bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metabolic response evaluated by 18F-FDG PET/CT as a potential tool in identifying subgroup of patients with advanced non-small cell lung cancer for immediate maintenance treatment after first-line chemotherapy.
Authors: Cho Su-Hee , Park Silvia , Park Lee Chun , Ji Jun Ho , Lee Ji Yean , Hwang Deok Won , Maeng Chi Hoon , Ahn Hee Kyung , Ahn Myung-ju , Park Keunchil , Ahn Jin Seok , Sun Jong-Mu 
Published: March 2020

e18148 Background: Platinum-based doublet regimens have been a mainstay of first-line treatment with advanced non–small cell lung cancerand ans the present guidelines recommend four to six cycles and waiting until disease progression. However subsequent disease progression is often rapid so sequential and maintenance therapy was performed in many studies. But almost studies didn’t show the significant survival benefit. Thus, we supposed that FDG PET may be a useful to determine what subgroup have better prognosis Methods: We founded out fifty-two patients who diagnosed to underwent baseline and follow-up FDG PET after 4 cycles of first-line platinum based chemotherapy. We obstained patient's characteristics and response rate (RR), progression-free survival (PFS), and overall survival (OS) from the medical records. And we checked maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG) from FDG PET. Results: Univariate analysis showed that MTV (hazard ratio = 1.032, P = 0.007) and TLG (hazard ratio = 1.030, P = 0.001) were independent predictive factors associated with decreased PFS and gender (hazard ratio = 5.248, P = 0.026), smoking (hazard ratio = 7.798, P = 0.006), EGFR mutation (hazard ratio = 0.106, P = 0.030) and TLG (hazard ratio = 1.027, P = 0.046) were significant predictors of OS. Histopathology was a marginally significant prognostic factor (P = 0.058). Multivariate analysis showed that TLG (hazard ratio = 1.030, P = 0.001) were independent predictive factors associated with decreased PFS and smoking (hazard ratio = 10.588, P = 0.002) and TLG (hazard ratio = 1.043, P = 0.007) were significant predictors of OS. Conclusions: There is a correlation between TLG and PFS significantly. We suggest that follow-up FDG PET after 4 cycle chemotherpy can help to discriminate patients who have benefit through sequential and maintenance therapy. But it need specific value for clinical use, so more large-scale prospective study is warranted.
Toxicity in patients (pts) age 65 or older with dose-adjusted REPOCH (DA-REPOCH) for untreated diffuse large B-cell lymphoma (DLBCL).
Authors: Stephens Deborah Marie , Ruppert Amy S. , Christian Beth , Jones Jeffrey Alan , Flynn Joseph M. , Porcu Pierluigi , Baiocchi Robert A. , Byrd John C. , Dotson Emily K. , Crawford Brooke S. , Blum Kristie A. 
Published: March 2020

e18508 Background: ORR of 97-99% and 5-yr PFS of 75-79% are reported with front-line DA-REPOCH in pts age 19-85. In these prospective series, 72% of pts escalated ≥ 1 dose level (DL), febrile neutropenia (FN) occurred in 36-51% pts, and 3-4% died of toxicity. Methods: We performed retrospective analysis of pts ≥ 65 treated with DA-REPOCH front-line for DLBCL at Ohio State University from 2002-2011. PFS estimates were calculated by the Kaplan-Meier method. Logistic regression and proportional hazards models were fit to identify variables associated with ORR and PFS, respectively. Results: 69 pts ≥ 65 yrs (range, 65-92) received DA-REPOCH for de novo (n=42) or transformed (prior CLL=16, FL=9, HL=2) DLBCL, including 28 pts ≥ 75. Performance status (PS) was ≥ 2 in 43%, 86% were stage III-IV, 77% had an aaIPI ≥ 2, 19% had bulky disease ≥ 10 cm, 83% had extranodal disease, and median creatinine clearance (CrCl) was 64 ml/min. Median number of cycles was 5 (range 1-7). Max DL was 1, 2, and 3 in 72, 13, and 6% of pts, respectively, and 9% received all cycles below DL 1. Max DL and number of cycles were similar between pts 65-74 and > 75. Dose reductions (DR), delays, FN, and hospitalization occurred in 48, 39, 38, and 42% of pts, respectively. DR were associated with age ≥ 75 (p=0.001) or reduced CrCl (p=0.02) and delays strongly associated with PS ≥ 2 (p=0.001). FN was associated with bulky disease (p=0.03); 31% of pts without bulky disease developed FN compared to 67% with bulk. Nine pts (13%, 3 pts ≥ 75) died of toxicity (7 pts at DL 1 and 2 at DL < 1). ORR was 67% (95% CI 52-75%). Median PFS was 17 mos (95% CI 6-43). Increased LDH (p=0.008 and p<0.001) and number of prior chemotherapies (p=0.04 and p<0.001) were independently predictive for ORR and PFS, respectively. DR and age were not associated with ORR or PFS, controlling for LDH and number of prior regimens. In 42 pts with de novo DLBCL, ORR was 71% (95% CI 54-85%) and median PFS was 36 mos (95% CI 7-94). Conclusions: In this retrospective study, toxicity is increased with DA-REPOCH in pts ≥ 65 with DLBCL, compared to published results in a younger population. Age ≥ 75, impaired CrCl, and poor PS are associated with increased risk of DR and delays, although age and DR do not appear to impact ORR and PFS.
Rituximab hypersensitivity reactions (HSR): Predictors of recurrent and severe reactions based on severity of reaction, NHL histologic subtype, and burden of disease.
Authors: Sallman David A , Macklin Eric , Ali Shihab , Michaelson James , Barnes Jeffrey A. , Abramson Jeremy S. , Banerji Aleena , Hochberg Ephraim P. 
Published: March 2020

e18520 Background: Rituximab is an anti-CD20 monoclonal antibody with efficacy in B-cell malignancies. Grade II-IV HSR occur in 5-10% of patients. There are no data to predict which patients are at risk for more severe rituximab HSR as well as no data on eventual successful rituximab administration in this population. Methods: We analyzed all rituximab HSR in patients at Massachusetts General Hospital between 2006-2010. Patients included had documented HSR on the chemotherapy infusion sheet on our electronic medical record or via referral to allergy for desensitization. Control rituximab-treated patients were identified from tumor registry data. ICD3 codes were used to determine the histologic subtypes. Rates of HSR were analyzed by logistic regression and Fisher's exact test. Severity of HSR was based on an established classification system. Results: Immediate HSR occurred in 9% of patients (79/901) treated with rituximab and premedications. A majority of patients with a HSR developed symptoms on their initial infusion (76%); however, 46% of moderate or severe HSR occurred on subsequent infusions. Severity of HSR was directly correlated to the risk of a recurrent reaction where all patients with severe HSRs and 56% of patients with moderate HSRs had a recurrent reaction in contrast to only 36% of patients with mild reactions (p = 0.005). Advanced stage of disease increased the risk of a moderate or severe HSR (HR = 4, p = 0.02). Waldenstrom’s Macroglobulinemia (WM) accounted for 10% of all HSR while representing only 1% of rituximab treated pts (p < .003 adjusting for multiple comparisons) and 70% of these patients had a HSR. All patients with complex HSR who were referred to allergy for desensitization (n=14) were able to complete therapy safely. Conclusions: Severe rituximab HSR commonly occurs after the initial infusion. Severity of the HSR predicted recurrent HSR and an advanced stage of disease predicted more severe reactions. WM had a disproportionately higher risk for HSR. Despite HSR, we found that all patients were able to tolerate the recommended number of infusions without severe adverse events utilizing medical management and/or desensitization.
Geographic variation of extranodal sites of mucosal associated lymphoid tissue lymphoma (MALToma): Analysis of series from two institutions.
Authors: Adab Kalid , Persky Daniel Oscar , Guillen-Rodriguez Jose , Rimsza Lisa M. , Frutiger Yvette M. , Haidau Augustin , Telfer Margaret C. , Braik Tareq , Catchatourian Rosalind , Miller Thomas P. 
Published: March 2020

e18534 Background: MALToma represents about 5% of Non-Hodgkin lymphomas (NHL). Prior studies report stomach to be the most common site of involvement (35-50%), while skin (16%) or salivary glands (26%) were reported to be the 2nd most frequent site in 2 different studies. Geographical variation may affect the proportions of primary sites of MALToma, which could provide further clues to investigating their causes. Methods: The data was obtained on 91 consecutive patients from the University of Arizona Cancer Center (UACC) clinical and pathological databases, and 25 patients from the Cook County Hospital (CCH) database, seen between 2005 and 2011.The frequency of clinical characteristics and their relation to survival were analyzed and compared between UACC and CCH. Results: UACC and CCH cohorts were balanced for gender (M:F ratio 0.65) and age (median 63 y (range, 26-88), but not for race or/and ethnicity. While at CCH 36% of pts were African-American (AA), 28% Hispanic (any race), 12% Caucasian and 20% unknown; at UACC 88% of pts were Caucasian, 10% Hispanic and 1% AA (p<0.0001). UACC had 8% pts with > 1 extranodal site, while CCH had none. The primary sites of MALToma were also different. At CCH, similarly to what’s commonly reported in the literature, 40% of pts had primary gastric involvement, 20% salivary gland, 12% lung, 8% orbit, 8% thyroid, 4% intestine, 4% skull base tumor, and 4% breast. At UACC, however, 22% of pts had primary skin involvement, 19% gastric, 16% lung, 13% orbit, 8% salivary gland, 6% intestine, 5% breast, 3% thyroid and 8% other. The difference was statistically significant for the frequency of primary skin (p=0.006) but not gastric involvement (p=0.084). 80% of patients with primary skin involvement were Caucasian. The median follow-up of the survivors was 18 months for both groups, with no statistically significant difference in median progression-free (7.5 years) or overall survival (14.6 years). Conclusions: There was higher prevalence of Caucasian race and skin involvement at UACC than at CCH. We speculate that sun-induced photodamage causes chronic inflammation contributing to eventual malignant transformation to primary skin MALToma.
Alternating non-cross-resistant multiagent chemotherapy (ANCRC) and high-dose chemotherapy followed by autologous stem cell support (HDC-ASCS) in first remission to improve outcome in patients with T-cell lymphoma.
Authors: Jitawatanarat Potjana , Dawar Richa , Chittawatanarat Kaweesak , Batty Nicolas , Czuczman Myron Stefan , Hernandez-Ilizaliturri Francisco J. 
Published: March 2020

e18538 Background: T-cell lymphomas represent a challenge for the practicing oncologist as evidence-based medicine is limited and the ORR to chemotherapy, PFS and OS rates are inferior when compared to B-cell lymphoma. CHOP offers limited activity, and there is a growing consensus that alternative regimens should be tested. We studied the impact of ANCRC or HDC-ASCS vs. CHOP in outcome of T-cell lymphoma. Methods: We retrospectively analyzed differences between the ORR, PFS and OS of T-cell lymphoma patients excluding ALCL treated with CHOP or HyperCVAD regimen alternating with HDAM in the front-line setting following by observation or HDC-ASCS. Pre-treatment demographic, clinical, and pathological characteristics were collected. Differences in outcomes were analyzed using a Cox proportional analysis. Results: ALCL, PTCL-NOS and AITL were the most common subtypes. After excluding ALCL (N=29), a total of 49 patients were included in the final analysis; 23 pts treated with CHOP; 12 pts with HyperCVAD/HDAM and 14 pts treated with other induction regimens. After induction therapy, 12 patients underwent HDC-ASCS in first remission. There were no differences in demographic and clinical characteristics between groups analyzed. There was a higher ORR and PFS among patients treated with hyperCVAD/HDAM (83.3%) vs. pts treated with CHOP (62%). However it did not improved OS when compared to CHOP. The use of HDC-ASCS in first remission was associated with improved OS. The median OS for pts observed after front-line chemotherapy was 32 months and 59 months for pts that received HDC-ASCS [Hazard ratio 0.54 (95% CI 0.16-1.83) (p=0.32)]. Conclusions: Our data suggest that hyperCVAD/HDAM results in higher ORR and PFS in T-cell lymphoma than CHOP. More importantly, the use of HDC-ASCS in first remission appears to improve the OS of non-ALCL T-cell lymphoma patients. ANCRC regimens incorporating novel agents follow by HDC-ASCS in first remission is emerging as an attractive therapeutic intervention for a selected group of T-cell lymphoma patients been evaluated in ongoing clinical trials.
The natural history of intravascular lymphoma.
Authors: Fonkem Ekokobe , Robison David J , Lok Edwin , Gautam Shiva , Wong Eric 
Published: March 2020

e18541 Background: The diagnosis of IVL is often delayed or found at post-mortem because this disease is rare. Published data consist of case reports or series, which are insufficient to offer a global perspective of this disorder. Methods: We included cases of IVL published between 1957 and 2011, and performed Wilcoxon rank sum test to evaluate survival differences. Results: There were 191 B-cell and 7 T-cell lymphomas. Median age was 65 (range 12-87) years. Central nervous system (CNS) was the first site of disease in 92(47%), skin in 41(21%), and lung in 22(11%) individuals. Forty-five% of CNS IVL was diagnosed at postmortem versus 12% for skin and 27% for lung IVL. Age is a significant prognostic factor and patients <75 years had a median survival of 14.0(range 0.1-165.0) months versus those ≥75 years had a median survival of 6.0(range 0.1-178.0) months (P=0.05). There is a trend favoring women, median survival 14.0(0.3-96) months, over men, median survival 7.0(0.1-178.0) months (P=0.07). Gender, ethnicity, organ site involvement, hemoglobin, LDH, bone marrow involvement and MRI were not significant. There is no difference in patient survival when treated with Adriamycin-based versus non-Adriamycin-based chemotherapies. Among the 12 CNS IVL patients with recurrence, 3(25%) recurred in CNS while 2(14%) recurred in skin and 7(58%) in lungs. Among the 9 patients with skin IVL, 4(45%) recurred in skin while 1(11%) in CNS, 1(11%) in lungs, and 3(33%) in other organs. Two (50%) of 4 patients with lung IVL had recurrence in the lungs and the other 2(50%) recurred in other organs. Conclusions: The treatment of CNS IVL is hampered by lack of timely diagnosis. The prognosis and pattern of relapse of CNS IVL patients is significantly different from those with skin and lung IVL, suggesting variations in the underlying biological mechanism of disease.
Absolute lymphocyte count (ALC), absolute monocyte count (AMC), and ALC/AMC ratio to predict outcome in aggressive non-Hodgkin lymphoma (aNHL).
Authors: Rivera-Rodriguez Noridza , Cabanillas Fernando , Pardo Wandaly Ibis , Santiago Karen J. , Pavia Orestes Antonio , Bruno Margarita 
Published: March 2020

e18547 Background: Prognostic factors in NHL have been well studied in the pre-rituximab era. More recently, tumor infiltrating macrophages were found to confer an adverse prognosis. Porrata et al. at Mayo Clinic have described the ALC, AMC, and ALC/AMC ratio as important prognostic factors. We have evaluated pts with aNHL treated in the rituximab era to identify prognostic factors Methods: From January 2006 and April 2011, 89 pts with aNHL treated at our center were accrued. Initial treatment was R-CHOP based. 59 were entered on R-CHOP + GM-CSF protocol and the remainder were identified from our database. Results: Median age was 59 (25-89), 44% were male; histologies included DLBCL (n=75), high grade follicular lymphoma (n=11), and other (n=5). Median follow up = 27 mo. 3 year FFS and OS for the entire group: 78% and 83% respectively. On univariate analysis, FFS was superior for low IPI (0-2, p=0.01), normal B2 microglobulin (p=0.008), females (p=0.04), ALC > 865 (p=0.001), ALC/AMC ratio of >1.43 (p=0.02) but contrary to Porrata’s findings, there was no difference by AMC. In pts with low IPI, there was a significant difference in FFS and OS for those with an ALC >865 (93% vs 56%, p=0.0008;96% vs 60%, p=0.0004). In females ALC had no prognostic value, but males with low ALC had a significantly worse FFS and OS (85 vs 34%, p=0.007; 91% vs 53%, p=0.006). Females with high AMC had superior FFS (p=.02) but the opposite trend was seen in males. On multivariate analysis, gender, B2-microglobulin, and combined IPI with ALC/AMC ratio >1.43 remained as independent prognostic factors with gender being the most significant factor in the model. Conclusions: Prior to Rituximab, gender was not prognostic. Our findings suggest that: 1- favorable impact of Rituximab occurs mostly in females; this could be related to their immune system. 2- Both ALC and ALC/AMC ratio have prognostic significance, and can identify patients with favorable IPI who have poor outcome. This effect is particularly striking for males. To the best of our knowledge this is the first study to find an interaction between gender and ALC, and ALC/AMC as well as a divergent effect of gender and AMC on prognosis
A single-center analysis of initial imaging in multiple myeloma (MM).
Authors: Markow Justin M. , Desai Amishi , Staszewski Harry 
Published: March 2020

e18554 Background: Current recommendations for the evaluation of MM include a skeletal survey (SS) and possibly an MRI. The literature documents a discrepancy in the detection of important skeletal lesions between these two techniques. There is limited data on the relationship between symptoms and spinal MRI findings. We analyzed the correlation of symptoms with an abnormal MRI in our patients. Methods: We analyzed 66 unselected,retrospectively identified patients with MM using lab values, ISS scores, the initial SS, and MRI. Skeletal symptoms, interval between studies, discordance between imaging by modality, and interventions were also tabulated. Risk ratios (RR) were calculated for the probability of radiologic abnormalities based on symptoms. Fischer's exact test was applied. Results: The baseline characteristics by age, gender, race, ISS score, and other lab values were similar between groups. 53% (35/66) of patients had an MRI at diagnosis. 51.4% (18/35) of these had different findings from the SS (95% CI, 35.6% - 67.0%). 30.8% (8/26) of patients with an MRI abnormality were asymptomatic or had symptoms in a different location than seen on MRI (95% CI, 16.3% - 50.1%). 15.4% (4/26) of these patients were asymptomatic at presentation (95% CI, 5.5% - 34.2%). (RR) for patients with any reported symptom and abnormal MRI finding is 2.6 (95% CI, 1.1 - 5.6, p< 0.01), while the RR for a symptom corresponding to its anatomic area on MRI is 1.3 (95%CI .8 - 2.1, p = 0.23). Conclusions: 30% of our patients with an abnormal MRI were asymptomatic or reported symptoms in a different area. The RR for an abnormal MRI result in patients with any symptom was significant, but the symptomatic area did not correlate with the anatomic MRI abnormality. This suggests that a significant amount of disease is missed because imaging may be confined to the symptomatic area and asymptomatic patients are less likely to have an MRI. Within this limited data set, there appears to be an advantage to performing routine initial MRI
Drug resource use and costs for novel agents in multiple myeloma.
Authors: Binder Gary , Harwin William N. , Stemkowski Stephen , Zhou Yunping , Khan Zeba M. , Nourbakhsh Ali 
Published: March 2020

e18560 Background: Lenalidomide plus dexamethasone and bortezomib are NCCN guideline-recommended treatments for multiple myeloma (MM). While several economic models have assessed these regimens (Fullerton AMCP 2007, Durie IMW 2011), there is a lack of published real-world evidence on payer drug costs, particularly regarding billed unit quantities. This analysis evaluated utilization quantities per claim and incurred payer costs for a common time period for lenalidomide and bortezomib in MM. Methods: A retrospective claims analysis was conducted using pharmacy and medical claims data from a large US payer. Claims for 5 million Medicare Advantage (MA) and commercial plan members continuously and non-continuously enrolled within the period 07/01/2009 to 06/30/2011 were evaluated to select patients having at least 2 medical claims for MM (ICD9 203.0x), and at least 1 claim for units of these drugs, to identify billed unit quantity and allowed charges per claim. Results: 1,249 patients had MM diagnoses and use of these drugs. The MA and commercial populations had similar utilization and costs. For bortezomib, average quantity billed per claim was 3.3 mg (94% of a full 3.5 mg/10 mL single-use vial); 78% of claims billed 3.5mg. For lenalidomide, average and most common quantity billed per claim was 21 capsules at an average strength of 17.1 mg; the most common strength was 25 mg (43%). Average allowed charges for a common 28-day month were $7,031 for bortezomib (applied over 28 days at $1,318 per each of 4 administrations per 21-day cycle) vs. $6,911 for lenalidomide. Conclusions: Billed and paid utilization for commercial and Medicare Advantage MM patients was generally 1 full vial of bortezomib and 21 capsules of lenalidomide per date of service. Drug costs per month of lenalidomide and bortezomib treatment were very similar, differing by less than $10/day, prior to physician administration charges. Future cost analyses should consider these rates and focus on total drug and medical costs of care, factoring in actual treatment episodes and evaluating common time periods.
Efficacy and safety of lenalidomide and dexamethasone in overtreated multiple myeloma patients.
Authors: Moscetti Alessandro , Resci Federica , Antolino Giusy , Saltarelli Francesca , Monarca Bruno , Bianchi Maria Paola , Naso Virginia , De Benedittis Daniela , La Verde Giacinto 
Published: March 2020

e18566 Background: Lenalidomide is a therapeutic option for pretreated patients with multiple myeloma, especially in association with steroids. Methods: Oraldaily lenalidomide (10-25 mg) for 21 days every month (median courses 8.6) and weekly dexamethasone (Dex) were administered until progression in 33 pretreated patients (median age 68.1 yrs) observed between June 2008 and January 2012 at Hematology Department of Sant’Andrea Hospital in Rome. Previous treatment included alkylants, anthracyclines, IFN-α, thalidomide, bortezomib and single or double autograft. Fifteen patients were evaluated after 6 courses of therapy, administered as second to fifth line, and prospectively followed-up; two patients weren’t considered because of early death. Treatment response was assessed according to IMWG uniform response criteria. Results: The overall response rate was 53.3% (8/15 pts) with a median duration of response of 12 months: 8 patients reached a partial response (PR), 6 showed a stable disease (SD) and 1 progressive disease (PD). The median progression free survival was 14 months. Among patients in PR, 5 are alive in continous treatment, 2 died due to PD after 17 courses administered as fifth line therapy and 1 died for unrelated surgical complicancies. The whole responses were achieved indifferently if lenalidomide was administered as second, third or fifth line of therapy (2, 3 and 3 patients respectively). Out of patients in SD, all experienced progressive disease after a median of 12 courses: 3 are still alive in salvage therapy, 3 died during treatment. The only patient in PD died 9 months after the end of Len-Dex treatment during salvage chemotherapy. The reported side effects included pneumonia, neutropenia, diarrhea, peripheral sensitive polyneuropathy, transient liver failure, lower urinary tract infection, skin rash, transient aphasia, conjunctival hemorrhage and deep vein thrombosis, all resolved with brief discontinuance and specific support therapy without hospitalization. Conclusions: Len-Dex association is a completely oral effective salvage therapy with good response rate and manageable side effects also for overtreated relapsed and refractory multiple myeloma patients.