Virginia Prates

Central nervous system involvement at first relapse in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and anthracycline monochemotherapy without intrathecal prophylaxis

With the advent of more effective therapy for the bone marrow in acute promyelocytic leukemia (APL) central nervous system (CNS) prophylaxis has been suggested to be useful. Using data from 739 patients treated on two Spanish national trials, the authors examine the incidence of CNS relapse in APL and whether risk factors for such relapse can be identified. Background The prevalence of and risk factors for central nervous system recurrence in patients with acute promyelocytic leukemia are not well established and remain a controversial matter. Design and Methods Between 1996 and 2005, 739 patients with newly diagnosed acute promyelocytic leukemia enrolled in two consecutive trials (PETHEMA LPA96 and LPA99) received induction therapy with all-trans retinoic acid and idarubicin. Consolidation therapy comprised three courses of anthracycline monochemotherapy (LPA96), with all-trans retinoic acid and reinforced doses of idarubicin in patients with an intermediate or high risk of relapse (LPA99). Central nervous system prophylaxis was not given. Results Central nervous system relapse was documented in 11 patients. The 5-year cumulative incidence of central nervous system relapse was 1.7% (LPA96 3.2% and LPA99 1.2%; p=0.09). The cumulative incidence was 0%, 0.8%, and 5.5% in low-, intermediate-, and high-risk patients, respectively. Relapse risk score (p=0.0001) and the occurrence of central nervous system hemorrhage during induction (5-year cumulative incidence 18.7%, p=0.006) were independent risk factors for central nervous system relapse. Conclusions This study shows a low incidence of central nervous system relapse in patients with acute promyelocytic leukemia following therapy with all-trans retinoic acid and anthracycline without specific central nervous system prophylaxis. Central nervous system relapse was significantly associated with high white blood cell counts and prior central nervous system hemorrhage, which emerged as independent prognostic factors.

SAFETY AND EFFICACY ANALYSIS OF ELDERLY PATIENTS TREATED WITHIN THE GATLA HL-05 CLINICAL TRIAL: PET ADAPTED THERAPY AFTER 3 CYCLES OF ABVD FOR ALL STAGES OF HODGKIN LYMPHOMA

tomography (PET) is in the medium and long‐term follow‐up after complete response of Hodgkin lymphoma (HL) and aggressive non‐Hodgkin lymphoma (NHL) with mediastinal involvement at diagnosis. The aim of this study was to verify the reliability of positive PET scans of the mediastinum in following up patients with mediastinal lymphoma, using histological findings as comparison (gold standard). Methods: From January 2002 to February 2016, 483 patients with mediastinal lymphoma were followed after the end of front‐line treatment. Ninety‐six patients with a positive PET scan of the mediastinum underwent computed tomography scanning and surgical biopsy. Results: For 67 HL and 29 NHL, a suspicion of lymphoma relapse was raised based on positive mediastinal PET scanning. Histology confirmed relapse in 63 (48 HL and 15 NHL) of 96 patients (65.6%). In the remaining 33 (34,4%) cases, biopsy revealed: necrotic tissue in 7 patients, fibrosis in 7 patients, thymus in 7 patients, sarcoidosis in 4 patients, tuberculous granulomas in 2 patients, sarcoid‐like lymph node granulomatosis in 1 patient, tuberculosis lymph node granulomatosis in 1 patient, reactive inflammation lymph node in 3 patients, and thymoma in 1 patient. The maximum standardized uptake value was significantly higher among patients who had signs of relapse (63 true positive cases) than among those who stayed in remission (33 false positive cases), the median values being 10.30 (range, 3.2‐25.0) and 5.0 (range, 2.8‐12.6) respectively (P < .05). Conclusions: The analysis on this large series of 96 patients confirms the concept that patients with positive PET in the mediastinum during the follow‐up cannot be considered sufficient for final diagnostic purposes considering that at least one third of the patients can present only benign or, anyway, unrelated neoplastic pictures. Histological confirmation can be safely obtained by various biopsy techniques, the choice of which should be made on the basis of the clinical and imaging study findings case by case.