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  • 1
    ISSN: 1569-8041
    Keywords: BCL-2 ; follicular lymphoma ; minimal residual disease ; PCR ; prognostic factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:We have observed that molecular response, as definedby a PCR-negative status during the first year of therapy, along withβ2–microglobulin (β2M), was the most important variable associatedwith failure-free survival (FFS) in follicular lymphoma (FL). Herein, wepresent an update of the previously published MDACC series. Patients and methods:A total of 116 patients (male : female ratio64 : 52; median age: 52 years) with indolent FL andBCL-2rearrangement (at MBRor mcrbreakpoints) assessablein peripheral blood (pb) by PCR prior to treatment, and with two or more PCRdeterminations during the first year, were selected for the present study. Results:Of the 116 patients, 4 who presented with progression and1 who died of unrelated causes during the first year were excluded from thelandmark analysis. One hundred patients (86%) achieved clinical CR and80 (69%) achieved a negative PCR status within first year. Median FFSwas 6.4 years. Five-year FFS was 73% and 28% for molecularresponders and nonresponders, respectively (P = 0.001). In spite ofthis strikingly higher FFS favoring molecular responders, no clear-cutplateauwas evident in this group. Molecular response assessed in pb(P = 0.001) and serum β2M (P 〈 0.001) were the mostimportant factors to predict FFS in the multivariate analysis. In the subsetof patients with normal β2M and molecular CR, there was a trend for aplateau in the FFS curve. No significant difference between the groups hasbeen observed so far in terms of survival. Conclusions:Molecular response assessed in pb using a PCRtechnique is, along with β2M, the most important factor to predict FFS inFL.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1569-8041
    Keywords: aggressive lymphomas ; intermediate grade lymphomas ; CHOP ; ATT ; prognostic factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: CHOP is currently considered the gold standard of treatmentfor intermediate grade lymphomas. We designed a new regimen known as ’ATT‘(alternating triple therapy) which uses three non-cross resistantcombinations in alternating sequence for nine cycles. Materials and methods: This is a phase II clinical trial with comparisonto CHOP/CMED historical controls using prognostic factors. The tumor scoresystem was used to evaluate the results of this trial. Two hundredsixty-eight eligible patients who had one or more of the following adversefeatures: bulky disease, elevated LDH or 〉1 extranodal site wereanalyzed. Outcome measures consist of survival and failure free survival. Results: At a median follow-up of 32 months, there was no statisticallysignificant difference in survival for those with favorable prognosticfactors (tumor score ≤2). However, there was a statistically significantdifference in favor of ATT for those with unfavorable tumor scores. When weexamined the failure-free survival of those with unfavorable tumor scores,we again observed a superiority for the ATT regimen over CHOP/CMED but theopposite was true for those with favorable tumor scores. We also found astatistically significant difference in favor of the ATT regimen whencompared with CHOP/CMED for patients ≤60 years old with a tumor score≥3, while no advantage was found for those 〉60 years. Conclusions: ATT appears more effective but only for patients 〈60 yearsold with unfavorable tumor scores. In those older than 60 years with favorabletumor score, CHOP/CMED appears superior. ATT might be an adequate regimen foryoung patients with poor prognostic features while CHOP/CMED might be a betterchoice for those with good prognosis irrespective of age. For those 〉60years with unfavorable tumor scores neither ATT or CHOP/CMED were adequatetreatment. Because of the phase II nature of this study, these conclusionsshould be considered as hypotheses which require prospective testing.
    Type of Medium: Electronic Resource
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