Selin Berk

Primary Gastric Lymphoma: Conservative Treatment Modality Is Not Inferior to Surgery for Early-Stage Disease

Objectives. The aim of this study was to evaluate clinical characteristics, prognostic factors, survival rates, and treatment modalities in patients with primary gastric lymphoma (PGL). Methods. We retrospectively reviewed and analyzed data from patients treated for PGL in our clinic from 1998 through 2010. Staging was performed using the Lugano Staging System. Overall and disease-free survival (OS and DFS) were calculated from the date of diagnosis. Results. We identified 79 patients. Thirty-seven patients (47%) were male. The median age at presentation was 57 (18–85) years. The median follow-up time was 41 (9–52) months. Thirty patients (38%) underwent surgery, 74 (92%) received chemotherapy, and 18 (23%) received radiotherapy. The five-year OS and DFS rates were 91.2% and 83.9%, respectively, in patients with stage I/II or IIE disease and 70.6% and 65.5%, respectively, in patients with stage IV disease (P = 0.02 for both rates). Treatment modality (surgical or conservative) had no impact on OS or DFS in early stages. In a multivariate analysis, poor performance status, advanced stage, and high LDH levels were significant bad prognostic factors for DFS, while advanced stage, poor performance status, and age > 60 years were significant bad prognostic factors for OS. Conclusion. Surgery provides no advantage for survival over conservative treatment; thus, conservative treatment modalities should be preferred initially at early stages of PGL.

Comparison of International Prognostic Index and NCCN-IPI in 324 patients with de novo diffuse large B-cell lymphoma: a multi-center retrospective analysis.

Erman Öztürk, Murat Özbalak, Selin Berk, Işıl Erdoğan, Emin Avşar, Anıl Dolgun, Mustafa Çetiner, Nil Molinas Mandel, Fevzi Fırat Yalnız, Tuğrul Elverdi, Ayşe Salihoğlu, Ahmet Emre Eşkazan Muhlis Cem Ar, Şeniz Öngören, Zafer Başlar, Yıldız Aydın, Teoman Soysal & Burhan Ferhanoğlu Division of Hematology, Department of Internal Medicine, Koç University, School of Medicine, Istanbul, Division of Hematology, Department of Internal Medicine, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Division of Oncology, V.K.V. American Hospital, Istanbul, Department of Biostatstics, Hacettepe University, Ankara, and Division of Oncology, Department of Internal Medicine, Koç University, School of Medicine, Istanbul, Turkey

Outcomes of Chronic Myeloid Leukemia Patients With Early Molecular Response at 3 and 6 Months: A Comparative Analysis of Generic Imatinib and Glivec

Micro‐Abstract We retrospectively evaluated 90 patients with chronic myeloid leukemia receiving either upfront original imatinib (OI) or generic imatinib (GI) for the effect of the early molecular response on the long‐term outcome. We demonstrated that achieving an optimal response at 3 and 6 months in patients receiving either first‐line GI or OI was clearly associated with greater response and event‐free survival rates. Background: The molecular response at 3 months of the original imatinib (OI) in patients with chronic myeloid leukemia has prognostic significance; however, this has never been tested for generic imatinib (GI). Patients and Methods: We evaluated the BCR‐ABL1 [international reporting scale (IS)] transcript levels at 3 and 6 months to determine whether an early molecular response (EMR) had a prognostic effect on the outcome among chronic myeloid leukemia patients receiving GI. Ninety patients were divided into 2 groups, according to the imatinib they received, as OI (group A) and GI (group B). Results: Two groups were equally balanced for age, gender, Sokal risk score, and optimal response. The 2 groups did not differ in achieving an EMR at 3 months, and patients with EMR at 3 months had significantly superior complete cytogenetic response and major molecular response rates compared with patients who did not achieve an EMR in both groups. The percentage of an optimal response [BCR‐ABL1 (IS), < 1%] and a warning response [BCR‐ABL1 (IS), 1%‐10%] at 6 months was 93% and 95% for groups A and B, respectively (P = .553). Patients with an optimal response (OR) at both 3 and 6 months had significantly superior event‐free survival rates compared with patients without an OR in groups A and B. Conclusion: The results of the present study have demonstrated most probably for the first time that an OR at 3 and 6 months in patients receiving either first‐line GI and OI is clearly associated with greater response and event‐free survival rates. Prospective randomized trials with larger numbers of patients and longer follow‐up periods are needed to address the effect of EMR in patients receiving GI.

Third-line treatment with second-generation tyrosine kinase inhibitors (dasatinib or nilotinib) in patients with chronic myeloid leukemia after two prior TKIs: real-life data on a single center experience along with the review of the literature

ABSTRACT Objectives: Newer tyrosine kinase inhibitors (TKIs) (bosutinib, ponatinib) and allogeneic hematopoietic stem cell transplantation (allo-HSCT) can be utilized as a salvage therapy in patients with chronic myeloid leukemia (CML) who failed two lines (imatinib → nilotinib or imatinib → dasatinib) of TKI therapy. However, these TKIs are not available in many countries and not all patients can undergo allo-HSCT. Methods: In this study, CML patients who received dasatinib or nilotinib as a third-line treatment were retrospectively evaluated. Results: Out of 209 patients, third-line dasatinib/nilotinib was administered in 21. During the follow-up, 16 out of 21 patients gained and/or maintained an optimal response, and 4 patients died due to progression. Seventeen patients were alive at the time of the analysis, of which 13 were still on TKI, whereas 4 patients quit treatment. Discussion: In patients failing two lines of TKI, dasatinib or nilotinib can be beneficial and safely administered as a third-line treatment especially in nations with restricted resources.

Relapse after allogeneic hematopoietic stem cell transplant in patients with chronic myeloid leukemia: tyrosine kinase inhibitors, donor lymphocyte infusions or both?

Before the introduction of the tyrosine kinase inhibitors (TKIs), the median survival of patients with chronic myeloid leukemia (CML) was 5–7 years [1], and the only possible treatment option that ...

Retrospective Evaluation of Hairy Cell Leukemia Patients Treated with Three Different First-Line Treatment Modalities in the Last Two Decades: A Single-Center Experience

Objective: In this study, we retrospectively analyzed the clinical outcome, treatment responses, infectious complications, and survival rates of 71 hairy cell leukemia (HCL) cases. Materials and Methods: Sixty-seven patients received a first-line treatment and 2-chlorodeoxyadenosine (cladribine-2-CdA) was administered in 31 cases, 19 patients received interferon-alpha (INF-α), splenectomy was performed in 16 cases, and rituximab was used in one. Results: Although the highest overall response rate (ORR) was observed in patients receiving 2-CdA upfront, ORRs were comparable in the 2-CdA, INF-α, and splenectomy subgroups. Relapse rates were significantly lower in patients who received first-line 2-CdA. The progression-free survival (PFS) rate with 2-CdA was significantly higher than in patients with INF-α and splenectomy, but we found similar overall survival rates with all three upfront treatment modalities. Infections including tuberculosis were a major problem. Conclusion: Although purine analogues have improved the ORRs and PFS, there is still much progress to make with regard to overall survival and relapsed/refractory disease in patients with HCL.

Simultaneous Detection of B-Cell Chronic Lymphocytic Leukemia and Colon Adenocarcinoma in the Same Mesenteric Lymph Node

A 50-year-old male patient presented with microcytic anemia (hemoglobin: 10.2 g/dL, hematocrit: 33.8%, mean corpuscular volume: 64 fL), leukocytosis of 19.7 x 109/L (lymphocytes of 51.2%, 10x109/L), and normal platelet count. During the etiological work-up of his anemia an abdominal computed tomography (CT) scan was done, which showed a mass of 6.5x5.5 cm located in the ascending colon and hepatic flexura causing a wall thickening of 20 mm. The thoracic CT was normal. A complete colonoscopy showed an ulcerovegetative lesion in the transverse colon narrowing the lumen and multiple biopsies were performed, which revealed a well-differentiated colon adenocarcinoma. During the surgical removal of the tumor, 4 peripancreatic and 48 mesenteric lymph nodes and the perilymphatic fat tissue were resected, which all had diffuse infiltration of atypical lymphocytes. In one mesenteric lymph node, both invasion of the colon adenocarcinoma and atypical lymphocytes were demonstrated (Figures 1A and ​and1B).1B). The atypical lymphocytes were immunohistochemically positive for CD20 (Figure 2), Bcl-2, CD23, and CD5 consistent with B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (B-CLL/SLL). After the patient was referred to the hematology department, flow cytometry was performed from the peripheral blood, which was also consistent with B-CLL/SLL. He had early-stage CLL and so we decided to monitor the disease; the patient was referred to the medical oncology department for the treatment of colon adenocarcinoma. Figure 1 Adenocarcinoma metastasis and diffuse infiltration of small lymphocytes in the same mesenteric lymph node (A: hematoxylin and eosin, 40x; B: hematoxylin and eosin, 400x). Figure 2 CD20 is positive in diffuse lymphoid infiltration, whereas it is negative in metastatic glands (40x). Patients with CLL have more than twice the risk of developing a second cancer, and this increased incidence is attributed to disease- or therapy-related immunosuppression [1]. The most common types of cancers developing in CLL patients are skin cancers, soft-tissue sarcoma, colorectal and lung carcinoma [2]. The incidental detection of CLL/SLL based on the histological evaluation of the lymph nodes resected for rectal adenocarcinoma is a rare entity [3,4]. The synchronous diagnosis of B-CLL/SLL and colon adenocarcinoma in our case is most probably coincidental. However in the synchronous presentation of these two malignancies, an epidemiological association has been noted [5], and this synchronous relationship can also be explained in terms of the immunosuppression over a prolonged period of time. Conflict of Interest Statement All authors have no conflict of interest to declare.