Anne Ortved Gang

Role of routine imaging in detecting recurrent lymphoma; a review of 258 patients with relapsed aggressive non-Hodgkin and Hodgkin lymphoma

After first‐line therapy, patients with Hodgkin lymphoma (HL) and aggressive non‐HL are followed up closely for early signs of relapse. The current follow‐up practice with frequent use of surveillance imaging is highly controversial and warrants a critical evaluation. Therefore, a retrospective multicenter study of relapsed HL and aggressive non‐HL (nodal T‐cell and diffuse large B‐cell lymphomas) was conducted. All included patients had been diagnosed during the period 2002–2011 and relapsed after achieving complete remission on first‐line therapy. Characteristics and outcome of imaging‐detected relapses were compared with other relapses. A total of 258 patients with recurrent lymphoma were included in the study. Relapse investigations were initiated outside preplanned visits in 52% of the patients. Relapse detection could be attributed to patient‐reported symptoms alone or in combination with abnormal blood tests or physical examination in 64% of the patients. Routine imaging prompted relapse investigations in 27% of the patients. The estimated number of routine scans per relapse was 91–255 depending on the lymphoma subtype. Patients with imaging‐detected relapse had lower disease burden (P = 0.045) and reduced risk of death following relapse (hazard ratio = 0.62, P = 0.02 in multivariate analysis). Patient‐reported symptoms are still the most common factor for detecting lymphoma relapse and the high number of scans per relapse calls for improved criteria for use of surveillance imaging. However, imaging‐detected relapse was associated with lower disease burden and a possible survival advantage. The future role of routine surveillance imaging should be defined in a randomized trial. Am. J. Hematol. 89:575–580, 2014.

R-CHOEP-14 improves overall survival in young high-risk patients with diffuse large B-cell lymphoma compared with R-CHOP-14. A population-based investigation from the Danish Lymphoma Group

BACKGROUND Optimal treatment of young patients with high-risk diffuse large B-cell lymphoma (DLBCL) remains a matter of debate and requires improvement. The combination chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) with addition of etoposide (CHOEP) has in other patient groups been shown to be effective. Further improvement has been accomplished with the use of rituximab in combination with the regimens every 2 weeks (R-CHOP-14, R-CHOEP-14). The aim of the present retrospective population-based study was to compare R-CHOP-14 with R-CHOEP-14 in a cohort of high-risk patients aged 18-60 years with two or more risk factors (stage III-IV, elevated lactate dehydrogenase levels, performance status 2-4). To our knowledge, this is the first study comparing these two regimens in this patient group. METHODS We obtained data for the period 2004-2009 from the Danish Lymphoma Database. One hundred and fifty-nine patients were eligible to enter the study. Primary end point was overall survival (OS) and secondary end points were response to treatment, progression-free survival (PFS) and safety. RESULTS Four-year OS was superior in the R-CHOEP-14 group: 75% compared with 62% for R-CHOP-14 (P = 0.04). This superiority was also seen for PFS: 4-year PFS was 70% for the R-CHOEP-14 group compared with 58% for the R-CHOP-14 group (P = 0.02). CONCLUSIONS R-CHOEP-14 is a promising regimen for young patients with high-risk DLBCL with improved OS and PFS compared with R-CHOP-14.BACKGROUND Optimal treatment of young patients with high-risk diffuse large B-cell lymphoma (DLBCL) remains a matter of debate and requires improvement. The combination chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) with addition of etoposide (CHOEP) has in other patient groups been shown to be effective. Further improvement has been accomplished with the use of rituximab in combination with the regimens every 2 weeks (R-CHOP-14, R-CHOEP-14). The aim of the present retrospective population-based study was to compare R-CHOP-14 with R-CHOEP-14 in a cohort of high-risk patients aged 18-60 years with two or more risk factors (stage III-IV, elevated lactate dehydrogenase levels, performance status 2-4). To our knowledge, this is the first study comparing these two regimens in this patient group. METHODS We obtained data for the period 2004-2009 from the Danish Lymphoma Database. One hundred and fifty-nine patients were eligible to enter the study. Primary end point was overall survival (OS) and secondary end points were response to treatment, progression-free survival (PFS) and safety. RESULTS Four-year OS was superior in the R-CHOEP-14 group: 75% compared with 62% for R-CHOP-14 (P=0.04). This superiority was also seen for PFS: 4-year PFS was 70% for the R-CHOEP-14 group compared with 58% for the R-CHOP-14 group (P=0.02). CONCLUSION R-CHOEP-14 is a promising regimen for young patients with high-risk DLBCL with improved OS and PFS compared with R-CHOP-14.

Utility of interim and end-of-treatment PET/CT in peripheral T-cell lymphomas: A review of 124 patients

According to the updated guidelines for imaging in lymphoma, 18F‐FDG positron emission tomography/computed tomography (PET/CT) is recommended for staging and evaluation of treatment response in FDG‐avid lymphomas. The purpose of the study was to evaluate the utility of PET/CT in nodal peripheral T‐cell lymphomas (PTCL). Patients with newly diagnosed nodal PTCL (peripheral T‐cell lymphoma NOS, anaplastic large‐cell lymphoma, or angioimmunoblastic T‐cell lymphoma) seen at five Danish hematology centers during the period 2006 to 2012 were included, if they had been pretherapeutically staged with PET/CT. Medical records were reviewed for baseline clinical and follow‐up information. Staging, interim (I‐PET), and end‐of‐treatment PET/CT (E‐PET) studies were centrally reviewed, and reported using the Deauville 5‐point score (DS). A total of 124 patients fulfilled the inclusion criteria. The median age was 58 years, and 88% received CHOP/CHOP‐like therapy. Five years PFS and OS of the study population was 36.8% (95% CI 27.3–46.4) and 49.7% (95% CI 38.9–59.6), respectively. The presence of PET/CT‐ascertained lung and/or liver involvement was associated with a worse outcome. The sensitivity of PET/CT for detecting biopsy‐defined bone marrow involvement was only 18% (95% CI 4–43). An interim DS >3 was not prognostic for worse OS and PFS among CHOP/CHOP‐like treated patients in uni‐ or multivariate analyses. A DS >3 after treatment predicted a worse prognosis. In conclusion, I‐PET was not predictive of outcome in CHOP/CHOP‐like treated PTCL patients when using the DS. Prospective studies are needed to determine the optimal use of PET/CT in PTCL including the role of quantitative PET/CT analysis. Am. J. Hematol. 90:975–980, 2015.

Overexpression of c-myc is associated with adverse clinical features and worse overall survival in multiple myeloma

Abstract The role of c-myc in multiple myeloma (MM) is controversial. We conducted a retrospective study of 117 patients with MM diagnosed between 2004 and 2010 at Herlev Hospital. Immunohistochemistry (IHC) and fluorescent in situ hybridization (FISH) were performed on tissue microarrays (TMAs) made from diagnostic bone marrow aspirates. Clinical data were obtained from the Danish Multiple Myeloma Database (DMMD). Overexpression of c-myc was found in 40% of patients. MYC translocation was found in 10% of patients. Overexpression of c-myc was not associated with MYC translocation. Overexpression of c-myc was associated with hypercalcemia (p = 0.02) and extramedullary myeloma (p < 0.01). Overexpression of c-myc was associated with shorter overall survival (OS) by multivariable analysis of the entire patient cohort [HR 1.92 (1.06–3.45), p = 0.03] and univariable analysis of high-dose-therapy (HDT)-ineligible patients [HR 2.01 (1.05–3.86), p = 0.04]. Further studies of c-myc overexpression in larger cohorts of patients with MM are warranted.

Little value of surveillance magnetic resonance imaging for primary CNS lymphomas in first remission: results from a Danish Multicentre Study

Keywords: Primary CNS lymphoma; Relapse; follow-up; magnetic resonance imaging; surveillance imaging

Utility of interim and end-of-treatment PET/CT in peripheral T-cell lymphomas: A review of 124 patients: PET/CT in Nodal Peripheral T-Cell Lymphomas

According to the updated guidelines for imaging in lymphoma, 18F‐FDG positron emission tomography/computed tomography (PET/CT) is recommended for staging and evaluation of treatment response in FDG‐avid lymphomas. The purpose of the study was to evaluate the utility of PET/CT in nodal peripheral T‐cell lymphomas (PTCL). Patients with newly diagnosed nodal PTCL (peripheral T‐cell lymphoma NOS, anaplastic large‐cell lymphoma, or angioimmunoblastic T‐cell lymphoma) seen at five Danish hematology centers during the period 2006 to 2012 were included, if they had been pretherapeutically staged with PET/CT. Medical records were reviewed for baseline clinical and follow‐up information. Staging, interim (I‐PET), and end‐of‐treatment PET/CT (E‐PET) studies were centrally reviewed, and reported using the Deauville 5‐point score (DS). A total of 124 patients fulfilled the inclusion criteria. The median age was 58 years, and 88% received CHOP/CHOP‐like therapy. Five years PFS and OS of the study population was 36.8% (95% CI 27.3–46.4) and 49.7% (95% CI 38.9–59.6), respectively. The presence of PET/CT‐ascertained lung and/or liver involvement was associated with a worse outcome. The sensitivity of PET/CT for detecting biopsy‐defined bone marrow involvement was only 18% (95% CI 4–43). An interim DS >3 was not prognostic for worse OS and PFS among CHOP/CHOP‐like treated patients in uni‐ or multivariate analyses. A DS >3 after treatment predicted a worse prognosis. In conclusion, I‐PET was not predictive of outcome in CHOP/CHOP‐like treated PTCL patients when using the DS. Prospective studies are needed to determine the optimal use of PET/CT in PTCL including the role of quantitative PET/CT analysis. Am. J. Hematol. 90:975–980, 2015.

Utility of interim and end-of-treatment PET/CT in peripheral T-cell lymphomas

According to the updated guidelines for imaging in lymphoma, 18F‐FDG positron emission tomography/computed tomography (PET/CT) is recommended for staging and evaluation of treatment response in FDG‐avid lymphomas. The purpose of the study was to evaluate the utility of PET/CT in nodal peripheral T‐cell lymphomas (PTCL). Patients with newly diagnosed nodal PTCL (peripheral T‐cell lymphoma NOS, anaplastic large‐cell lymphoma, or angioimmunoblastic T‐cell lymphoma) seen at five Danish hematology centers during the period 2006 to 2012 were included, if they had been pretherapeutically staged with PET/CT. Medical records were reviewed for baseline clinical and follow‐up information. Staging, interim (I‐PET), and end‐of‐treatment PET/CT (E‐PET) studies were centrally reviewed, and reported using the Deauville 5‐point score (DS). A total of 124 patients fulfilled the inclusion criteria. The median age was 58 years, and 88% received CHOP/CHOP‐like therapy. Five years PFS and OS of the study population was 36.8% (95% CI 27.3–46.4) and 49.7% (95% CI 38.9–59.6), respectively. The presence of PET/CT‐ascertained lung and/or liver involvement was associated with a worse outcome. The sensitivity of PET/CT for detecting biopsy‐defined bone marrow involvement was only 18% (95% CI 4–43). An interim DS >3 was not prognostic for worse OS and PFS among CHOP/CHOP‐like treated patients in uni‐ or multivariate analyses. A DS >3 after treatment predicted a worse prognosis. In conclusion, I‐PET was not predictive of outcome in CHOP/CHOP‐like treated PTCL patients when using the DS. Prospective studies are needed to determine the optimal use of PET/CT in PTCL including the role of quantitative PET/CT analysis. Am. J. Hematol. 90:975–980, 2015.