2016-4

More documents

Recommendations

Info

RESEARCH ARTICLEDOI: 10.4274/tjh.2015.0088Turk J Hematol 2016;33:281-285The Prognosis of Adult Burkitt’s Cell Leukemia in Real-LifeClinical PracticeErişkin Burkitt Hücreli Löseminin Klinik Pratikteki SeyriÜmit Yavuz Malkan 1 , Gürsel Güneş 1 , Hakan Göker 1 , İbrahim C. Haznedaroğlu 1 , Kadir Acar 2 , Eylem Eliaçık 1 , Sezgin Etgül 1 , Tuncay Aslan 1 ,Seda Balaban 1 , Haluk Demiroğlu 1 , Osman İ. Özcebe 1 , Nilgün Sayınalp 1 , Salih Aksu 1 , Yahya Büyükaşık 11Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey2Gazi University Faculty of Medicine, Department of Hematology, Ankara, TurkeyAbstractObjective: Many studies reported an improved prognosis inpatients with Burkitt’s lymphoma obviating the need of stem celltransplantation. However, prognosis of the advanced disease [i.e.Burkitt’s cell leukemia (BCL)] has not been reported with currenttreatment modalities except for a few prospective trials. The aim ofthis study is to compare the prognoses of BCL patients with similarlytreated and nontransplanted patients with other types of acutelymphoblastic leukemia (ALL) and with ALL patients that underwentallogeneic stem cell transplantation (ASCT) in their first remissions.Materials and Methods: In this retrospective analysis, BCL patientsaged between 16 and 63 who were admitted between 2000 and 2014to the hospitals of Hacettepe or Gazi University and were treated withintensive therapies aimed at cure were included. All ALL patients whowere treated with a similar protocol not including transplantationduring the same period (NT-ALL group) and all ALL patients whounderwent ASCT in the first complete remission during the sameperiod (T-ALL group) served as control groups.Results: The central nervous system or extramedullary involvementrates, lactate dehydrogenase levels, and white blood cell counts atdiagnosis were higher in the BCL group than the NT-ALL group andthese differences were significant. BCL patients had disease-freesurvival (DFS) durations comparable with the T-ALL cohort but NT-ALL patients had significantly shorter DFS durations. Both cumulativerelapse incidence and cumulative nonrelapse mortality were higher inNT-ALL patients compared to the T-ALL group and BCL patients.Conclusion: DFS in BCL patients treated with a widely acceptedmodern regimen, R-HyperCVAD, is comparable to results in otherALL patients receiving allogeneic transplantation. Our results are inagreement with a few prospective noncomparative studies suggestingno further need for stem cell transplantation in BCL.Keywords: Burkitt’s cell leukemia, PrognosisAmaç: Yapılan birçok çalışmada Burkitt lenfomanın seyrinin düzeldiği,hatta kemik iliği nakli ihtiyacının ortadan kalktığı ileri sürülmektedir.Ancak birkaç ileriye dönük çalışma haricinde, güncel tedavi yöntemlerialtında hastalığın lösemik formunun seyri hakkında araştırmayapılmamıştır. Bu çalışmanın amacı Burkitt hücreli lösemi (BHL)hastalarının klinik seyrinin, benzer tedavi alan ve transplantasyonuygulanmayan diğer akut lenfoblastik lösemi (ALL) hastaları ve ilkremisyonlarında allojenik kök hücre nakli (AKHN) uygulanan ALLhastalarıyla kıyaslanmasıdır.Gereç ve Yöntemler: Geriye dönük olarak tasarlanan bu çalışmayayaşları 16 ile 63 arasında değişen, 2000 ile 2014 yılları arasındaHacettepe ve Gazi Üniversitesi Hastaneleri’ne başvurup kür amacıylaintensif tedavi verilen BHL hastaları alınmıştır. Transplantasyonharicinde benzer tedavi protokolüyle tedavi edilen tüm ALL hastaları(NT-ALL) ve aynı dönemde ilk tam remisyonlarında AKHN uygulananhastalar (T-ALL) kontrol grupları olarak çalışmaya alınmışlardır.Bulgular: Santral sinir sistemi ya da ekstra medüller tutulumhızları, tanı anındaki laktat dehidrogenaz düzeyleri ve beyaz küresayısı BHL hastalarında NT-ALL hastalarına göre istatistiksel olarakanlamlı olacak şekilde daha yüksekti. BHL hastaları T-ALL hastalarıylabenzer hastalıksız sağkalım (HS) süresine sahip olmakla beraber, NT-ALL hastalarında HS süresi önemli oranda azalmıştı. Kümülatif nüksinsidansı ve kümülatif nüks dışı ölümler NT-ALL hastalarında T-ALL veBHL hastalarında kıyasla daha fazlaydı.Sonuç: Sonuç olarak, geniş kabul gören modern bir rejim olanR-HyperCVAD ile tedavi edilen BHL hastalarında HS süresi allojeniktransplantasyon uygulanmış diğer ALL hastaları ile benzer bulundu.Bizim çalışmamızın sonuçları, literatürde ileri dönük dizayn edilmişancak kontrol grupları ile karşılaştırma olmadan yapılmış ve BHL’detransplantasyon gerekmediğini öne süren az sayıdaki çalışma ileörtüşmektedir.ÖzAnahtar Sözcükler: Burkitt hücreli lösemi, PrognozAddress for Correspondence/Yazışma Adresi: Ümit Yavuz MALKAN, M.D.,Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, TurkeyPhone : +90 532 778 00 87E-mail : umitmalkan@hotmail.comReceived/Geliş tarihi: February 23, 2015Accepted/Kabul tarihi: December 14, 2015281
Malkan ÜY, et al: The Prognosis of Adult Burkitt’s Cell Leukemia Turk J Hematol 2016;33:281-285IntroductionIn the last decade, many studies reported an improved prognosisin patients with Burkitt’s lymphoma obviating the need forstem cell transplantation. There is a general consensus that theprognosis of Burkitt’s lymphoma is closely related to the diseasestage and degree regarding the involvement of bone marrow andperipheral blood. However, prognosis of the advanced disease(i.e. Burkitt’s cell leukemia) specifically has not been reportedwith current treatment modalities except for a few prospectivetrials, which may not reflect everyday real-life clinical practiceswith their own limitations.The aim of this study is to compare the prognoses of Burkitt’s cellleukemia patients with similarly treated and nontransplantedpatients with other types of acute lymphoblastic leukemia andwith acute lymphoblastic leukemia patients that underwentallogeneic stem cell transplantation in their first remissions.Materials and MethodsStudy PopulationIn this retrospective analysis, Burkitt’s cell leukemia patientsaged between 16 and 63 years who were admitted between2000 and 2014 to the hospitals of Hacettepe or Gazi Universityand treated with intensive therapies aimed at cure wereincluded in the study. Twenty-five patients who were treatedwith HyperCVAD ± rituximab were included in the study; asonly one patient was treated with the R-EPOCH regimen,that patient was excluded from the study. The diagnosisof Burkitt’s cell leukemia was made based on the presenceof characteristic morphological (FAB L3 morphology and>95% Ki-67 proliferation index) or cytogenetic/molecular(specific translocations involving MYC at band 8q24 or MYCrearrangement in fluorescence in situ hybridization analysis)properties and mature B-cell immunophenotype (TdT negativityplus sIg positivity of >20% or κ/λ light-chain clonality). Theminimal criterion for the diagnosis of a leukemic diseasecondition was more than 25% bone marrow involvement. Allacute lymphoblastic leukemia patients who were treated with asimilar protocol not including transplantation during the sameperiod (NT-ALL group) and all acute lymphoblastic leukemiapatients who underwent allogeneic stem cell transplantationin the first complete remission during the same period (T-ALLgroup) served as control groups.Treatment ProtocolsSpecifics of the HyperCVAD ± rituximab regimen, includingcentral nervous system (CNS) prophylaxis and treatmentstrategies, were as described by Thomas et al. [1]. Chemotherapyconsisted of 8 alternating courses without maintenance therapy.When given, rituximab was administered during courses 1 to 4.Odd courses (1, 3, 5, 7) were HyperCVAD. When given, rituximabwas administered at 375 mg/m 2 i.v. over 2 to 6 h on days 1 and11 of HyperCVAD and on days 2 and 8 of MTX and ara-C, duringthe first 4 courses.Study End-Points and Statistical AnalysisNumerical descriptive data were expressed as median (minimummaximum).Continuous and categorical data were compared withthe t-test and chi-square test, respectively. Primary endpointsof the study were complete remission (CR) rate, disease-freesurvival (DFS), and overall survival (OS). OS was calculatedfrom diagnosis to the date of mortality of any reason. DFS wasanalyzed in CR patients from date of CR attainment to relapseor death in remission. The patients who did not die and thosewho did not relapse or die in remission at last follow-up werecensored at this time for OS and DFS computations, respectively.Cumulative relapse (CRI) and cumulative nonrelapse mortalityincidences (CNRMI) were computed for patients who attainedCR, from the date of CR until relapse or nonrelapse mortality(NRM), respectively. The patients who did not relapse or die inremission at last follow-up were censored at this time. Relapsewas considered a competing risk for NRM, and NRM wasconsidered a competing risk for relapse during CRI and CNRMIcomputations. Categorical and continuous data were comparedby the chi-square and independent-samples t-test, respectively.Survival analyses were computed by the Kaplan-Meier method.Comparisons of survival rates were done by the log-rank test.CRI and CNRMI were calculated according to Gray’s test [2]as described by Scrucca et al. [3]. Cumulative incidences werecalculated by means of the statistical software environmentR, Version 2.15.2 (The R Foundation for Statistical Computing,Vienna, Austria) [4]. SPSS 17.0 (SPSS Inc., Chicago, IL, USA) wasused for other statistical analyses.ResultsT-ALL patients were frequently referred after remission attainmentfrom other centers. Some of these patients’ baseline parameterswere missing. There were 25, 44, and 48 patients in the Burkitt’scell leukemia, NT-ALL, and T-ALL groups, respectively. Importantbaseline characteristics of Burkitt’s cell leukemia and NT-ALLpatients are presented in Table 1. All 25 Burkitt’s cell leukemiapatients had been treated with the HyperCVAD ± rituximabregimen and were not transplanted. Rituximab treatments weregiven to most of the Burkitt’s cell leukemia patients; only 3Burkitt’s cell leukemia patients had not received rituximab. Onlynontransplanted acute lymphoblastic leukemia (NT-ALL) patientswho were treated with HyperCVAD were selected as controls.Median numbers of HyperCVAD ± rituximab regimens given toBurkitt’s and NT-ALL patients were 8 and 7.5, respectively. TheCNS or extramedullary involvement rate, lactate dehydrogenaselevels, and white blood cell count at diagnosis were higher in282
Page 1 and 2: Volume 33 Issue 4 December 2016 80
Page 3 and 4: Contact InformationEditorial Corres
Page 5 and 6: TURKISH JOURNAL OF HEMATOLOGYINSTRU
Page 7 and 8: should include a conclusion, in whi
Page 9 and 10: as appropriate, and then click the
Page 11 and 12: 335 Evaluation of Insulin-like Grow
Page 13 and 14: 6 th International CongressonLeukem
Page 15 and 16: Kesik V, et al: Prognostic Markers
Page 23 and 24: Tombak A, et al: Azacitidine and El
Page 29: Tombak A, et al: Azacitidine and El
Page 33 and 34: Malkan ÜY, et al: The Prognosis of
Page 35 and 36: RESEARCH ARTICLEDOI: 10.4274/tjh.20
Page 37 and 38: Ghasemi M, et al: Identification of
Page 43 and 44: Yorulmaz G, et al: Hyperparathyroid
Page 49 and 50: Kahlon P, et al: Therapeutic Intern
Page 51 and 52: Kahlon P, et al: Therapeutic Intern
Page 55 and 56: Işlak Mutcalı S, et al: Early Cha
Page 61 and 62: Çalık Başaran N, et al: Infectio
Page 71 and 72: Terzi YK, et al: HFE Mutations and
Page 73 and 74: Terzi YK, et al: HFE Mutations and
Page 77 and 78: Baytan B, et al: Emotional Status a
Page 79 and 80: Baytan B, et al: Emotional Status a
Page 81 and 82:
Ishibashi M, et al: CBFA2T3-GLIS2 F
Page 83 and 84:
Ishibashi M, et al: CBFA2T3-GLIS2 F
Page 85 and 86:
Ayer M, et al: Evaluation of IGF-1
Page 87 and 88:
Ayer M, et al: Evaluation of IGF-1
Page 89 and 90:
Patıroğlu T and Akar HH; HLA (A,
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
BRIEF REPORTDOI: 10.4274/tjh.2016.0
Page 97 and 98:
Düzgöl M, et al: Varicella Infect
Page 99 and 100:
Jain M, et al. Chediak-Higashi Synd
Page 101 and 102:
Pradhan S: Auer Rod-Like Inclusions
Page 103 and 104:
Milosevic I: Coexistence of Chronic
Page 105 and 106:
LETTERS TO THE EDITOR Turk J Hemato
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
LETTERS TO EDITOR Turk J Hematol 20
Page 119 and 120:
LETTERS TO EDITOR Turk J Hematol 20
Page 121 and 122:
33 rd Volume Index / 33. Cilt Dizin
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129:
show all

2016-4

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?