LYMPHOID TUMORS

Non-Hodgkin’s Lymphomas in Children: 25-Year Clinical Experience

LYMPHOID TUMORS , , , , , ,

TT Valiev, AV Popa, AS Levashov, ES Belyaeva, NS Kulichkina, BV Kurdyukov, RS Ravshanova, GL Mentkevich

Scientific Research Institute of Pediatric Oncology and Hematology, NN Blokhin Russian Cancer Research Center, 24 Kashirskoye sh., Moscow, Russian Federation, 115478

For correspondence: Timur Teimurazovich Valiev, DSci, 24 Kashirskoye sh., Moscow, Russian Federation, 115478; Tel: +7(499)324-98-69; e-mail: timurvaliev@mail.ru

For citation: Valiev TT, Popa AV, Levashov AS, et al. Non-Hodgkin’s Lymphomas in Children: 25-Year Clinical Experience. Clinical oncohematology. 2016;9(4):420–37 (In Russ).

DOI: 10.21320/2500-2139-2016-9-4-420-437

ABSTRACT

Background & Aims. Current polychemotherapeutic protocols based on differentiated and risk-adopted approaches permitted to consider non-Hodgkin’s lymphomas (NHL) potentially curable diseases although they had been considered fatal previously. The aim of this study is to summarize and analyze outcomes of NHL therapy over a 25-year period.

Methods. 246 patients were enrolled in the study. They were treated in the department of chemotherapy of hemoblastoses in the Scientific Research Institute of Pediatric Oncology and Hematology under the NN Blokhin Russian Cancer Research Center over the period of 25 years: from April 1, 1991, till June 1, 2016. B-NHL-BFM 90/95 protocols and a modified B-NHL-BFM 95 protocol (with rituximab) were used for B-cell NHLs (n = 130). Patients with lymphocytic leukemia (n = 75) were treated using ALL-mBFM 90/95 and ALL IC-BFM 2002 protocols. 21 patients with anaplastic large cell lymphomas (ALCL) received treatment according to the B-NHL-BFM 90/95 protocol, and 20 patients received the НИИ ДОГ-АККЛ-2007 protocol.

Results. Taking into account clinical and immunological characteristics of ALCL, the authors invented an original НИИ ДОГ-АККЛ-2007 protocol. Special attention was paid to potential modification of standard treatment regimens for B-cell NHL by adding rituximab. The article demonstrates the evolution in prescription of rituximab for B-cell NHL and possibilities for reduction of the total number of polychemotherapy cycles for late-stage tumors without deterioration of treatment outcomes.

Conclusion. The obtained results permit to conclude that introduction of achievements of oncoimmunology, molecular biology, and cytogenetics will become the basis for further modification of existing treatment options for NHL.

Keywords: Burkitt lymphoma, diffuse large B-cell lymphoma, anaplastic large-cell lymphoma, primary mediastinal (thymic) large B-cell lymphoma, T- and B-cell lymphoblastic lymphomas, treatment, children.

Received: June 12, 2016

Accepted: June 17, 2016

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Plasma cell neoplasms in HIV-Infected Patients: A Literature Review and Case Series

LYMPHOID TUMORS , ,

RA Leigton2, AV Pivnik1, EP Sergeeva1, NV Kremneva1, OV Mukhin1

1AS Loginov Moscow Clinical Scientific Center, 86 Entuziastov sh., Moscow, Russian Federation, 111123

2Peoples’ Friendship University of Russia, 6 Miklukho-Maklaya str., Moscow, Russian Federation, 117198

For correspondence: Prof. Aleksandr Vasil’evich Pivnik, MD, PhD, 86 Entuziastov sh., Moscow, Russian Federation, 111123; Tel.: 8(495)304-30-39; e-mail: pivnikav@gmail.com

For citation: Leigton RA, Pivnik AV, Sergeeva EP, et al. Plasma cell neoplasms in HIV-Infected Patients: A Literature Review and Case Series. Clinical oncohematology. 2017;10(4):464–70 (In Russ).

DOI: 10.21320/2500-2139-2017-10-4-464-470

ABSTRACT

Aim. Analysis of 37 published and 2 author’s cases of multiple myeloma (MM) in HIV-positive patients.

Materials & Methods. Description of 37 patients and 2 author’s previously unpublished observations.

Results. The median age of patients was 37 years (66 in the general population), only 2 % being under 40 years. Abnormal MM progression was observed including the emergence of extramedullary lesions, low levels of M-gradient, and the development of plasmoblastic leukemia. Historically, before highly active antiretroviral therapy (HAART) was introduced, a rapid progression of MM with a short life expectancy was observed. HAART in combination with chemotherapy showed the best results of MM treatment in terms of overall and relapse-free survival. According to the literature data HAART may also be used to treat HIV-negative patients with MM. The cytological analysis of MM showed atypical myeloma cells with no lysozyme, leukocyte common antigen, CD19, and CD20. The CD38 was clearly identified. Anaplastic MM may be regarded as the first manifestation of AIDS. The author’s results were similar to the published data.

Conclusion. MM in HIV-infected patients in stage with secondary diseases is still considered to be not HIV-related. In HIV-positive MM patients on HAART overall and relapse-free survival rates were higher than that in HIV-negative patients with MM. The serum levels M-gradient was shown to decrease or even become indeterminate in MM patients receiving HAART for HIV infection. Thus, the HAART was proposed for MM HIV-negative patients.

Keywords: plasma cell neoplasms, HIV-infection in stage with secondary disease, HAART.

Received: April 7, 2017

Accepted: July 6, 2017

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The Comparison of De Novo Grade 3 Follicular Lymphoma and Transformed Grade 3 Follicular Lymphoma: Own Data

LYMPHOID TUMORS , , , ,

LV Plastinina, AM Kovrigina, TN Obukhova, ES Nesterova, AU Magomedova, YaK Mangasarova, AE Misyurina, FE Babaeva, SM Kulikov, AI Vorob’ev, SK Kravchenko

National Medical Hematology Research Center, 4 Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167

For correspondence: Lyubov’ Vasil’evna Plastinina, 4 Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167; Tel.: 8(495)612-23-61; e-mail: dr.plastinina@yandex.ru

For citation: Plastinina LV, Kovrigina AM, Obukhova TN, et al. The Comparison of De Novo Grade 3 Follicular Lymphoma and Transformed Grade 3 Follicular Lymphoma: Own Data. Clinical oncohematology. 2017;10(4):453–63 (In Russ).

DOI: 10.21320/2500-2139-2017-10-4-453-463

ABSTRACT

Background. Grade 3 follicular lymphoma (FL) is a heterogenetic group of tumors. The selections of patients with similar characteristics of the tumor process is important for classification 3 grade forms of FL and risk stratification, as well as for the development of new therapeutic approaches. Different morphological, immunohistochemical and cytogenetical characteristics of the tumor result in different clinical forms of the disease.

Aim. To describe the clinical, morphological, immunohistochemical and cytogenetical characteristics of grade 3 FL and evaluate their prognostic value for R-CHOP-21 chemotherapy.

Materials & Methods. We performed retrospective and prospective analysis of morphological, immunohistochemical and genetical characteristics of 93 primary patients with grade 3 FL (21–78 years, median 53 years, women to men — 1:1.4) admitted to National Medical Hematology Research Center from years 2001 to 2016. Morphological and immunohistochemical assessment of the affected lymph nodes and bone marrow biopsy material was performed. Data obtained from the standard cytogenetic and FISH assessment were compared to identify the BCL2 rearrangement.

Results. We proposed an algorithm for differential diagnosis of the 2 types of grade 3 FL: de novo FL (n = 22) and transformed FL (n = 21). De novo grade 3 FL had the immunophenotype of CD10– in 19 (86 %) cases, MUM1++ (monomorphically) in 19 (90 %), and BCL-2 in 5 (22 %). It was characterized by the absence of the BCL2 rearrangement (n = 22, 100 %) and bone marrow involvement (n = 14, 67 %) and/or bone marrow involvement (n = 7, 100 %). Third grade FL transformed from grades 1 or 2 had was CD10+ (n = 19, 90 %), MUM1+ (heterogeneously, n = 16, 76 %) or MUM1– (n = 4, 19 %), BCL-2+ (n = 20, 95 %) and had BCL2 rearrangement (n = 19, 90 %). Small cell bone marrow involvement was observed in 71 % of cases, whereas large cell involvement was seen predominantly in de novo FL (p = 0.06). The analysis showed that 5-year relapse-free survival in patients with grade 3 de novo FL after R-CHOP-21 therapy was 87 % compared to 16 % with transformed FL (p = 0.06) for the median 41 months of follow up.

Conclusion. We described the morphological, immunohistochemical and cytogenetical characteristics of grade 3 de novo FL and grade 3 FL, transformed from grades 1 or 2. The described variants show different sensitivity to immunochemotherapy.

Keywords: follicular lymphoma of the 3rd cytologic grade, de novo FL, transformed FL, histologic transformation, MUM1 expression.

Received: April 14, 2017

Accepted: July 23, 2017

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  3. Ковригина А.М., Пластинина Л.В., Кравченко С.К. и др. Диагностика фолликулярной лимфомы педиатрического типа у молодых взрослых (собственные данные). Клиническая онкогематология 2017;10(1):52–60. doi: 10.21320/2500-2139-2017-10-1-52-60.[Kovrigina AM, Plastinina LV, Kravchenko SK, et al. Diagnosis of Pediatric-Type Follicular Lymphoma in Young Adults (Own Data). Clinical Oncohematology. 2017;10(1):52–60. doi: 10.21320/2500-2139-2017-10-1-52-60. (In Russ)]
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First-Line Therapy for Patients with Advanced Hodgkin’s Lymphoma: Efficacy and Toxicity of Intensive ЕАСОРР-14 Program (NN Blokhin National Medical Cancer Research Center Data)

LYMPHOID TUMORS , ,

EA Demina1, AA Leont’eva1, GS Tumyan1, YuE Ryabukhina1, OP Trofimova1, NV Volkova1, YuI Pryamikova1, VM Sotnikov2, VB Larionova1, EG Medvedovskaya1, EV Paramonova1, LV Manzyuk1, NA Probatova1, NV Kokosadze1, EA Osmanov1

1NN Blokhin National Medical Cancer Research Center, 24 Kashirskoye sh., Moscow, Russian Federation, 115478

2Russian Scientific Center of Radiology and Nuclear Medicine, 86 Profsoyuznaya str., Moscow, Russian Federation, 117997

For correspondence: Prof. Elena Andreevna Demina, MD, PhD, 24 Kashirskoye sh., Moscow, Russian Federation, 115478; Tel.: +7(499)324-90-89; e-mail: drdemina@yandex.ru

For citation: Demina EA, Leont’eva AA, Tumyan GS, et al. First-Line Therapy for Patients with Advanced Hodgkin’s Lymphoma: Efficacy and Toxicity of Intensive ЕАСОРР-14 Program (NN Blokhin National Medical Cancer Research Center Data). Clinical oncohematology. 2017;10(4):443–52 (In Russ).

DOI: 10.21320/2500-2139-2017-10-4-443-452

ABSTRACT

Aim. To assess the efficacy and toxicity of intensive 6 courses EACOPP-14 treatment with or without radiotherapy (RT) for advanced stages of Hodgkin’s lymphoma (HL).

Materials & Methods. From November 2009 to February 2015, 95 patients with advanced stages of HL (IIX–IIE, III–IV) aged between 17 and 50 years (median 29 years) were selected for the participation in the protocol ЛХМосква1-3. The study population consisted of 46.3 % men and 53.7 % women. The results of the treatment were assessed in 91 patients who have received more than 2 courses of EACOPP-14. The follow up period was at least 3 months after the receiving the therapy. Consolidation RT with a total dose of 30 Gy for residual tumor lesions and/or initially large tumors was performed after the chemotherapy.

Results. Complete remission was achieved in 82 (90.1 %) patients, partial remission in 2 (2.2 %), and the progression was observed in 7 (7.7 %) patients. The overall 4-year survival rate was 90.8 %, the progression-free survival was 88.2 %. The toxicity of the ЕАСОРР-14 program was slightly lower than that of 8 courses of ВЕАСОРРesc, and was comparable to the toxicity of other modifications of intensified ВЕАСОРР scheme. Hematological toxicity grade 3 and 4 was most commonly observed: leukopenia was observed after 64.9 % of courses, anemia — after 24 % of courses, thrombocytopenia — after 3.8 % of courses. The rate of infections did not singificantly differ and accounted for 24 %. The most frequent non-infectious complications were mucositis (21.1 %) and polyneuropathy (11.7 %). Complications resulted in the change of treatment in only 3 (3.01 %) of patients. The exclusion of bleomycine from the ЕАСОРР-14 program reduced the frequency of RT complications. Grade 3 pulmonitis developed in 4.5 % of cases, while radiation-induce pulmonary fibrosis verified by CT developed in 15.2 % of cases. The ЕАСОРР-14 6 courses program showed its high efficacy both with and without RT, high tolerance and the possibility of full administration for the majority of patients with the various stages of HL.

Conclusion. Current research showed the efficacy of treatment without RT for patients with advanced stages of HL with negative PET results and small (< 2.5 cm) residual tumors after intensive ЕАСОРР-14 program. This approach allowed to avoid a number of late treatment complications.

Keywords: Hodgkin’s lymphoma, advanced stages, intensive first-line chemotherapy.

Received: March 10, 2017

Accepted: June 23, 2017

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REFERENCES

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Bortezomib Combination Therapy of Relapsed and Refractory Acute Lymphoblastic Leukemia in Children

LYMPHOID TUMORS , ,

NA Batmanova, MA Shervashidze, AV Popa, LYu Grivtsova, IN Serebryakova, GL Mentkevich

NN Blokhin Russian Cancer Research Center, 24 Kashirskoye sh., Moscow, Russian Federation, 115478

For correspondence: Natal’ya Andreevna Batmanova, 24 Kashirskoye sh., Moscow, Russian Federation, 115478; Tel.: +7(925)321-26-42; e-mail: Batmanova_nataly@mail.ru

For citation: Batmanova NА, Shervashidze MА, Popa АV, et al. Bortezomib Combination Therapy of Relapsed and Refractory Acute Lymphoblastic Leukemia in Children. Clinical oncohematology. 2017;10(3):381–9 (In Russ).

DOI: 10.21320/2500-2139-2017-10-3-381-389

ABSTRACT

Background & Aims. Despite significant success in the treatment of acute lymphoblastic leukemia (ALL) in children, relapses and drug resistance to the standard therapy remain the main cause of treatment failure. The addition of bortezomib to the combination therapy of relapsed ALL to change the sensitivity of blast cells may be a perspective approach to cure patients. The aim was to evaluate the efficacy and toxicity of the anti-relapse ALL treatment protocols REZ BFM 95/96 without bortezomib and COG AALL07P1 with bortezomib in relapsed and refractory ALL in children.

Materials & Methods. The study included 54 children with a confirmed ALL of various localizations. From 1995 to 2011, ALL REZ BFM 95/96 treatment without bortezomib was administered to 26 patients. From 2011 to 2016, 28 children received COG AALL07P1 combination treatment with bortezomib.

Results. The immediate treatment efficacy significantly higher in patients treated with bortezomib (85.7 % vs 57.6 %) after induction chemotherapy with the ALL REZ BFM 95/96. The analysis of the long-term outcomes (disease-free, event-free, overall survival) showed no significant differences between the groups. The event-free survival of patients with isolated bone marrow relapses for a period of 2 years was 20.3 ± 17.5 %. The tolerability of the program was acceptable, complications developing during myelosuppression were not associated with the administration of bortezomib.

Conclusion. The intensification of induction chemotherapy in recurrent remission according to COG AALL07P1 protocol with the addition of bortezomib allowed to increase the number of complete remissions including MRD negative ones.

Keywords: acute lymphoblastic leukemia, refractoriness, relapses, bortezomib.

Received: February 24, 2017

Accepted: May 2, 2017

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REFERENCES

  1. Менткевич Г.Л., Маякова С.А. Лейкозы у детей. М.: Практическая медицина, 2009. 346 с.
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  17. Messinger YH, Gaynon PS, Sposto R, et al. Bortezomib with chemotherapy is highly active in advanced B-precursor acute lymphoblastic leukemia: Therapeutic Advances in Childhood Leukemia & Lymphoma (TACL) Study. Blood. 2012;120(2):285–90. doi: 10.1182/blood-2012-04-418640.

 

Pomalidomide in Combination with Low-Dose Dexamethasone as the Treatment of “Double Refractory” Multiple Myeloma

LYMPHOID TUMORS , , ,

AV Petrov2, DV Motorin2, OS Pokrovskaya1, ES Urnova1, MV Nareiko1, DV Babenetskaya2, YuA Alekseeva2, LL Girshova2, LP Mendeleeva1, AYu Zaritskii2

1 Hematology Research Center, 4а Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167

2 Federal Almazov North-West Medical Research Centre, 2 Akkuratova str., Saint Petersburg, Russian Federation, 197341

For correspondence: Aleksei Vladilenovich Petrov, 2 Akkuratova str., Saint Petersburg, Russian Federation, 197341; Tel.:+7(921)317-28-02; e-mail: avlpetrov@mail.ru

For citation: Petrov AV, Motorin DV, Pokrovskaya OS, et al. Pomalidomide in Combination with Low-Dose Dexamethasone as the Treatment of “Double Refractory” Multiple Myeloma. Clinical oncohematology. 2017;10(3):372–80 (In Russ).

DOI: 10.21320/2500-2139-2017-10-3-372-380

ABSTRACT

Background. The development of radical therapy for multiple myeloma (MM) is still a pressing problem. This progressive disease requires repeated courses of therapy using drugs without cross-resistance. The prognosis of “double refractory” MM which is resistant to key antitumor drugs, first generation protease inhibitors and immunomodulating agents, remains poor. The median progression-free survival (PFS) and overall survival (OS) in this cohort of patients are 5 and 9 months, respectively.

Aim. The aim was to assess the effectiveness and tolerability of pomalidomide in combination with low-dose of dexamethasone in “double refractory” relapsed/refractory multiple myeloma (RRMM).

Materials & Methods. According to study protocol, 10 patients from Hematology Research Center and Federal Almazov North-West Medical Research Centre with RRMM were included in the period from September 2015 to July 2016. The median age was 62.5 years (range 48–76 years), and the median number of therapy lines was 4 (range 3–5). All patients had a disease progression after the administration of bortezomib, lenalidomide, and alkylating agents. In addition, 6 (60 %) of 10 patients received high-dose melphalan chemotherapy followed by auto-HSCT. The median number of therapy lines was 6 (range 4–15).

Results. The overall response rate was 60 % and the minimum response (stabilization of the disease) was observed in 40 % of patients (IMWG criteria). The median PFS was 7.8 months; OS in 18 months was observed in 70 % of cases (the median not achieved). Treatment-associated grade III–IV hematologic toxicity was observed in 2 patients (5 episodes). Non-hematological adverse events of grade III–IV included acute coronary syndrome, deep vein thrombosis, neuropathic pain, and in 1 case acute delusional disorder, which required discontinuation of the therapy. The presence of initial cytopenia and renal failure before therapy with pomalidomide did not require the dosage reduction or discontinuation of treatment.

Conclusion. Pomalidomide with low-dose dexamethasone demonstrated a high overall response rate an acceptable toxicity profile in patients with RRMM.

Keywords: multiple myeloma, “double-refractoriness”, immunomodulating agents, pomalidomide.

Received: January 24, 2017

Accepted: May 6, 2017

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  42. Richardson PG, Siegel DS, Vij R, et al. Pomalidomide alone or in combination with low-dose dexamethasone in relapsed and refractory multiple myeloma: a randomized Phase II study. Blood. 2014;123(12):1826–32. doi: 10.1182/blood-2013-11-538835.
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  44. Kumar S, Paiva B, Anderson K. International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol. 2016;17(8):e328–46. doi: 10.1016/S1470-2045(16)30206-6.

 

Treatment of Drug-Resistant Mycosis Fungoides and Sezary Syndrome

LYMPHOID TUMORS , , , ,

LG Gorenkova, EA Penskaya, SK Kravchenko, AM Kovrigina, TN Moiseeva, AI Vorob’ev

Hematology Research Center, 4а Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167

For correspondence: Liliya Gamilevna Gorenkova, PhD, 4а Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167; 8(495)612-23-61; e-mail: l.aitova@mail.ru

For citation: Gorenkova LG, Penskaya EA, Kravchenko SK, et al. Treatment of Drug-Resistant Mycosis Fungoides and Sezary Syndrome. Clinical oncohematology. 2017;10(3):366–71 (In Russ).

DOI: 10.21320/2500-2139-2017-10-3-366-371

ABSTRACT

Background. The most common diseases among cutaneous T-cell lymphomas are mycosis fungoides (MF) and its leukemic variant Sezary Syndrome (SS). These malignant tumors have a progressive character course. To date, no therapy for these diseases has proven effective, especially in the late stages of the disease.

Aim. We aimed to assess the effectiveness of treating resistant forms of MF/SS with prolonged gemcitabine regimen after initial treatment failure.

Materials & Methods. The study included 14 patients with drug-resistant forms of MF/SS (10 patients with MF, 3 patients with SS, and 1 patient with the transformation of MF into large cell lymphoma). The median age was 62 years (range 34–78 years). The study population included 9 males and 7 females. Gemcitabine was administered at a dosage of 250 mg/m2 as a 6–8 hour IV infusion weekly, in a cycle of 21–28 days.

Results. The overall response was 79 % (29 % of patients with complete remission, 50 % of patients with partial remission). In 21 % of patients, the treatment results met the criteria for tumor stabilization. The disease progression was observed in 2 (14 %) patients. This study demonstrates the potential of using prolonged gemcitabine regimen in patients of different age groups with advanced resistant MF/SS who received at least two courses of previous ineffective therapy. In order to evaluate long-term results, further research is needed.

Conclusion. The administration of prolonged gemcitabine regimen may be a treatment of choice in resistant forms of MF/SS after initial treatment failure in different age groups including elderly patients.

Keywords: mycosis fungoides, Sezary syndrome, treatment of drug-resistant forms, gemcitabine, prolonged infusion.

Received: December 6, 2016

Accepted: March 17, 2017

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REFERENCES

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  20. Sezer O, Eucker J, Jakob C, et al. Achievement of complete remission in refractory Hodgkin’s disease with prolonged infusion of gemcitabine. Invest New Drugs. 2001;19(1):101–4.
  21. Российские клинические рекомендации по диагностике и лечению лимфопролиферативных заболеваний. Под ред. И.В. Поддубной, В.Г. Савченко. М.: Буки Веди, 2016. С. 85–91.
    [Poddubnaya IV, Savchenko VG, eds. Rossiiskie klinicheskie rekomendatsii po diagnostike i lecheniyu limfoproliferativnykh zabolevanii. (Russian clinical guidelines in diagnosis and treatment of lymphoproliferative disorders). Moscow: Buki Vedi Publ.; 2016. pp. 85–91. (In Russ)]
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The IVDG Regimen is the Possible Treatment of Choice as First Line Therapy For Hodgkin’s Lymphoma in Elderly Patients with Cardiovascular and Pulmonary Comorbidity

LYMPHOID TUMORS , , ,

KD Kaplanov1,2,3, TYu Klitochenko1,3, AL Shipaeva1, MN Shirokova1, IV Matveeva1, NB Lavrishina1

1 Volgograd Regional Clinical Oncology Dispensary, 78 Zemlyachki str., Volgograd, Russian Federation, 400138

2 Volgograd Medical Research Center, 1 Pavshikh Bortsov pl., Volgograd, Russian Federation, 400131

3 Volgograd State Medical University, 1 Pavshikh Bortsov pl., Volgograd, Russian Federation, 400131

For correspondence: Kamil’ Daniyalovich Kaplanov, PhD, 78 Zemlyachki str., Volgograd, Russian Federation, 400138; e-mail: kamilos@mail.ru

For citation: Kaplanov KD, Klitochenko TYu, Shipaeva АL, et al. The IVDG Regimen is the Possible Treatment of Choice as First Line Therapy For Hodgkin’s Lymphoma in Elderly Patients with Cardiovascular and Pulmonary Comorbidity. Clinical oncohematology. 2017;10(3):358–65 (In Russ).

DOI: 10.21320/2500-2139-2017-10-3-358-365

ABSTRACT

Background. Among the newly diagnosed patients with Hodgkin’s lymphoma (HL), the proportion of elderly patients account for 15–35 %. In > 60 age group the choice of antitumor treatment requires an more individualised approach compared to a younger population. The ABVD regimen is acceptable in terms of efficiency and hematological toxicity, but is associated with a high risk of bleomycine-induced pulmonary complications. In ≥ 60 age group the morbitity and mortality of pulmonary complications account for 24 % and 18 %, respectively.

Aim. We aimed to evaluate the efficacy of the IVDG regimen in comparison with ABVD by the principle of “non-inferiority”.

Materials & Methods. This single centre, prospective, controlled, randomised study was started in 2009. The study included all primary patients aged ≥ 60 years with verified HL, regardless of the number and severity of comorbidities. The ABVD regimen was administered in 17 patients, and 20 patients received IVDG. The median age in the ABVD and IVDG groups was 67 and 70 years, respectively. The advanced stages of HL were reported in 13 (65 %) patients on IVDG, and in 12 (71 %) patients on ABVD (p = 0.9). Both of the groups were comparable in terms of the prevalence of chronic heart failure and chronic obstructive pulmonary disease. The prevalence of ischemic heart disease was higher in the IVDG group (n = 16) compared to ABVD (n = 8) (p = 0.04).

Results. IVDG and ABVD groups did not differ in the frequency of complete (14 and 10) and partial (3 and 4) remissions. Differences in 5-year overall survival were insignificant: 49 % in the IVDG group, vs 22 % in ABVD group (p = 0.41). No infectious or hemorrhagic complications were observed in both groups. The incidence of drug-induced pulmonary fibrosis after treatment was significantly lower in the IVDG group (n = 0) vs ABVD group (n = 4; 24 %) (p = 0.004).

Conclusion. The IVDG regimen may be used as first line treatment for HL in the elderly patients, especially in those having cardiac or pulmonary comorbidities. Compared to ABVD the IVDG regimen had similar efficacy and more beneficial safety profile in terms of cardiovascular and pulmonary toxicity.

Keywords: Hodgkin’s lymphoma, elderly patients, comorbidity, chemotherapy.

Received: December 22, 2016

Accepted: March 5, 2017

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Effect of Patients’ Endocrine Status on Effectiveness of Treatment with Rituximab: State of the Art

LYMPHOID TUMORS , , , ,

YuV Komoza1, VA Komoza1, SV Chernavskii2, OA Rukavitsyn2

1 Bryansk Regional Oncology Dispensary, 96 Stanke Dimitrova pr-t, Bryansk, Russian Federation, 241033

2 Academician NN Burdenko Principal Military Clinical Hospital under the Ministry of Defence of the Russian Federation, 3 Gospital’naya pl., Moscow, Russian Federation, 105229

For correspondence: Yuliya Valer’evna Komoza, 96 Stanke Dimitrova pr-t, Bryansk, Russian Federation, 241033; e-mail: smile-32@mail.ru

For citation: Komoza YuV, Komoza VA, Chernavskii SV, Rukavitsyn OA. Effect of Patients’ Endocrine Status on Effectiveness of Treatment with Rituximab: State of the Art. Clinical oncohematology. 2017;10(2):187–90 (In Russ).

DOI: 10.21320/2500-2139-2017-10-2-187-190

ABSTRACT

The non-Hodgkin’s lymphoma morbidity rate is gradually increasing, and its peak is registered in patients aged 45–60 years. At the same time, the world population steadily becomes older. Monoclonal antibodies (Rituximab) have been used in the treatment of patients with CD20-positive lymphomas for more than 20 years. The use of this drug enhanced the effectiveness of the therapy significantly. However, when patients were divided into groups by age and sex, better results were obtained in the group of women over 60 years. The review presents the results of several studies which have analyzed the effectiveness of rituximab-based schemes in patients depending on their sex and age, using different dosages and administration regimens. The article also presents our personal conclusions about the possible causes of the differences in efficacy of the drug in some patient populations. Identification of the causes contributing to the improvement of the effectiveness of rituximab in elderly women may significantly change approaches to the treatment of lymphomas in patients of both sexes.

Keywords: non-Hodgkin’s lymphoma, rituximab, lymphoma therapy effectiveness, gender differences, age differences.

Received: November 30, 2016

Accepted: January 17, 2017

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Prognostic and Differential Diagnostic Value of Standardized Uptake Volume (SUV) of Fluorodeoxyglucose in Patients with Hodgkin’s Lymphoma

LYMPHOID TUMORS , ,

AA Rukavitsyn, SI Kurbanov, OA Rukavitsyn

Academician NN Burdenko Principal Military Clinical Hospital under the Ministry of Defence of the Russian Federation, 3 Gospital’naya pl., Moscow, Russian Federation, 105229

For correspondence: Anatolii Anatol’evich Rukavitsyn, 3 Gospital’naya pl., Moscow, Russian Federation, 105229; Tel: +7(499)263-53-17; e-mail: rukavitsin46@gmail.com

For citation: Rukavitsyn AA, Kurbanov SI, Rukavitsyn OA. Prognostic and Differential Diagnostic Value of Standardized Uptake Volume (SUV) of Fluorodeoxyglucose in Patients with Hodgkin’s Lymphoma. Clinical oncohematology. 2017;10(2):182–6 (In Russ).

DOI: 10.21320/2500-2139-2017-10-2-182-186

ABSTRACT

Background & Aims. Hodgkin’s lymphoma (HL) is still considered one of the most curable oncohematological diseases of lymphoid tissue. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) combined with multispiral computed tomography (CT) is one of precise and easily available methods of imaging of lymphoid neoplasia. The aim is to determine the correlation between the standardized uptake volume (SUV) of 18F-FDG and results of the first-line anti-tumor treatment of HL patients; to evaluate the possibility of differential diagnosis between HL and diffuse large B-cell lymphomas (DLBCL) based on SUV.

Materials & Methods. 76 patients (69 men and 7 women) aged from 19 to 75 years (median age 36.7 years) with DLBCL (n = 22) and HL (n = 54) were retrospectively enrolled in the study. The diseases were diagnosed over the period from 2011 until 2015. A combined PET-CT imaging was performed for the disease staging.

Results. The comparison of median SUVs in patients with HL (n = 54) and DLBCL (n = 22) demonstrated that the difference had a very high level of significance (p < 0.001). HL patients demonstrated a significantly lower 18F-FDG SUV than DLBCL patients. The analysis of PET findings demonstrated a correlation between the chosen treatment option for the lymphoma and the SUV level (p < 0.001). HL patients demonstrated an insignificant negative correlation between the SUV level rise and the treatment outcome (p = 0.2).

Conclusion. The SUV level does not affect the treatment outcomes of HL patients according to the ABVD protocol, as well as the metabolic response rate and tumor mass reduction. However, the SUV levels significantly differ in patients with HL and DLBCL. These data may be used as additional criteria for differential diagnosis of HL and DLBCL.

Keywords: SUV, PET-CT, Hodgkin’s lymphoma, DLBCL.

Received: November 21, 2016

Accepted: January 23, 2017

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