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Individualized liposomal doxorubicin-based treatment in elderly patients with non-Hodgkin's lymphoma.

Background: We retrospectively evaluated the efficacy and safety of individualized liposomal doxorubicin-based treatment in elderly patients with non-Hodgkin’s lymphoma and poor general health. Patients and Methods: 22 patients (median age 83.5 years) were treated with liposomal doxorubicin combined with CHOP-based chemotherapy (cyclophosphamide, doxorubicin, vincristine, prednisone) or other individualized doxorubicin-based treatments including liposomal doxorubicin combined with rituximab. Efficacy and adverse reactions were measured. Results: Patients received a total of 80 courses of chemotherapy (mean dose 143.6 mg/patient liposomal doxorubicin). The numbers of patients achieving complete remission, uncertain complete remission, partial remission, stable disease, or progressive disease were 10 (45.5%), 4 (18.2%), 4 (18.2%), 1 (4.5%), and 3 (13.6%), respectively. The most frequently reported adverse reaction was bone marrow suppression. No serious infections were reported. 3 (13.6%) patients showed skin changes. None experienced congestive heart failure or acute myocardial infarction. There were no chemotherapyrelated deaths. Overall survival rates at 1, 3, and 5 years were 81.8, 59.1, and 40.9%, and progression-free survival rates were 83.3, 66.7, and 54.5%. Conclusions: Individualized liposomal doxorubicin-based chemotherapy is effective and safe for elderly patients with non-Hodgkin’s lymphoma.

Successful treatment with low-dose decitabine in acute myelogenous leukemia in elderly patients over 80 years old: Five case reports

The incidence of acute myelogenous leukemia (AML) in patients over 80 years old is >20 times greater than that observed in younger patients. Previously, no standard treatment protocol for elderly patients with AML existed, however the development of hypomethylating agents, including decitabine, has brought about promising results in AML. In the present study, we report on the usage of a lower than routine dosage of decitabine in patients over 80 years old with AML. Since January 2010, 5 patients diagnosed with AML over the age of 80 years old received treatment with decitabine in our hospital. Decitabine was administered at a dose of 10–15 mg/m2 and repeated every other day for a total of 5 days. This cycle was repeated for ∼6 weeks. The 5 patients received a total of 19 cycles of treatment with decitabine. No patient achieved complete or partial remission. An antileukemic effect was observed in 25% of courses (3/12). An increase in platelet count of >20×109/l was observed in 26.3% (5/19) of cycles compared with previous treatment. An increase in hemoglobin concentration of >20 g/l was observed in 36.8% (7/19) of cycles in comparison to previous treatment, four of which achieved normal hemoglobin levels. One patient became red blood cell transfusion-independent. The median survival time was 19.8±4.8 months. Survival time from decitabine administration to mortality was 13.2±5.1 months. The main side-effect was bone marrow suppression with grade III–IV thrombocytopenia, grade III–IV leukocytopenia, grade III–IV neutropenia and anemia accounting for 94.7% (18/19), 47.4% (9/19), 89.5% (17/19) and 21.1% (4/19), respectively. Severe infection or bleeding was not observed and no patient stopped treatment due to adverse effects. In conclusion, extremely low-dose decitabine may be used safely in elderly patients and achieved longer survival times than reported previously in AML patients aged 80 and above. It is suggested that complete remission may not be the primary objective, while improvement of quality of life may be a better choice in AML patients over 80 years old. The cases observed in our study were limited, so more cases are required for further study.

Individualized fludarabine-based regimen in elderly patients with chronic lymphocytic leukemia/small lymphocytic lymphoma.

IntroductionThe aim of this study was to investigate the efficacy and safety of a fludarabine-based individualized regimen in elderly patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL).MethodsSixteen patients were treated with the individual regimen of fludarabine combined with rituximab. Adverse reactions and efficacy of treatment were observed.ResultsSixteen patients received a total of 69 courses of immunochemotherapy, with an average administration of 275 mg fludarabine per person. The overall response rate was 81.3% (13/16), in which seven cases (43.8%) achieved complete remission, six cases (37.5%) achieved partial remission, two cases (12.5%) had stable disease, and one case (6.3%) developed disease progression. The most frequent side effect was myelosuppression. Two patients experienced grade 3–4 cytopenia, one case developed a grade 3 infection, and no treatment-related death was observed.ConclusionThe individual regimen of fludarabine combined with rituximab demonstrated marked clinical efficacy and acceptable toxicity in elderly patients with CLL/SLL.

Recombinant human thrombopoietin alleviates infection-associated thrombocytopenia: a retrospective study in senile patients.

Objective: To examine the efficacy and adverse events of recombinant human thrombopoietin (rhTPO) in the treatment of infection-associated thrombocytopenia in senile patients. Methods: The current study is a retrospective analysis of the patients receiving rhTPO for infection-associated thrombocytopenia in our hospital. Results: Forty-nine cases were included in the analysis as rhTPO group. The absolute platelet count after treatment, increase in platelet count, and the overall response rate were considerably higher in the rhTPO group than that in the control group. Improvement in bleeding score was higher in the rhTPO treatment group than that in the control group (2.1 ± 5.4 vs 0.4 ± 1.7). Bleeding event was stopped in 68.2% of the patients after rhTPO treatment and in 35% of the patients in the control group (P = .032). A stratified analysis indicated that the therapeutic efficacy is much better in patients without organ failure. Conclusion: Recombinant human TPO is effective in alleviating infection-associated thrombocytopenia and hemorrhage in senile patients, particularly if given prior to the emergence of organ failure.

Treatment for orbital diffuse large B-cell lymphoma in an elderly patient by autologous cytokine-induced killer cells

Dear Editor, Ocular adnexal lymphomas (OALs) are largely represented by extranodal marginal zone lymphomas, about 10% are diffuse large B-cell lymphomas (DLBCLs) [1, 2]. The prognosis of DLBCL worsens with age. Therefore, the treatment must be tailored to the condition of the individual elderly patient. Autologous cytokine-induced killer (CIK) cells have been shown to be effective in the treatment of cancer and minimal residual diseases. Here, we report on CIK cells treatment in an elderly orbital DLBCL patient. In May 2009, an 89-year-old patient was admitted to the department of ophthalmology because of a mass in his right eye for 2 months without any other symptoms. After the mass was partly exsected, histopathological diagnosis was DLBCL of the right orbit and immunohistochemical analyses showed CD20+++/MUM-1+/bcl-6+/CD10-/ CD5-/CD3-/Cyclin D1-. In July 2009, the patient was referred to our department for further therapy. A detailed examination showed a possible involvement of the upper pole of the left kidney, extensive enlargement of the lymph nodes, and splenomegaly. He was determined to be stage IV. Because of his age, severe pulmonary and cardiac comorbidities, rituximab was used as the principal therapy. Rituximab was given at a dose of 600 mg once a week for 2 weeks from July 31, 2009, after he signed the informed consent. Twenty days later, the regimen of R-COP (rituximab 0.6 g d1, CTX 0.6 g d3, VDS 2 mg d3, Dex 10 mg d3, Dex 7.5 mg d4-7) was given; the orbital mass, possible involvement of left kidney, and lymph nodes all became smaller, and a partial remission was obtained. But the patient refused to use rituximab and chemotherapy because of some cardiac adverse effects. After this, he received 5 cycles of CIK cells infusion. The first cycle of CIK cell infusion was on October 29, 2009. It had been 2 months from the end of R-COP chemotherapy to the beginning of CIK treatment. His orbital lymphoma and possible involvement of the kidney disappeared after the second cycle of CIK infusion (see Fig. 1). PET showed complete remission on January 25, 2010. The last one was on July 23, 2010. At the end of treatment, enlarged lymph nodes of CT became normal. The side effects of CIK cells treatment were minor. Presently, 20 months after diagnosis, the patient lives well and continues in complete remission. Ocular DLBCL is an uncommon disorder of OALs, rituximab with CHOP has shown good efficacy in treating DLBCL. However, the tolerance is poor for many elderly patients. CIK cells are T lymphocytes that are enriched with CD3CD56 cells, which can be easily and rapidly expanded in vitro from human peripheral blood. It is a promising new treatment that has the potential to kill a wide spectrum of tumor cells, especially malignant hematological diseases [3–6]. The peripheral blood mononuclear cells were isolated and primed with anti-CD3 monoclonal antibody, interferon-γ, interleukin (IL)-2, and IL-1. After 14 days of culture, the immunophenotype and survival rate of the CIK cells were determined with a flow cytometer, then CIK cells were transfused. One course of the therapy was defined as follows: about 2–3×10 of CIK cells (survival rate >95%) were transfused twice, then rhIL-2 S.-X. Li :H.-L. Zhu (*) :B. Guo :X.-C. Lu : B. Yang :Y. Liu : S.-Q. Yao Department of Geriatric Hematology, Chinese People’s Liberation Army General Hospital, Beijing 100853, China e-mail: bjzhuhl301@vip.sina.com