Xiao Xiao Wang

Clinical outcomes of patients with newly diagnosed primary central nervous system lymphoma are comparable on treatment with high-dose methotrexate plus temozolomide and with high-dose methotrexate plus cytarabine: a single-institution experience.

Abstract The role of temozolomide in untreated PCNSL patients has not yet been clearly defined. The purpose of this study was to compare the efficacy and toxicity of MT and MC chemotherapy in this population. A total of 41 consecutive patients were enrolled from March 2001 to July 2011. The ORR and CRR for MT vs. MC were 70% vs. 61.9% and 45% vs. 38.1% on ITT basis, (p = NS); 73.7% vs. 68.4% and 47.4% vs. 42.1% on PP basis, respectively (p = NS). Grade 3-4 hematological toxicities were more common in MC than in MT group (85.7% vs. 15%, p = 0.0001). One treatment-related death was observed in each group. The 5-year PFS and OS of MT (36% and 62.2%) were comparable to MC (32.6% and 46.7%), (p = NS). In summary, our preliminary results suggest that MT combination may be a simplified and effective regimen comparable to MC for newly diagnosed PCNSL.

A TNM Staging System for Nasal NK/T-Cell Lymphoma

Ann Arbor stage has limited utility in the prognostication and treatment decision making in patients with NK/T-cell lymphoma (NKTCL), as NKTCL is almost exclusively extranodal and the majority is localized at presentation for which radiotherapy is the most important treatment and local invasiveness is the most important prognostic factor. In this study, we attempted to establish a TNM (Tumor-Node-Metastasis) staging system for nasal NKTCL (N-NKTCL). The staging rules of other head and neck cancers were used as reference along with the data of our 271 eligible patients. The primary tumor was classified into T1 to T4, and cervical lymph node metastasis was classified into N0 to N2 according to the extent of involvement. Any lesions outside the head and neck were classified as M1. N-NKTCL thereby was classified into four stages: stage I comprised T1-2N0M0; stage II comprised T1-2N1M0 and T3N0M0; stage III comprised T3N1M0, T1-3N2M0, and T4N0-2M0; and stage IV comprised TanyNanyM1. This staging system showed excellent performance in prognosticating survival. In the current series, the 5-year survival rates of patients with stages I, II, III, and IV N-NKTCL were 92%, 64%, 23%, and 0, respectively. Moreover, the predictive value of several currently used factors was abrogated in the presence of the TNM stage. The TNM staging system is highly effective in stratifying tumor burden and survival risk, which may have significant implications in the treatment decision making for patients with N-NKTCL.

Treatment outcome of docetaxel, capecitabine and cisplatin regimen for patients with refractory and relapsed nasopharyngeal carcinoma who failed previous platinum-based chemotherapy.

Objective: Although cisplatin combined with 5-fluorouracil is a common first-line regimen for advanced nasopharyngeal carcinoma (NPC), there are no standard regimens for refractory or relapsed patients. A study of DXD regimen [cisplatin (D), capecitabine (X) and docetaxel (D)] was conducted to evaluate the efficacy and toxicity for patients with refractory or relapsed NPC. Methods: The regimen was administered as follows: 50 mg/m2 docetaxel and 50 mg/m2 cisplatin on day 1 and 800 mg/m² capecitabine on days 1 – 14, repeated every 3 – 4 weeks. Results: Thirty patients were enrolled. The overall response and complete remission rate was 46.4 and 21.4%. Median follow-up was 24 months; median overall survival (OS) and progression-free survival (PFS) were 14.0 and 8.0 months. Five-year OS and PFS rates were 14.8 and 13.3%, respectively. Four patients achieved long-term tumor-free survival (range, 53.8 – 125.3 months). Multivariate analysis demonstrated that Epstein–Barr virus DNA status (p = 0.003) and therapeutic effect (p < 0.001) were significant independent factors for OS and PFS. The main grade 3/4 toxicities included neutropenia (26.6%), anemia (13.3%) and thrombocytopenia (10.0%). There were no chemotherapy-related deaths. Conclusion: The DXD regimen appeared to be effective and well tolerated by patients with refractory or relapsed NPC. Further investigation is warranted.

Safety and efficacy of non-initial rapid infusion of rituximab plus chemotherapy in Chinese patients with CD20+ non-Hodgkin’s lymphoma

Objective: To evaluate the safety and efficacy of rapid rituximab infusion (RRI) plus chemotherapy in patients with CD20+ non-Hodgkin’s lymphoma (NHL). Research design and methods: A total of 177 patients received 4 – 6 cycles of rituximab-based chemotherapy. The first cycle was given with standard schedule. In the second and subsequent cycles, RRI was initiated. Rituximab was administered as 20% of the dose infused in the first 30 min and the remaining 80% was given over 60 min. Benadryl and dexamethasone were given before infusions. Vital signs were measured at baseline and during infusion. Results: In the first cycle, 48 patients experienced grade I – II infusion reactions and two patients showed grade III – IV infusion reactions. Six patients experienced infusion reactions during RRI. Two patients showed grade III infusion reactions to RRI and dropped out of the study. With a median follow up of 37.5 months, the 3-year overall survival and progression-free survival rates of the whole cohort were 93.1 and 81.1%, respectively. Conclusions: Our preliminary observations suggested that RRI may be safe and feasible for patients with CD20+ NHL.

Long-term results of the R-CEOP90 in the treatment of young patients with chemotherapy-naïve diffuse large B cell lymphoma: A phase II study

Although immuno-chemotherapy with a combination of the CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) chemotherapy regimen and the monoclonal antibody rituximab (R) has dramatically improved longterm survival in patients with diff use large B-cell lymphoma (DLBCL), it fails in approximately 20 – 50% of cases [1]. Th erefore, a simpler and more effi cacious regimen with lower toxicity for DLBCL is urgently needed. Th e anthracycline has been regarded as the most important cytotoxic drug in the R-CHOP schedule, but dose increase of doxorubicin is restricted by its cardiac toxicity. To reduce the cardiac toxicity, we replaced doxorubicin with epirubicin in R-CHOP (R-CEOP) [2,3], and evaluated whether escalating the dose of epirubicin (90 mg/m 2 ) could improve the treatment outcome in the R era. Th e R-CEOP90 regimen included rituximab 375 mg/m 2 day 1, cyclophosphamide 750 mg/m 2 day 2, epirubicin 90 mg/m 2 day 2, vincristine 1.4 mg/m 2 (maximum 2 mg) day 2 and prednisolone 100 mg/day days 2 – 6. Patients with stages IA and IIA disease received four cycles of R-CEOP90 followed by involved fi eld radiotherapy (30-45 Gy) of bulky disease and extranodal and residual masses. For patients with stages IB, IIB and III – IV disease, six cycles of R-CEOP90 were given. Between November 2004 and September 2009, 41 patients with chemotherapy-naive DLBCL at Sun Yat-san University Cancer Center were enrolled in this study. Th e median age of the whole group was 43 years (range 18 – 65 years). Twenty patients had stage III – IV disease. Twenty-six patients had an age-adjusted International Prognostic Score (aaIPI) score of 0 – 2 and 15 had an aaIPI score of 3. Among them, 11 patients carried hepatitis B virus (HBV). A total of 218 cycles were carried out, with a median cycle duration of 21 days (range 21 – 33 days). Th e epirubicin dose was reduced by 25% in six patients (14.63%), and the cyclophosphamide dose was reduced by 25% in fi ve patients (12.19%). Complementary radiotherapy (30 – 45 Gy) was administered to 14 patients. Among fi ve patients with a partial response (PR), one with stage IIA and bulky disease received an allogeneic hematopoietic stem cell transplant (AHSCT) followed by 36 Gy of radiotherapy, and four with stages III – IV disease were switched to second-line regimens, among whom two with a complete response (CR) received AHSCT. All 41 patients were eligible for response evaluation. Th e overall response rate (ORR) was 100%, with a CR rate of 87.8% (36 cases). Median follow-up of all patients was 63 months (range 6 – 99 months), with one case missing. At the last follow-up, seven patients had died, among whom fi ve had died of tumor, one of severe infection caused by grade 4 neutropenia and one of fulminant hepatitis due to reactivation of HBV. Second malignancy (follicular lymphoma) occurred in one patient. Th e 5-year overall survival (OS) and progression free survival (PFS) were 82.5% (95% confi dence interval [CI] 76.5 – 88.5%) and 80.0% (95% CI 72.7 – 86.3%), respectively. Th e 5-year OS in the low-intermediate risk group (aaIPI 0 – 2) and high risk group (aaIPI 3) was 92.0% (95% CI 86.6 – 97.4%) and 66.7% (95% CI 54.5 – 78.9%), respectively ( p 0.046) (Figure 1). Th e 5-year PFS in the low-intermediate risk and high risk groups was 86.8% (95% CI 79.7 – 93.9%) and 66.7% (95% CI 54.5 – 78.9%), respectively ( p 0.111). Th e 5-year OS in patients with stages I – II and III – IV disease was 95.0% (95% CI 90.1 – 99.9%) and 70.0% (95% CI 59.8 – 80.2%), respectively ( p 0.047). Th e 5-year PFS in patients with stages I – II and III – IV disease was 95.0% (95% CI 90.1 – 99.9%) and 65.0% (95% CI 54.3 – 75.7%), respectively ( p 0.022). Myelosuppression was the most frequent toxicity (Table I). Grade 3 – 4 neutropenia occurred in 15 patients