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

522s Lymphoma and Plasma Cell Disorders
8049 General Poster Session (Board #32F), Mon, 1:15 PM-5:15 PM
Transformation of follicular lymphoma in the era of immunochemotherapy:
A population-based study from British Columbia. Presenting Author:
Abdulwahab J. Al-Tourah, British Columbia Cancer Agency-Fraser Valley
Centre and University of British Columbia, Surrey, BC, Canada
Background: Several published series have established that the risk of
transformation of follicular lymphoma (FL) to aggressive lymphoma is
approximately 3% /year (15%-20% at 5 years). The addition of rituximab
(R) to chemotherapy (immuno-chemotherapy) has significantly improved
the outcome of patients with FL. The impact of immuno-chemotherapy on
the risk of transformation remains unknown. We assessed whether the
introduction of immuno-chemotherapy has altered this risk. Methods: We
examined the Lymphoid Cancer Database of the British Columbia Cancer
Agency for FL patients treated with immuno-chemotherapy. Inclusion
criteria: FL grades 1-3A by WHO criteria; only patients requiring treatment
at diagnosis were included. Exclusion criteria: FL grade 3B or composite
histology (FL and DLBCL) at diagnosis; pts who received anthracyclinebased
chemotherapy; and HIV positivity. The diagnosis of transformation
was confirmed by biopsy when possible (n�19; 79%) but patients who
were considered to have transformed based on pre-defined clinical assessment
(n�5; 21%) were also included in the analysis. Results: We identified
261 pts with FL grade 1-3A requiring treatment at diagnosis, who received
immuno-chemotherapy; median f/u 47 months (0.2-116), median age, 61
y (34-86). Treatment: 243 (93%), R-CVP of which 145 (59%) also
received maintenance R; 9 (4%), R-Fludarabine combination. 24 pts
developed transformed aggressive lymphoma. The risk of transformation for
the entire group was approximately 2% per year or 10% at 5 years.
However, pts treated with maintenance R (n�151) had a lower risk of
transformation compared to pts who only received R-chemo at induction
(n� 110), 8% vs 20% at 5 years respectively, (P� 0.003). The posttransformation
outcome remains poor with a median survival of 6 months.
Conclusions: We and other groups have demonstrated that the risk of
transformation from FL to aggressive lymphoma is approximately 15% to
20% by 5 years. Our study suggests that the introduction of immunochemotherapy
has reduced this risk to less than 10%. This effect is
particularly apparent when patients receive maintenance R. The outcome
for patients who develop transformation remains poor.
8051 General Poster Session (Board #32H), Mon, 1:15 PM-5:15 PM
Efficacy of alemtuzumab (ALZ) in combination with dose-adjusted EPOCH
(DA-EPOCH) in untreated nodal peripheral T-cell lymphoma (PTCL).
Presenting Author: Cliona Grant, National Cancer Institute, Bethesda, MD
Background: The survival of patients (pts) with PTCL (excluding ALCL) is
disappointing following anthracycline-based therapy and novel approaches
are needed. In diffuse large B-cell lymphoma, the addition of anti-CD20
therapy to CHOP has significantly improved outcome and we investigated if
in PTCL, adding ALZ – which targets CD52, expressed on most PTCLs – was
feasible and improved outcome. Methods: This was a single-center phase
I/II trial of ALZ, in combination with DA-EPOCH in patients with treatmentnaïve
CD52� PTCL. The MTD of 30 mg ALZ was combined with DA-EPOCH
for phase II evaluation resulting in an intention-to-treat population (ITTP)
of 30 pts. Results: Patient (n�30) characteristics: median (range) age 50
(17-77); M:F 1:1; Stage III/IV 27 (90%); IPI �2 22 (73%). Histologies:
ATLL 11 (37%), PTCL NOS 6 (20%), AITL 5 (16%), Hepatosplenic 3
(10%), Peripheral T NK cell 2 (7%), Other 3 (10%). At 67 months median
follow-up, 11 patients were alive, 10 disease-free. Median overall (OS) and
event-free survivals (EFS) were 15.4 and 6.7 months respectively. Outcome
was substantially better for pts with ‘nodal’ (AITL, PTCL-NOS, Other)
compared to ‘non-nodal’ (ATLL and ‘extranodal’ histologies) PTCL subtypes.
3-year OS for the two groups was 58.3% and 27.8% respectively
(p�0.082); 3-yrs EFS was 50% (median 27.0 months) and 22.2%
(median: 5 months) respectively (p�0.041). Half of the ‘nodal’ PTCL pts
had sustained long-term complete remissions demonstrated by a plateau in
the EFS curve at 27 months. There were 3 treatment related deaths: 2 from
neutropenic sepsis; 1 from toxoplasma. Other toxicities included CMV and
BK virus reactivation in 53% and 30% respectively. Febrile neutropenia
was seen in 20% and grade 4 thrombocytopenia in 12 % of cycles.
Conclusions: Although it has significant infectious toxicity, ALZ 30mg and
DA-EPOCHin untreated PTCL is feasible and associated with a long-term
favorable outcome in nodal but not extranodal or leukemic PTCL. A phase
III study of ALZ 30mg with anthracycline-based therapy is ongoing and we
await the results with interest.
8050 General Poster Session (Board #32G), Mon, 1:15 PM-5:15 PM
Long-term follow-up results of a phase I/II study of concurrent chemoradiotherapy
for localized nasal NK/T-cell lymphoma (NKTCL): JCOG0211.
Presenting Author: Motoko Yamaguchi, Mie University, Tsu, Japan
Background: Concurrent chemoradiotherapy has been regarded as one of
the standard management for localized nasal NKTCL. However, its longterm
efficacy and toxicity is not known. Methods: The JCOG0211 trial is a
phase I/II study of concurrent chemoradiotherapy consisting of radiotherapy
(RT) of 50 Gy and 3 cycles of DeVIC (carboplatin, etoposide,
ifosfamide, dexamethasone) for newly diagnosed, localized nasal NKTCL
(JCO 2009). Patients (Pts) with newly diagnosed, localized diseases (IE &
contiguous IIE with cervical node involvement) who were 20-69 yrs of age
with PS 0-2 were eligible. 3-D conformal RT planning with a wide margin
(� 2 cm to the gross tumor, the entire nasal cavity and the nasopharynx)
and a 2-step cone down were required. 33 pts were enrolled in the study,
27 of whom were treated with RT and a 2/3-dose of DeVIC, which was
selected as the recommended phase II dose in the preceding phase I
portion of the trial. All pts completed RT without any protocol violations.
Long-term follow-up results on overall survival (OS), progression-free
survival (PFS) and toxicity were evaluated. Results: The median follow-up
was 69 months (range, 62-96). The pt (N�33) characteristics were as
follows: median age 54 yrs (range, 21-68); stage IIE 33%; B symptom (�)
36%; elevated serum LDH 21%. %5-yr OS and PFS were 73% (95%CI,
54-85%) and 67% (95%CI, 48-80%), respectively. 11 pts (33%) experienced
disease recurrence. Two achieved a 2nd CR by salvage chemotherapies
followed by allogeneic stem cell transplantation, and the remaining 9
pts died of disease. There was no observed death and disease progression
after 34 and 31 months, respectively. One pt experienced Grade 3 irregular
menstruation for 3 years. No other Grade 3 or 4 late non-RT-associated
adverse events (AEs) were observed. One pt received plastic surgery due to
Grade 4 RT dermatitis. No other Grade 3 or greater RT-associated late AEs
were encountered. Conclusions: Both survival benefit and disease control
from concurrent chemoradiotherapy with RT and DeVIC are maintained
during a 5-yr follow-up, indicating the excellent efficacy of this approach as
a first-line therapy for localized nasal NKTCL. Long-term toxicity is
acceptable.
8052 General Poster Session (Board #33A), Mon, 1:15 PM-5:15 PM
Radioimmunotherapy efficiency and safety in consolidation and relapse
treatment of aggressive B-cell non-Hodgkin lymphoma: An updated analysis
of 230 patients of the international RIT-network. Presenting Author:
Karin Hohloch, Hematology and Oncology, Georg August University Göttingen,
Goettingen, Germany
Background: In aggressive lymphoma, few reliable clinical data about the
use of radioimmunotherapy exist. Pts. with DLBCL registered in the
international RIT-Network (RIT-NT) were analyzed with regard to Indication,
line of therapy and outcome. Methods: The RIT-NT recruited 1111 pts.
between Dec. 2006 and 2010. It is a web-based registry that collects
observational data from RIT-treated patients with malignant lymphoma.
232 pts. with DLBCL registered in the database were evaluated in the
analysis. Results: 232 pts with DLBCL are registered, 17 pts were excluded.
Histologic subtypes: 190 DLBCL, 15 primary mediastinal, 9 large cell
anaplastic, 1 intravascular. Median age was 62 years (range 17-88), 27%
of pts �70 years old. Stage I 16pts, II 54 pts, III 60 pts, IV 68 pts; 6
extranodal involvement, for 11 pts. stage is not documented. 187 pts had
1-3 previous chemotherapies (Ctx), 21 pts 4-6 previous Ctx, 1 pts had 7
previous Ctx, for 6 pts. previous Ctx is not documented. 15 pts. had
previous RIT and 24 pts a stem cell transplantation prior to RIT. 6 pts had
bone marrow infiltration prior to RIT, 3 with more than 25%. 87 pts had RIT
as first line (8 pts. conditioning, 68 pts consolidation, 1 primary therapy,
10 other), and 84 pts received RIT in relapse (2d to 8 th. line therapy) (2
pts. conditioning, 31 pts consolidation, 26 recurrence, 19 therapy refractory,
6 other). Grade IV° hematotoxicity occured for neutrophils and
platelets, grade III° for hemoglobin after RIT. Median time to recovery of
blood count was 81 days (range 0-600 days). ORR was 63,3 %; CR 54,4%;
PR 8,8%, SD 0,9%, PD 23,7%, N.D. 12%. CR rate first line was 76,3 %,
for relapse 44,3%. Mean overall survival (OS) in first line was 26,5 months
14,3 months for pts. treated in relapse or refractory disease. Conclusions:
Most pts. with DLBCL in the RIT-N received RIT as consolidation after first
line therapy with excellent CR rates and OS compared to published data
from risk groups . In relapsed DLBCL RIT is a safe and feasible treatment
leading to satisfactory response rates with low toxicity. A prospective
randomized phase III trial in front line DLBCL is currently planned (ZEST).
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