Annual Meeting Proceedings Part 1 - American Society of Clinical ...

8045 General Poster Session (Board #32B), Mon, 1:15 PM-5:15 PM
Survival outcomes in marginal zone lymphomas in the rituximab era:
Analysis of the Surveillance, Epidemiology, and End Results (SEER)
database. Presenting Author: Jorge J. Castillo, The Miriam Hospital,
Providence, RI
Background: Despite prognostic models developed for marginal zone
lymphoma (MZL), the impact of different characteristics and treatments on
survival in the population is largely unknown. We studied survival of MZL
patients included in the SEER database. Methods: Records of MZL adult
cases diagnosed between 1989-2008 were studied using descriptive
methods and analysis of overall (OS) and lymphoma-specific (LSS) survival
based on Kaplan-Meier function, stratified log-rank tests and Cox proportional
hazard models. Results: 13,957 patients with MZL were identified
and classified as splenic (SMZL; n�1,111, 8%), nodal (NMZL; n�4,101,
29%) or extranodal MALT-type MZL (MALT; n�8,745, 63%). The median
age was 68 years, 74% of patients were white and 55% were women.
Median follow-up was 40 months. MALT was more common in non-
Caucasians (p�10-27 ). B-symptoms were more common in SMZL (p�10- 5). Both LSS and OS were significantly better for MALT (p�10-60 ) with no
difference between SMZL and NZML (p�0.30). 10-year LSS estimates
were 67% for SMZL, 67% for NMZL, 84% for MALT. There was evidence
for improved LSS since 2000 in MALT (HR 0.69, 95% CI 0.59-0.82,
p�0.0003) and NMZL (HR 0.64, 95% CI 0.54-0.77, p�10-5 ), but not for
SMZL (HR 0.85, 95% CI 0.56-1.28, p�0.43). Similar results were found
for OS. There were differences in survival in MALT subtypes depending on
primary site (p�10-12 ; Table). Conclusions: In the rituximab era, survival
has improved for MALT and NMZL, but not for SMZL, possibly due to
disparate treatment paradigms. The prognosis of MALT is different depending
on primary site of involvement.
Site n 5-year OS (%) 95% CI
Skin 664 87.1 83.5-90.0
Thyroid 179 85.8 78.0-90.9
Ocular 1,108 82.4 79.4-85.0
Salivary 719 82.4 78.7-85.5
Connective tissue 190 81.7 73.9-87.4
Breast 277 78.9 72.2-84.2
Gastric 3,207 72.1 70.3-73.9
Lung 737 72.1 67.9-75.9
Bowel 791 71.1 67.2-74.7
Other 392 72.7 67.0-77.7
8047 General Poster Session (Board #32D), Mon, 1:15 PM-5:15 PM
The utility of serum lactate dehydrogenase (LDH) in the follow-up of
patients with diffuse large B-cell lymphoma (DLBCL). Presenting Author:
Navneeth Rao Bongu, Nebraska Medical Center, Omaha, NE
Background: The prognostic significance of high serum LDH is well
established for both indolent and aggressive lymphomas at diagnosis. The
performance characteristics of LDH in predicting relapse after treatment in
patients (pts) with DLBCL has not been well studied. The determination of
utility of LDH monitoring in pts with DLBCL would have widespread
practice implications. Methods: We searched the Nebraska Lymphoma
Study Group database to identify pts with DLBCL who were treated with a
rituximab-based regimen, from 2000 to 2010, and sustained a complete
response (CR). For the pts who relapsed (RP), after sustaining a CR, we
collected the LDH level at relapse and the LDH level 3 months prior
(considered baseline). For pts who never relapsed (NR), we collected the
last 2 LDH levels at follow-up; levels had to be at least 3 months apart. The
relative increase of LDH was compared, to baseline, among RP vs. NR.
Results: We identified 129 pts, 15 pts were excluded from the analysis as
their LDH results were not available, 27 relapsed and 87 didn’t. Median
age of pts was 57 years. Only 9/27 RP (33%) had increase in LDH above
upper limit of normal (ULN) at relapse. The mean increase in LDH at
relapse was 1.2 fold above the ULN for RP vs. 0.83 for NR (p�0.59). The
mean increase in LDH, from baseline, was 1.1 fold in NR vs. 1.3 in RP
(p�0.3). The likelihood ratio (LR) of relapse was 4.65 for pts who had 1.5
fold increase in LDH above baseline (1.5xLDH) vs. those who didn’t
(p�0.03). The sensitivity, specificity, positive and negative predictive
values of 1.5xLDH for detecting relapse, compared to clinical and imaging
findings were 0.18, 0.95, 0.55, and 0.79 respectively. Also, 1.5xLDH at
relapse was significantly associated with the presence of fever (LR�5.74;
p�0.03) but not with other symptoms including drenching night sweats,
anemia, or new/progressive lymphadenopathy. Conclusions: A 1.5 fold
increase in LDH, over a period of 3 months, is associated with increased
likelihood of relapse from DLBCL. Modest elevations in LDH (�1.5 fold of
baseline) doesn’t seem to be associated with relapse. LDH, when elevated
at least 1.5 fold of baseline, is a specific (i.e. 56%), but not a sensitive (i.e.
19%) marker, for relapse of DLBCL.
Lymphoma and Plasma Cell Disorders
521s
8046 General Poster Session (Board #32C), Mon, 1:15 PM-5:15 PM
Early determination of treatment sensitivity in HIV-related Hodgkin lymphoma
by FDG-PET/CT after two cycles of ABVD chemotherapy: A
European Cooperative Study Group on AIDS and Tumors (GECAT) study.
Presenting Author: Nicolas Mounier, CHU l’Archet, Nice, France
Background: The high prognostic value of FDG-PET/CT performed after 2
cycles of chemotherapy for HIV negative Hodgkin lymphoma (HL) is well
known. However, experience with PET in HIV-related HL needs to be further
studied as nodal FDG uptake can be observed in various opportunistic
infections and AIDS-related conditions. Methods: A total of 45 consecutive
HL patients (pts) were enrolled in 10 centers from the GECAT. There were
42 males and 3 females. Median age was 46 yo, range [26;64]. Median
CD4 count was 391/mm3 , range [33;1191]. Viral load was negative in 38
pts (84%) and uncontrolled in 5 pts (11%). Forthy three pts (96%)
received concomitant HAART. HL was staged III-IV in 25 pts. International
Prognostic Index scored 3-5 in 24 pts. All PET studies were performed after
2 ABVD cycles. They were scored, blinded to treatment outcome, according
to the 5-point Deauville visual scale. It was considered as negative when
scored 1-3 (i.e tumor FDG uptake less or equal than liver uptake) and
positive when scored 4-5 (i.e. more than liver uptake or new lesions).
Chemotherapy was not modified : 4-8 cycles of ABVD, as initially planned.
Results: Overall, 35 pts (78%) achieved a CR after the end of treatment.
Three pts received Involved Field Radiation Therapy. At a median follow-up
of 18 months, 3 pts relapsed and 2 of them died from HL. The 2 yr OS and
PFS were estimated at 94 and 90%, respectively. PET after 2 cycles of
ABVD was negative in 40 pts (89%) and positive in 5 pts (11%). Patients
with negative PET had a significantly better outcome than those with
positive PET in term of 2 yr PFS (94% vs 60%, P�0.005), and 2 yr OS
(100% vs 60%, P�0.0002). The negative predictive value was estimated
at 97% and specificity at 93%. All patients who were PET-negative after
the 2nd cycle stayed PET-negative after the 4th cycle and entered a
durable CR. Conclusions: This largest study in HIV-positive HL showed that
interim PET could play a central role in driving risk-tailored treatment. In
further studies, de-escalation strategies should be tested for patients
responding after 2 cycles of ABVD and those not reponding should be
managed with intensive salvage strategies.
8048 General Poster Session (Board #32E), Mon, 1:15 PM-5:15 PM
Association of low expression of VEGF121 soluble isoform with prognostic
impact and survival in patients with activated B-cell-like (ABC-like) diffuse
large B-cell lymphoma (DLBCL) from the CORAL trial. Presenting Author:
Catherine Thieblemont, Saint-Louis Hospital, Paris, France
Background: Gene expression profiling (GEP) has demonstrated that survival
of DLBCL is influenced by the origin of the tumor cells (COO),
germinal center-like (GC-like) vs ABC-like (Alizadeh et al. 2000), but also
by the tumor microenvironment, particularly the angiogenesis (Lenz et al.,
2008). To further understand the prognostic impact of these tumoral
characteristics, we analysed the prognostic impact of COO and the
expression of biomarkers involved in angiogenesis, in a selected population
of 36 patients with relapsed/refractory DLBCL included in CORAL (Gisselbrecht,
ASCO 2011). Methods: Expression of 5 biomarkers including VEGF
(isoforms 121, 165, and 189), and their receptors (VEGFR-1 and R-2) was
assessed by quantitative qRT-PCR after total RNA extraction and cDNA
synthesis of tumor samples. COO was determined by GEP, and progression
free- (PFS) and overall- (OS) survivals were analysed. Results: In the study
population, VEGF121 expression below the median was associated to a
better outcome, with 4 year-PFS at 63% vs 33% (p�.053), and a
4-year-OS at 79% vs 37% (p � 0.032), respectively. VEGF-165 -189,
VEGF-R1, -R2 did not have any significant impact. Eighteen patients were
predicted as ABC-like DLBCL and 18 as GCB-like DLBCL. In patients with
ABC-like DLBCL, low VEGF121 level was associated to a significantly
better survival than in those with high VEGF121 level: 4-year OS at 100%
vs 36% (p�.011). The type of induction treatment, R-ICE or R-DHAP, did
not influence the outcome. The differences in outcome according to VEGF
isoforms were not significant among CGB patients. Conclusions: Our data
suggest that angiogenesis plays a central role in ABC-like DLBCL. VEGF121
seemed to be a key player in this context and should be proposed as a target
in the treatment of patients with ABC-like DLBCL.
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