Intensive Induction Therapy Compared to CHOP for Hepatosplenic T-cell Lymphoma

Publication date: Available online 21 October 2019Source: Clinical Lymphoma Myeloma and LeukemiaAuthor(s): Daniella Klebaner, Divya Koura, Dimitrios Tzachanis, Edward D. Ball, Steven Horwitz, Aaron M. GoodmanAbstractHepatosplenic T-cell Lymphoma (HSTCL) is a rare peripheral T-cell lymphoma that disproportionately affects individuals with a clinical history of immunosuppression. It carries a poor prognosis, and due to its rarity, there is no single or well-established treatment.We conducted the largest-to-date individual-level meta-analysis based on literature searches to determine the best induction therapy for HSTCL. We compared response rates and survival among patients who received “non-CHOP-based” induction with regimens containing cytarabine, etoposide, and/or platinum-based treatment to those receiving treatment with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP-like therapy. We also review additional regimens including alemtuzumab and pentostatin, and assessed the role of consolidation with hematopoietic stem-cell transplantation (HSCT).We identified 166 patients with HSTCL, 118 of whom had sufficient information on induction treatment and survival. Eighty-four patients received non-CHOP-based (N=34) or CHOP/CHOP-like (N=50) induction treatment. Non-CHOP-based induction was associated with a complete/partial response (CR/PR) rate of 82% compared to 52% (p = .006) with CHOP/CHOP-like and increased median overall survival (p = .000...
Source: Clinical Lymphoma Myeloma and Leukemia - Category: Cancer & Oncology Source Type: research

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Conclusions The major challenges in the development of adoptive cell therapy for T cell tumors, as mentioned above, remain fratricide, T cell aplasia and the potential for leukemic transduction or poor T cell function if used in the autologous setting. Approaches to overcome fratricide include the genetic modification and deletion of the T cell antigen in the case of long-term CAR-T cell persistence or regulated CAR-T expression. To ensure restoration of T cell immunity, transient CAR expression can be achieved incorporation of a CAR suicide gene, transient CAR expression using mRNA electroporation, or short-lived NK cell...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research
Discussion In this section, we discuss the mechanisms responsible for lymphomagenesis in the various inborn errors of immunity and provide an overview of the treatment. Defects in Immune Responses That Predispose to Lymphomagenesis in PIDDs The complex immune mechanisms and their interplay that predisposes to neoplastic transformation of B or T cells and development of lymphomas in PIDD patients has not been fully elucidated. However, it is expected that the etiology in most cases is multifactorial and related to a dynamic regulation of immune response and environmental triggers (Figure 3). An underlying intrinsic susce...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Human T-cell lymphotrophic virus types 1 and 2 (HTLV-1/2) are delta retroviruses endemic to the Caribbean and Japan (Gessain et al., 2013). They are known to cause adult T-cell lymphoma-leukemia (ATLL) and tropical spastic paraparesis/HTLV-1 associated myelopathy (HAM) (Mahieux et al., 2003). Given the link between immunosuppressive states and development of lymphoproliferative disorders, there is hesitation on the behalf of clinicians to offer stem cell transplantation to patients who test positive for HTLV-1/2 antibody. We reviewed four cases of patients who underwent autologous stem cell transplantation (ASCT) at our in...
Source: Blood - Category: Hematology Authors: Tags: 723. Clinical Allogeneic and Autologous Transplantation: Late Complications and Approaches to Disease Recurrence Source Type: research
Conclusion Our results suggest that achievement of a CR is imperative in patients with advanced ENKL, and is desirable for any patient for whom auto-SCT is utilized. SMILE-based chemotherapy appeared effective in attaining a CR, and was also an effective salvage regimen. For patients attaining a first CR, auto-SCT should be strongly considered, but should definitely be utilized in patients attaining CR2. For patients with refractory disease, allo-SCT can be considered in a selected group of patients. Micro-Abstract We present a cohort of primarily non-Asian patients with advanced stage and relapsed/refractory ENKL. Our res...
Source: Clinical Lymphoma Myeloma and Leukemia - Category: Cancer & Oncology Source Type: research
Conclusion Allogeneic HSCT is a promising treatment modality for CD8+ PCAETL. Because of the aggressive nature of this disease and lack of sustained remission with currently available therapies, HSCT should be considered early in the course of treatment. Two novel agents, brentuximab and pralatrexate, showed significant activity against CD8+ PCAETL, and may be incorporated earlier in the treatment course. Micro-Abstract Several studies have suggested that hematopoietic stem cell transplantation (HSCT) might provide a cure for primary cutaneous aggressive epidermotropic cytotoxic CD8-positive T-cell lymphoma (CD8+ PCAETL). ...
Source: Clinical Lymphoma Myeloma and Leukemia - Category: Cancer & Oncology Source Type: research
We describe the clinicopathologic features of 17 patients who had a hematologic malignancy of various types, were treated, and subsequently developed a lymphoproliferative disorder (LPD). There were 10 men and 7 women with a median age of 59 years (range, 36 to 83 y). The primary hematologic neoplasms included: 5 chronic lymphocytic leukemia/small lymphocytic lymphoma, 3 plasma cell myeloma, 2 acute monoblastic leukemia, and 1 case each of mixed-phenotype acute leukemia, chronic myeloid leukemia, splenic marginal zone lymphoma, follicular lymphoma, mantle cell lymphoma, T-cell prolymphocytic leukemia, and peripheral...
Source: The American Journal of Surgical Pathology - Category: Pathology Tags: Original Articles Source Type: research
Several studies have suggested that hematopoietic stem cell transplantation (HSCT) might provide a cure for primary cutaneous aggressive epidermotropic cytotoxic CD8-positive T-cell lymphoma (CD8+ PCAETL). We summarize published literature on this disease and present outcomes of 8 patients with CD8+ PCAETL treated at our institution. In our experience, allogeneic HSCT and the novel agents brentuximab and pralatrexate show substantial activity against this disease.
Source: Clinical Lymphoma, Myeloma and Leukemia - Category: Hematology Authors: Tags: Original Study Source Type: research
Several studies have suggested that hematopoietic stem cell transplant (HSCT) may provide a cure for Primary Cutaneous Aggressive Epidermotropic Cytotoxic CD8 positive T-Cell Lymphoma (CD8+ PCAETL). We summarize published literature on this disease and present outcomes of 8 patients with CD8+ PCAETL treated at our institution. In our experience, allogeneic HSCT and the novel agents brentuximab and pralatrexate demonstrate substantial activity against this disease.
Source: Clinical Lymphoma, Myeloma and Leukemia - Category: Hematology Authors: Source Type: research
Publication date: Available online 12 October 2017 Source:Clinical Lymphoma Myeloma and Leukemia Author(s): Jonathan E. Brammer, Dai Chihara, L. Michelle Poon, Paolo Caimi, Marcos de Lima, Celina Ledesma, Gabriela Rondon, Stefan O. Ciurea, Yago Nieto, Michele Fanale, Bouthaina Dabaja, Richard T. Maziarz, Richard E. Champlin, Chitra Hosing, Yasuhiro Oki
Source: Clinical Lymphoma Myeloma and Leukemia - Category: Cancer & Oncology Source Type: research
We present a cohort of primarily non-Asian patients with advanced stage and relapsed/refractory ENKL. Our results demonstrate that achievement of complete response (CR) is imperative at all stages of disease in order to attain long-term disease control. The SMILE regimen was effective in relapsed/refractory disease to achieve complete remission. Autologous stem cell transplant should be strongly considered in patients with advanced ENKL who achieved CR, whereas allo-SCT can be considered for select patients who have not attained a CR.
Source: Clinical Lymphoma, Myeloma and Leukemia - Category: Hematology Authors: Tags: Original Study Source Type: research
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