reported in 40%. A greater proportion of those in the old group reported that their lifestyle (86%) and general activity level (87%) had been affected. The reported prevalence of medical issues was highest in the young group and lowest in the old group, both during and after treatment. Fear of relapse was the top reported psychosocial issue following treatment for patients in all three age groups. Of those who discussed their fear of relapse with their doctor (young 42% vs old 21%, p = 0.0022), less than one third of patients felt their discussion helped alleviate the fear. Conclusions: This study emphasizes that lymphoma patients in all age groups need more information and support beyond what is currently being provided. While certain age-specific trends were identified, the majority of patient-reported issues span across all three of the age groups examined.
Serum soluble CD25 and ferritin in distinguishing patients with uncomplicated hematologic malignancies from patients with hematologic malignancies complicated by hemophagocytic lymphohistiocytosis.
Authors: Zoref Lorenz Adi , Hofstetter Liron , Murakami Jun , Pasvolsky Oren , Guber Elad , Yacobovich Joanne , Ellis Martin , Jordan Michael 
Published: May 2020

e20072 Background: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyper-inflammatory syndrome with distinct clinical and laboratory features. In adults, HLH is often associated with underlying malignancy, most commonly hematologic malignancies (HM). HLH occurs in 1% of adults with HM and overall survival can be low as 10-20%. Abnormal serum levels of the inflammatory markers sCD25 and ferritin are diagnostic criteria for familial HLH. However, because these reactants are often elevated in malignancy, appropriate levels for diagnosis in HM-HLH are unknown. In this study, we establish optimal sCD25 and ferritin levels for the diagnosis of HM-HLH in adults. Methods: Patients from three centers in Israel and Japan with HM-HLH and HM in whom sCD25 testing was performed were studied. The diagnosis of HLH was according to the HLH 2004 diagnostic criteria. Initial (at HLH presentation) and the maximum ferritin levels were analyzed. Sensitivity, specificity, and optimal cutoffs were calculated by receiver operating characteristic (ROC). Results: 62 patients with HM's without HLH and 40 patients with HM-HLH were included. The distribution of ages and HM subtypes was similar between groups (mostly B cell, T/NK cell, and Hodgkin's lymphoma). The median sCD25 concentration in HM was 1776 U/ml versus 8077 U/ml in HM-HLH. The median initial/ maximum ferritin levels were 190/202 ng/ml for the HM group and 2267/4515 ng/ml for the HM-HLH group. Both sCD25 and ferritin were very sensitive but nonspecific. sCD25 > 2400 U/ml had a sensitivity/specificity of 95%/65%, while initial ferritin > 500 ng/ml had a sensitivity/specificity of 95%/75%. ROC analysis demonstrated optimal confirmatory cutoff values (maximizing specificity) of > 10,056 ng/ml for sCD25 (sensitivity/specificity 47%/95%). While initial ferritin demonstrated a cutoff of > 5231 ng/ml (sensitivity/specificity 22.5%/95%, AUC = 0.88) the maximum ferritin performed better with the cutoff of > 5748 ng/ml (sensitivity/specificity 45%/95%, AUC = 0.92). Conclusions: Our data suggest that the current HLH 2004 criteria of ferritin > 500 ng/ml and sCD25 > 2400 U/ml are effective screening criteria for the complication of HLH in HM patients. sCD25 > 10,000 U/ml and initial ferritin > 5,200 ng/ml are highly specific. Patients with suspected HM- HLH should have serial ferritin testing which increases specificity of this test. Future prospective studies are needed to confirm these findings.
Outcome of germinal center B-cell type compared to non-germinal center/activated B-cell type diffuse large b-cell lymphoma as determined by immunohistochemistry using the Hans algorithm.
Authors: Patil Neha , Girgis Marian 
Published: May 2020

e20076 Background: Classification of diffuse large B cell lymphoma (DLBCL) takes into consideration - cell of origin, germinal center B-cell (GCB) vs non germinal center/activated B-cell type (non-GCB/ABC), since its determination by gene expression profiling predicts prognosis when treated with standard therapy. In this report we evaluated impact of choice of therapy and stem cell transplant (SCT) on the outcome of GBC and ABC subtype determined by immunohistochemistry (IHC) using Hans algorithm. Methods: We reviewed pathology reports DLBCL patients diagnosed from 2009 - 2016. For GCB and non-GCB/ABC patients data was collected including demographics, stage, initial and subsequent chemo, response and SCT. Results: Out of total 267 patients with DLBCL Per Hans algorithm, 117 (43.8%) were GCB, 94 (35.2%) ABC. GCB group - Median age at diagnosis was 65 years. 65% were older than 60 years. 27% Double expressors (DE). Frontline therapy was R-CHOP in 67.5% patients. 38% received other chemo - BR, hyperCVAD, RICE, RCVP. 26% patients had multiple lines of treatment. Average duration of first remission was 2.6 years. Complete response (CR) was achieved in 53% patients. Partial response (PR) in 27%. Median survival was 84.8 months. 12% underwent SCT. After SCT - 8 achieved CR, 3 PR, and 1 in PD. ABC group - Median age at diagnosis was 67 years. 67% were older than 60 years. DE were 19%. Frontline therapy was R-CHOP in 78% patients. 20% received other chemo. 21% needed multiple lines of treatment. CR was achieved in 76%. Median survival was 59.2 month. Median duration of remission for patients who received R-CHOP was 2 years and 1.25 years for other chemo. 7.4% had SCT - 5 auto and 2 allo. Conclusions: GCB and non-GCB/ABC DLBCL identified by IHC who received R-CHOP as induction had better outcome than who received other chemo. GCB had better overall survival compared to non-GCB/ABC. Median duration of first remission was 2 to 2.6 years and 30% patients received multiple lines of therapy. Only 15% patients underwent SCT – 66% achieved CR in GCB and 85% in ABC. Clinical trials adding newer agents and better stratifying patients who benefit from SCT are warranted. [Table: see text]
Is ethnicity related to the distribution of lymphomas by subtype in a majority minority Hispanic community?
Authors: Garza Juan , Diaz Duque Adolfo Enrique , Janania Martinez Michelle , Surapaneni Prathibha , Snedden Tyler William , Kakarla Sushanth , Rawlings Jeremy , Gregorio David , Ananth Snegha , Michalek Joel , Liu Qianqian 
Published: May 2020

e20083 Background: Non-Hodgkin Lymphoma (NHL) continues to be in the top 10 of all cancer related deaths. Discrepancies exist among world regions in lymphoma subtype incidence, with a percentage of DLBCL being higher in Latin America versus Nordic countries. T cell lymphomas (TCL) are reported to be more common in east Asia than in the Western hemisphere.The geographic differences in distribution along with under representation of ethnic minorities across all lymphoma subtypes, establish the basis of our analysis at the only NCI-designated cancer center within a Hispanic (H) predominant patient population. We aim to describe our population diagnosed with Hodgkin Lymphoma (HL) and NHL and compare to known overall global and USA statistics. Methods: Observational study, retrospectively analyzed patients with diagnosis of Lymphoma (HL and NHL). The patients received care at UT Health San Antonio, the biggest Hispanic serving Academic Institution in South Texas, between 2008-2018. Key variables included age, gender, race/ethnicity, stage, treatment received, vitality at 3 and 5 years. Continuously distributed outcomes were summarized with the mean and standard deviation and categorical outcomes were summarized with frequencies and percentages. Primary end point was to characterize distribution of HL and NHL by subtypes in our Cancer Center and compare to North American and overall global distribution. Results: A total of 685 patients with lymphoma were identified. Of the NHL subtypes; DLBCL was the most common identified (209, 31%), (FL) was the most common indolent lymphoma (IL) among all demographic groups (123, 26%), followed by HL (116, 17%) which was more common among non-Hispanic (NH) subgroup (73, 63% vs 42, 36%). Among the TCL, CTCL – Mycosis fungoides was the most common subtype (18, 35%) followed by ALK negative ALCL (12, 24%). Incidence by Gender: The percentage of males (M) was slightly higher vs. females (F) in all subtype lymphoma diagnoses, M (352, 51%), F (333, 49%). M had a higher incidence in DLBCL (108, 52% vs 101, 48%), BL (9, 69% vs 4, 31%), and HL (67, 58% vs 49, 44%). Incidence by Race: Total lymphoid neoplasm rates were higher for H (383, 57%) than NH (293, 43%), other (1, 0.2%), not specified (5, 1%). H had a higher incidence in all subtype lymphomas except for Nodular lymphocyte predominant HL (5, 63% vs 3, 37%). Conclusions: Our Hispanic Hispanic Serving Academic Institution, the distribution of lymphomas doesn’t change when compared with previous reported data. Our population and distribution of lymphoma subtypes are similar to global and USA data.
Autologous stem cell transplantation versus no transplant in patients above 70 with multiple myeloma.
Authors: Lemieux Christopher , Muffly Lori S. , Iberri David Joseph , Rezvani Andrew , Lowsky Robert , Frank Matthew Joshua , Craig Juliana K. , Liedtke Michaela , Negrin Robert , Weng Wen-Kai , Meyer Everett , Johnston Laura J. , Shizuru Judith , Shiraz Parveen , Arai Sally , Miklos David Bernard , Sidana Surbhi 
Published: May 2020

e20509 Background: We evaluated outcomes of patients with multiple myeloma (MM) ≥ 70 years who were seen for Autologous Stem Cell Transplant (ASCT) consult, based on whether they underwent transplant vs. non-transplant treatment. Methods: 138 patients with MM ≥ 70 years (median 71, range 70-78) were evaluated in the BMT clinic from 1/2010 to 11/2019 for a transplant consult. Results: Of the 138 patients, 53 proceeded to ASCT. ASCT was not pursued in 85 patients despite most (79%) being eligible for transplant. Reasons for deferring ASCT in eligible patients included patient preference (48%, n = 32) and physician preference (52%, n = 35). 68 patients were seen during first-line therapy, of which 29 underwent upfront transplant. The remainder were seen at second-line or beyond. There was no difference in baseline characteristics among the 113 patients with available follow-up (ASCT = 53, non-ASCT = 60), including median age (71 vs. 72 years, p = 0.4), high-risk cytogenetics (41% vs. 31%, p = 0.4), high-risk HCT-CI (32% vs. 20% p = 0.2), and ISS stage III (34% vs. 27%, p = 0.6). In the 53 patients who underwent transplant, conditioning melphalan dose was 200 mg/m2 (75%, n = 40) and 140 mg/m2 (25%, n = 13). Day 100 transplant related mortality was 0% (n = 0). Progression-free survival (PFS) and overall survival (OS) were compared in patients who were seen for consultation within 1 year of diagnosis (n = 80). With a median follow-up of 27 months, median PFS amongst patients ≥ 70 years undergoing ASCT (n = 39) was 47 months compared to 34 months in the non-ASCT (n = 41) group, p = 0.006. Median OS was not reached in either group. Estimated 5-years OS was 76% in the ASCT group and 82% in the non-ASCT group (p = 0.6). There was no difference in PFS of patients ≥ 70 undergoing ASCT compared to a cotemporaneous cohort of patients < 70 (n = 639) from our institution (47 vs. 57 months, p = 0.3). Conclusions: Selected patients ≥ 70 years with MM undergoing ASCT have better PFS compared to patients with similar characteristics who do not undergo ASCT. ASCT is safe in this older population and outcomes were similar compared to younger patients. [Table: see text]
Lebanese experience in treating multiple myeloma: A multicenter retrospective study.
Authors: Nasr Fadi , Nasr Lewis , Ghoche Ahmad , Diab Saada 
Published: May 2020

e20526 Background: Multiple myeloma is a clonal plasma cell malignancy that accounts for slightly more than 10% of hematologic cancers. Novel agents and stem-cell transplantation are changing disease prognosis and patient’s survival. Our objective was to do a multicenter retrospective analysis in order to look at the effect of autologous bone marrow transplant on progression free survival (PFS) of multiple myeloma. Methods: 134 myeloma patients from different Lebanese centers were included in a retrospective, observational study. We reviewed disease characteristics of patients that were diagnosed with multiple myeloma between July 2002 and January 2018. Results: 62.7% were males and 33.7% females with a median age of 65.5 years at diagnosis. 37 patients had a Karyotype on diagnosis, of which 21.6% were normal and 78.4% had abnormal cytogenetics including loss of chromosome Y, hypoploidy and tetraploidy. Regarding the M component, we had 52.2% IgG, 17.9% IgA, 1.4% IgM, 11.2% Kappa, 5.2% lambda, and 0.7% had 2 spikes M and G. 53.7% patients had bony lesions on diagnosis, 16.4% didn’t and 29.9% patients were unknown. According to ISS staging, 11.9% patients had an ISS of 1, 11.2% an ISS of 2, and 23.9% an ISS of 3. The majority (40.3%) were transplanted, 24.6% were not and 6.7% were still on induction therapy at the time of data cutoff [31/12/2018]. 28.4% had an unknown transplant status. 6.7% patients were diagnosed based on atypical plasmacytosis, 22.4% had monoclonal spike and 67.8% had multiple diagnostic modalities including immunofixation and urine studies. 29.1% of patients had plasmocytes between 10 and 60% and 9% had more than 60% plasmocytes on bone marrow at diagnosis. VCD was the main induction protocol used (38.8%) followed by VTD (14.2%) and VRD (9%). For the transplant group, 11.7% were in CR, 23.5% in VGPR and 19.6% were in PR before high dose melphalan. No death occurred during induction. 126 patients were still alive and taking treatment at the time of data cutoff. Mean PFS was 49.69 months (± 32.83) and 22.28 months (± 16.36) in the transplant and non-transplant group respectively (p = 0.001). Conclusions: Few previous reports described transplant data in Lebanese myeloma patients. As in the international data, we found a significant progression free survival in the transplanted group compared to the non-transplanted one.