bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence patterns and survival outcomes in primary small intestine B-cell lymphoma (PSIBCL) and the effect of Rituximab.
Authors: Jayarangaiah Apoorva , Wang Shuai , Viteri Malone Mariuxi Alexandra , Elrafei Tarek N. , Steinberg Lewis , Kumar Abhishek 
Published: May 2020

e20025 Background: PSIBCL is a rare manifestation of primary extra-nodal B-cell Non-Hodgkin’s lymphoma and is underreported in literature. We assessed the incidence patterns, and clinicopathologic features and their impact on survival in this population. Methods: Using the SEER database, we identified patients with PSIBCL who were ≥ 18 years old from 1975-2016. Patients were identified using ICD-O-3 and histology codes. Age-adjusted incidence rates were calculated using SEER*Stat 8.36. Using SPSS 26, overall survival (OS) was analyzed using the Kaplan-Meier method and multivariate Cox proportional hazards model was used to determine the prognostic factors. Results: We identified 4810 patients with PSIBCL. PSIBCL accounts for 0.8% of all B-cell Non-Hodgkin’s lymphoma. Age adjusted incidence rose from 0.2 to 0.4 per 100,000 during the study period. Annual percentage change of age adjusted incidence was +2.0 (95% CI 1.4-2.6). Incidence was highest among males, age > 80 years, white & Asian race. The median age of diagnosis was 63 yrs (51-75). 83% presented with either Diffuse large B-cell lymphoma (54%) or Follicular lymphoma (29%). The site of disease was specified in 65%; of those, duodenum (24%), jejunum (15%) and ileum (23%). Staging was reported in 88%; early stage disease (stage I/II) was found in 67%. Median OS for the entire cohort was 27 years (95% CI 23-32) and 5-year OS was 72.6%. Although the incidence was lower in black patients, the 10 year OS was worse (61% black vs 67.4% white). Survival was improved after 1997 (10-year OS rate 71.3% vs 52.0%). These results may correlate to Rituximab approval in 1997. In the multivariate analysis, age > 65, male sex, black race, late stage (stage III/IV), DLBCL and Burkitt lymphoma subtypes were associated with unfavorable OS. Conclusions: Analysis of four decades of data show an upward trend in incidence. PSIBCL has a favorable outcome with a clear survival advantage in patients diagnosed after 1997; this is likely attributable to Rituximab approval.
Toxicity and tolerability of DA-EPOCH-R for aggressive lymphomas in the elderly: A retrospective cohort study.
Authors: Banaag Shanley , Singla Manish , Kwok Mary , Chen Dechang 
Published: May 2020

e20030 Background: There remain concerns regarding appropriate patient selection for dose-adjusted EPOCH-R in the treatment of lymphoma, particularly diffuse large B-cell lymphoma, where efficacy is comparable to R-CHOP but significantly more toxic. As the average age at diagnosis of DLBCL is between 60-70 years old, ability of elderly patients to complete and tolerate therapy is critical in treatment decision. Our aim was to investigate the differences in tolerability and toxicity of DA-EPOCH-R among different age groups. Methods: We conducted a retrospective review of patients treated with DA-EPOCH-R at Walter Reed National Military Medical Center. The institutional pharmacy database was queried to identify adult patients diagnosed with lymphoma and treated with DA-EPOCH-R from July 2005 through March 2018. Chart reviews were performed and information on dose reductions, delays, and adverse treatment effects were recorded and stratified between patients aged < 45 years, 45-59, 60-74 and ≥75 years. Results: 70 patients were identified for review. Average age was 55.8 +/- 15.5 years; 49% of patients were ≥ 60 years, including 9 patients who were ≥ 75 years. Diagnoses included diffuse large B-cell lymphoma (n = 46), transformed lymphoma (n = 12), primary mediastinal B-cell lymphoma (n = 4), Burkitt lymphoma (n = 3), T-cell lymphoma (n = 3), and high-grade B-cell lymphoma, NOS (n = 2). There was no significant difference in the median number of cycles completed between the age groups ( p= 0.2540). However, there was a significant difference in the maximum dose level achieved ( p= 0.0003). The median dose level achieved was 3.4 for patients age < 45 (range 1-5), 2.5 for patients age 45-59 (range 1-5), 1.88 for patients age 60-74 (range 1-4), and 0.88 for patients age ≥75 (range -2 to 2). Patients greater than 60 years were more likely to have any dose delay ( p= 0.001), more total dose delays (p = 0.004), and to experience gastrointestinal (GI) toxicities ( p= 0.014). There were no significant differences seen in peripheral neuropathies ( p= 0.425) nor hospitalizations ( p= 0.242). One patient passed away due to toxicity. Conclusions: This study demonstrates the use of DA-EPOCH-R in a real-world setting for the treatment of aggressive lymphomas. Our data suggest that elderly patients can complete all planned courses of DA-EPOCH-R but do not reach the dose intensity achieved by younger patients. In addition, elderly patients are more likely to require dose delays and experience GI toxicities without significant differences in hospitalizations or peripheral neuropathy.
Prognostic value of baseline elevated red cell distribution width in DLBCL.
Authors: Diamond Akiva , Boughan Kirsten M , De Lima Marcos J.G. , Caimi Paolo Fabrizio 
Published: May 2020

e20031 Background: Elevated red cell distribution width (RDW) has been associated with all-cause mortality, risk of developing cancer and cancer mortality in large retrospective studies. The underlying mechanism may be due to inflammatory and nutritional abnormalities. We hypothesized DLBCL patients with an elevated RDW at the time of diagnosis would have a worse prognosis. Methods: A retrospective single-institution study included 541 DLBCL patients diagnosed between 2001 and 2016. RDW over 14.5% was considered high, as this was the upper limit of normal at our institution. The overall and progression free survival was estimated using Kaplan-Meier methods, and the difference between groups was compared using the log-rank test. Univariate and multivariate analyses were performed with Cox proportional hazards regression. Results: We identified 410 DLBCL pts with available baseline RDW, 229 (56%) had RDW > 14.5. Median follow up from diagnosis was 60 months. The complete response rate was 63.8% in the group with high RDW (n = 152) and 88.4% in the normal RDW group (n = 216, p < 0.0001) . For patients with high RDW, 1-year overall survival (OS) was 65% (95%CI 0.58-0.72) vs 90% (95%CI 0.87-0.94) for pts with normal RDW < / = 14.5; 2-year OS was 57% (95%CI 0.50-0.65) vs 84% (95%CI 0.79-0.89), respectively (p < 0.0001). This difference remained statistically significant when the analysis was restricted to patients treated with anthracycline-containing regimens given with curative intent (2y OS = 66% vs. 87.5%, p < 0.0001). Univariate analysis revealed that R-IPI, high RDW, elevated LDH, albumin < 3.5mg/dl, Hgb < 10g/dl, advanced stage disease, bulky disease, extra nodal disease, and ECOG performance status 3-4 were associated with worse OS. In multivariate analysis, older age (HR 2.07, 95%CI 1.38-3.1), high RDW (HR 1.68, 95%CI 1.15-2.5), albumin < 3.5mg/dl (HR 1.76, 95%CI 1.18-2.6) and ECOG 3-4 (HR 2.47, 95%CI 1.47-4.2) were independent prognostic factors for OS. Conclusions: High RDW is associated with worse response rates and independently associated with worse OS in patients with DLBCL. Based on our study, DLBCL patients with high RDW at diagnosis should be considered at higher risk of mortality and treatment failure. Further research is needed to clarify the underlying mechanism and to evaluate the utility of incorporating RDW into prognostic indices.
Factors affecting 48-hour methotrexate levels following high-dose methotrexate (HDMTX) in lymphoma.
Authors: O'Donoghue Darragh , Truong Huong , Finnes Heidi Diann , McDonald Jennifer , Ansell Stephen M. , Leung Nelson 
Published: May 2020

e20033 Background: HDMTX is an important component of lymphoma therapy due to its central nervous system penetration. Although HDMTX can be safely administered to most patients, it can cause significant toxicity with those who have prolonged exposure to high plasma concentrations of MTX due to delayed elimination. Therefore, serum MTX concentration monitoring is still a standard approach for identifying patients at high risk of developing MTX toxicity. A majority of MTX is excreted within the first 48 hours of infusion. Higher MTX plasma concentrations at 48 hrs increase the likelihood of delayed MTX elimination. This study will assess baseline characteristics associated with high 48-hour MTX levels (≥ 1µM) which has been associated with increased risk of complications. Methods: A retrospective review of the electronic medical record was conducted to identify lymphoma patients who received HDMTX from 1/1/2002 to 12/31/18. Baseline demographics including age, gender, comorbidities, body surface area, BMI, weight and baseline chronic kidney disease (CKD) were recorded. Demographics, HDMTX dosing per protocol (3.5g/m2 vs 8g/m2), HDMTX adjusted by renal function (CrCl < 100), and ratio of MTX dose to BSA (MTX/BSA) were compared to 48 hour MTX levels. Analysis was performed in JMP 15. Results: 2553 cycles were of HDMTX were identified. There was a significant association of increasing age, (p = 0.039), male patients (p < 0.001), 8g/m2 dosing (p < 0.001), higher MTX dose (p < 0.001), MTX/BSA (p < 0.001), GFR by CKD-EPI (p < 0.001) and lower number of comorbidities (p < 0.001) with 48-hour MTX levels ≥1. There was no significant association of 48-hour MTX levels ≥1 and GFR by Cockcroft-Gault (p = 0.73), baseline CKD (p = 0.78), and renal adjusted HDMTX (p = 0.52). Multivariate analysis revealed significance for MTX/BSA, gender, BSA, GFR by CKDEPI (p < 0.001), and age (P = 0.0002). Conclusions: Hematologists should be aware that age, gender, GFR by CKD-EPI, and ratio of MTX dose to BSA are associated with elevated 48-hour MTX levels ≥1.
Safety and outcome of allogeneic stem cell transplantation in mycosis fungoides and Sezary syndrome: A seven-year tertiary center analysis.
Authors: Toprak Selami Kocak , Cengiz Seval Guldane , Atilla Erden , Civriz Bozdag Sinem , Kurt Yuksel Meltem , Topcuoglu Pervin , Akay Bengu Nisa , Sanli Hatice , Gurman Gunhan , Ozcan Muhit 
Published: May 2020

e20038 Background: Allogeneic hematopoietic stem cell transplantation (AHSCT) is a promising strategy for treatment of advanced-stage mycosis fungoides/Sezary syndrome (MF/SS). In this study, we retrospectively analyzed the outcomes of AHSCT for MF/SS and found that MF/SS appears to be susceptible to graft versus leukemia (GVL) effects. Methods: We studied outcomes in a consecutive series of 14 patients with MM/SS who underwent AHSCT between January 2012-November 2019 at our center. Treatment response was evaluated according to the Consensus WHO criteria for MF/SS. Results: The median age of patients 51.5 years (range: 28-68 years). Eight patients had MF and six patients had SS. Nine of those 14 patients had large cell transformation. All patients had advanced disease (stages IIB: n = 1, IIIA: n = 2, IIIB: n = 6, IVA1: n = 2 and IVB = 3). The median interval from disease onset to AHSCT was 3.7 years (range: 10.5 mos-11.3 years). All of the patients received at least three lines of treatments prior to AHSCT. Four patients achieved CR (3 are alive and still in CR) and all the other patients had progressive disease (PD) at the time of AHSCT. Graft source was peripheral blood stem cell in all patients. Six patients underwent transplantation from 9/10 HLA-matched unrelated donors and eight patients from HLA-identical sibling donors. Most of the patients (12/14) received RIC regimen (Flu-Cy-TBI) and ATG-Fresenius also added the protocol in AHSCT from unrelated donors. Five patients had stage 2-4 cutaneous acute GVHD and chronic GVHD developed in four patients (mild: n = 1, moderate: n = 2, severe: n = 1). Six patients who underwent transplantation at PD attained CR after AHSCT however relapse occurred in four patients at a median of four months (range: 3-10 months) after HSCT. At the time of data collection, nine patients have deceased; three were due to early TRM, three were underlying disease, two had aspergillus infection and one had nocardia infection. Two patients were alive with disease being treated by the Brentixumab vedotin, gemcitabine and DLI. With a median follow up period of 8.7 months after AHSCT, the estimated 1-year OS and PFS was 40.4%±5% and 35.4%±3.9%, respectively. Conclusions: AHSCT is an effective treatment option for advanced-stage MF/SS. Further studies are warranted to improve the outcome after AHSCT.
Primary cutaneous diffuse large B-cell lymphoma, leg-type: The Mayo Clinic experience.
Authors: Alhaj Moustafa Muhamad , Parrondo Ricardo Daniel , Gannon Nicole , Hastings Jacquelyn , Seegobin Karan , Hoppe Bradford , Menke David M , Kharfan-Dabaja Mohamed , Ayala Ernesto , Jiang Liuyan , Tun Han W. 
Published: May 2020

e20044 Background: Primary Cutaneous Diffuse Large B-cell Lymphoma, Leg-type (PCDLBCL) is a rare lymphoma comprising 4% of all cutaneous lymphomas with an aggressive clinical course. We investigated disease characteristics and outcomes among patients PCDLBCL. Methods: Following IRB approval, we identified patients retrospectively with PCDLBCL treated at the Mayo Clinic Cancer Center 1998-2019. Results: 45 pts were identified with a median age of 71 years (Range- 48-95) and 28 (62%) were female. Disease locations were legs (62%), arms (22%), head (11%), trunk (2%) and multiple sites (2%). At diagnosis, (51%) had a single lesion, (29%) had multiple lesions in 1-2 contiguous regions, (16%) had multiple lesions in non-contiguous regions or > 2 regions and data was not available (4%). Immunohistochemistry showed positive staining for BCL-2 (92%), BCL-6 (76%), c-MYC (62%), MUM1 (95%), CD10 (11%), and cytoplasmic IgM (8/9- 89%). By Han’s criteria, (95%) had activated B cell lymphoma (ABC). Median Ki-67 was 90% (range, 50,100%). 9/12 (75%) were positive for MYD88 L265P mutation. 13/21 (62%) were double expressor and 3/22 (14%) had double hit lymphoma. 37/45 (82%) had ECOG < 2. LDH was elevated in 13/37 (35%). The median number of therapies was 1 (range; 1-11). The initial treatments were chemo-radiation (30%), chemo alone (38%), rituximab alone (11%), radiation (RT) alone (16%), rituximab-RT (2.5%), and surgical (2.5%). The median follow-up time for the whole cohort was 80 months (95% CI; 32, 169). The median progression free survival and overall survival (OS) were 20 months (95% CI; 12, 34) and 80 months (95% CI; 48, 119). 22/45 (49%) are alive. The cause of death was disease-related in 11/23 (48%). The median number of relapses was 1 (range; 0, 11) with (60%) relapsed after first line. 4/45 pts had autologous stem cell transplant after relapse. 7/45 (16%) had a systemic relapse at a median time of 35 months from diagnosis (range; 16, 112). Age above 60 years was associated with worse OS; 70 months (95% CI; 30, 99) vs NR (95% CI; 135, NR), p = 0.025. ECOG performance status < 2 was associated with better OS, NR months (95% CI; 80, NR) vs 48 months (95% CI; 3.3, 88),p = 0.0003. 1 pt received Ibrutinib on 11th relapse and had 3 years of PFS. Conclusions: PCDLBCL is predominantly ABC type, affects elderly pts and is characterized by multiple cutaneous relapses followed in some cases by systemic relapses. Increased age and poor performance status had a negative impact on OS. High incidence of MYD88 L265P mutation is observed in PCDLBCL similar to immune-privileged site lymphomas.
A closer look at Hispanics with follicular lymphoma in a majority-minority community.
Authors: Janania Martinez Michelle , Snedden Tyler William , Garza Juan , Surapaneni Prathibha , Ananth Snegha , Rawlings Jeremy , Gregorio Dave , Kakarla Sushanth , Liu Qianqian , Michalek Joel , Diaz Duque Adolfo Enrique 
Published: May 2020

e20047 Background: Follicular Lymphoma (FL) is the most common type of indolent non-Hodgkin lymphoma. It is most commonly diagnosed in non-Hispanics (NH) and is well characterized in this population. Hispanics (HI) on the other hand have been historically underrepresented in clinical trials and observational studies. Some studies suggest that there are differences in age, clinical presentation, treatment patterns and outcomes in HI. The aim of our study was to determine demographics and clinical characteristics of FL patients and compare outcomes between HI and NH. To our knowledge, this is the largest cohort of FL patients from a single academic institution that serves predominantly HI. Methods: We retrospectively analyzed 123 patients with FL; all received care between 2008-2018. Key variables included age, gender, race/ ethnicity, comorbidities, insurance status, stage, treatment received, outcome at 3 and 5 years and vitality status in 2018. Continuously distributed outcomes were summarized with mean/standard deviation and categorical outcomes with frequencies/percentages. Significance of associations between categorical outcomes was assessed with Pearson’s Chi Square or Fisher’s Exact test. All statistical testing was two-sided with a significance level of 5%. Results: We identified 123 patients with diagnosis of FL, 71 HI (58%), 49 NH (40%), 3 unspecified (2%); 88% Caucasian, 5% African American, 4% Asian, 3% other; 56% females and 44% males. Median age at diagnosis was 56.31 (SD 11.97). Funding source was commercial insurance N = 55 (45%), Medicare N = 40(33%), hospital payment plan N = 20 (16%), unfunded N = 5 (4%) and Medicaid N = 3 (2%). Most prevalent co-morbidities were HTN 40% and diabetes mellitus 20%; 40% had no co-morbidities. At diagnosis ECOG of 0-1 was seen in 116 (94%); 21 were Stage I (17%), 19 Stage II (15%), 40 Stage III (33%), and 43 Stage IV (35%). FLIPI score was 0-1 in 43 patients (35%), 2 in 32 (26%), 3 in 23 (19%), not documented in 25 (20%). Median PFS was 1287.10 days (SD 879.18). At 3 year follow up there was: complete/ partial response in 76% HI vs 84% NH; disease progression in 18% vs 3%; death in 6% vs 3%, respectively (p-value = 0.739). At 5 year follow up: complete/partial response in 76% HI vs 86% NH; disease progression in 14% vs 10%; death 10% vs 3%, respectively (p-value = 0.62). At the end of 2018, 88% HI were alive compared to 95% NH, [p-value = 0.457]. Conclusions: Contrary to existing data, our study found that HI with FL have no difference in outcome when compared to NH. This could be explained by our prevalently HI population, but further studies are needed.
Hypomagnesemia is associated with an increased risk of early clinical failure in patients with Burkitt lymphoma.
Authors: Gile Jennifer , Ruan Gordon , Abeykoon Jithma P. , McMahon Molly , Witzig Thomas E. 
Published: May 2020

e20048 Background: No literature exists regarding whether hypomagnesemia at the time of diagnosis in Burkitt Lymphoma (BL) is associated with inferior survival. Methods: Patients with new diagnosis of BL who were seen at Mayo Clinic, MN from 2000-2019 with a serum magnesium level available prior to chemotherapy were included. Patients were allocated to two groups; Abnormal Magnesium Group (AMG), defined as a magnesium level < 1.7 mg/dL and Normal Magnesium Group (NMG), defined as ≥ 1.7 – 2.3mg/dL. Two-sided Wilcoxon rank sum test and Chi square/Fischer’s exact test were used to compare the continuous and categorical variables, respectively. Kaplan-Meier and log-rank tests were used to perform all time to event analysis which were done from time of treatment. Hazard ratios (HR) with confidence intervals (CI) were calculated using Cox-proportional hazards. Results: Of 90 patients with a diagnosis of BL, 42 patients had a magnesium level at or before time of diagnosis. The Table lists the baseline characteristics and significant findings of the AMG/NMG groups. The median follow-up was 30 months. Hypomagnesemia was predictive for inferior EFS at 30 months - 34.3% (95% CI: 8.7–74.0) for AMG and 79.3% (95% CI: 60.8-90.4) for NMG (p = 0.038). OS at 30 months for AMG was 42.9% (95% CI: 14.4-77.0) and for NMG was 93.7% (95% CI: 78.1-98.4%) (p = 0.002). Other parameters significant on univariate analysis included the Charlson Comorbidity Index (p = 0.034), creatinine (p = 0.009), and number of treatments (p = 0.048). In the multivariate analysis, creatinine (p = 0.005) and number of treatments (p = 0.004) were significant. Likelihood ratio testing of predictors associated with inferior OS were significant for hypomagnesemia (likelihood ratio 3.99, p = 0.046). Conclusions: Patients with hypomagnesemia at the time of BL diagnosis have inferior outcomes compared to BL patients with a normal magnesium level. Prospective studies are needed to confirm this finding and test Mg replacement strategies to mitigate the effects of hypomagnesemia. [Table: see text]
Survival from time of transformation in patients with transformed lymphoma at time of diagnosis.
Authors: Kelly Alaina , Boughan Kirsten M , Rojas Patricio , Ahmad Nausheen , Diamond Akiva , De Lima Marcos J.G. , Caimi Paolo Fabrizio 
Published: May 2020

e20054 Background: Histologic transformation (HT) to aggressive lymphoma can occur in indolent lymphoma and is considered to convey poor prognosis. Most data come from follicular lymphoma (FL). We conducted a retrospective analysis to compare outcomes of transformed marginal zone lymphoma and lymphoplasmacytic lymphoma (tMZL/LPL) with those of transformed FL (tFL). Methods: We collected data from patients diagnosed with HT between 2000 and 2018. Transformed CLL was excluded. Survival estimates were done with the Kaplan Meier method; comparisons were done with log-rank test. The effect of covariates on OS was evaluated with Cox proportional hazards method. Results: We identified 87 pts (58 tFL, 29 tMZL/LPL). There were no differences in baseline characteristics, except for COO subtype by Hans criteria and circulating IgM. There were no differences in OS or EFS based on the underlying lymphoma subtype (OS: tFL = 60.1m vs. tMZL/LPL = 64.8m, p = 0.53; EFS: tFL = 25.2m vs. tMZL/LPL = 27.6m). Univariate and multivariate analyses identified age at HT (HR for age > 60 = 3.5, 95% CI: 1.7-7.6), poor performance status (HR for ECOG ≥3 = 23, 95% CI: 7.3-70) and having a previous diagnosis of indolent lymphoma (HR for previous diagnosis = 3.7, 95% CI: 1.87-7.4) as adverse risk factors for OS after HT. Pts with previous diagnosis of indolent lymphoma with subsequent HT had inferior OS than pts presenting first with HT (median OS 25m vs. not reached, p < 0.0001); EFS (median EFS for treated pts = 11m vs. 49m). Conclusions: Underlying lymphoma does not affect OS after HT and long term survival can be achieved in pts who receive treatment. tMZL/LPL is more frequently of non-GCB origin has monoclonal IgM. Pts who present with HT as their first lymphoma-related event have better OS. These findings will lead to further exploration of the genetic changes that occur at the time of transformation of indolent lymphomas. [Table: see text]