12th Congress of the European Hematology ... - Haematologica

plete remission or recurrent disease after previous chemotherapy.
ESHAOx consisted of E, 40 mg/m 2 on days 1 to 4; S, 500 mg on days 1
to 5; HA, 2 g/m 2 on day 5; and Ox, 130 mg/m 2 on day 1, every 3 weeks.
Eligible patients were scheduled to receive a maximum of 6 cycles, and
high dose chemotherapy and hematopoietic stem cell rescue allowed.
Responses were evaluated every 3 cycles. All patients gave written
informed consent before study entry. Results. Between May 2006 and January
2007, 27 patients were enrolled. Nineteen (70%) patients with
relapsed, 8 patients with refractory, and 10 (37%) patients with IPI 3-5
were included in this study. Twenty patients were evaluable for response
with 7 ongoing and 26 for toxicity. A total of 61 cycles were administered
for a median number of 2 (range 1-5) per patient. There were 4
(20%) complete responses and 6 (30%) partial responses, producing an
overall response rate of 50% (95% CI, 28-72%). Most common grade 3/4
toxicity of the courses was myelosuppression with including neutropenia
(39%) and thrombocytopenia (20%). There was one therapy-related
death due to neutropenic sepsis. Non-hematologic toxicity was very
favorable. Conclusions. The preliminary results of ESHAOx combination
showed antitumor activity and favorable toxicity profile, suggesting it
can be used as salvage regimen for relapsed/refractory aggressive NHL
patients.
0721
LONG-TERM SURVIVAL OF A BROAD AGE POPULATION OF PATIENTS WITH MANTLE CELL
LYMPHOMA AFTER FRONTLINE HIGH DOSE SEQUENTIAL CHEMOTHERAPY WITH RITUX-
IMAB AND AUTOLOGOUS STEM CELL TRANSPLANTATION
S. Cortelazzo, 1 A. Billio, 2 M. Magni, 3 A. Rossi, 2 M. Pintimalli, 2
M. Marchesi, 4 M. Zanni, 4 M. Mian, 2 C. Tarella4 M. Boccadoro, 4
A. Andreini, 4 F. Benedetti, 4 G. Pizzolo, 4 M. Gianni, 3 A. Rambaldi2 1 Hematology BZ, BOLZANO; 2 Division of Hematology, BOLZANO; 3 Chair of
Oncology, MILAN; 4 Chair of Hematology, TURIN, Italy
Intensive therapeutic programs improve the clinical outcome of MCL,
but are toxic in elderly patients and did not prevent the continuous
relapse rate. The aim of the present study was to evaluate if an up-front
Rituximab supplemented and age-adapted high-dose sequential
chemotherapy (R-HDS) supported by ASCT can improve the survival of
a broad age population with disseminated MCL. From. 1992 to 2005, 54
patients (pts) 60 years (group 2) were
enrolled in the study. The majority of both groups had an advanced
stage, bone marrow infiltration and >1 IPI risk factors. Group 1 received
standard R-HDS including: HD-cyclophosphamide (CTX) 7 gr/sqm and
HD-Ara-C (2 g/sqm every 12 hours for 6 days), followed by HDS HDmelphalan
(180 mg/sqm) and/or HD-mitoxantrone plus melphalan (60
and 180 mg/sqm) and ASCT. Rituximab (375 mg /sqm) was given for a
total of 6 doses, twice after HD-CTX and HD-Ara-C, as in vivo purging
before CD34 + cells harvest and twice after ASCT. Elderly patients
received an age-adapted R-HDS: HD-CTX (3-4 gr/sqm) and HD-Ara-C
(1-1.5 g/sqm every 12 hours for 3-5 days), followed by HD-melphalan
(120 mg/sqm) and HD-mitoxantrone plus melphalan (40 and 120
mg/sqm). 35 pts (65%) in group 1 and 9 (47%) in group 2 completed the
planned program. After ASCT the CR rate was 89% in young and 95%
in elderly patients and the treatment-related mortality was 4%. With a
median follow-up of 43 months (range 6-101) in group 1 and 30 months
(range 9-68) in group 2, the 5-year estimated OS, EFS and DFS were
respectively 77%, 71% and 72%, in group 1 and 58%, 56% and not yet
achieved in group 2. We conclude that R-HDS produces long-term remissions
with a manageable toxicity also in elderly pts with advanced stage
MCL.
0722
MUCOSA-ASSOCIATED LYMPHOID TISSUE LYMPHOMA IN PATIENTS WITH HUMAN
IMMUNODEFICIENCY VIRUS INFECTION
E. Boulanger, 1 V. Meignin, 1 M. Baia, 2 V. Molinier-Frenkel, 2 K. Leroy, 2
J.C. Delchier, 2 M. Bentata, 3 C. Goujard, 4 D. Salmon, 5 M.A. Valantin, 6
Y. Levy, 2 E. Oksenhendler, 1 L. Gerard, 1 C. Copie-Bergman2 1 Hopital Saint Louis, PARIS; 2 Hopital Henri Mondor, CRETEIL; 3 Hopital Avicenne,
BOBIGNY; 4 Hopital Bicetre, LE KREMLIN BICETRE; 5 Hopital Cochin,
PARIS; 6 Hopital Pitie-Salpetriere, PARIS, France
Background. In Human Immunodeficiency Virus (HIV)-infected
patients, the risk of non-Hodgkin lymphoma is significantly increased
compared to the general population. However, mucosa-associated lymphoid
tissue (MALT) lymphomas have been only occasionally reported
during the setting of HIV infection. Aims. To describe the features of a
retrospective series of 8 HIV-infected patients affected with MALT lymphoma.
Methods. Morphological and immunohistochemical analyses
including BCL10 immunostaining, were performed, as well as in situ
hybridization for Epstein-Barr virus-encoded RNA (EBER) detection, fluorescence
in situ hybridization (FISH) analyses with MALT1,
immunoglobulin heavy chain (IGH) and BCL10 probes, PCR detection
of monoclonal IGH gene rearrangements and RT-PCR detection of API2-
MALT1 chimeric transcript resulting from the t(11;18)(q21;q21) translocation.
Results. Four men and four women with a median age of 42 years
(range, 35-67) were included. Six patients were infected with HIV-1, one
with HIV-2 and one with HIV-O. Upon lymphoma diagnosis, 5 patients
were receiving antiretroviral treatment, consisting of a highly active antiretroviral
therapy (HAART) in 2 cases. The median CD4 + cell count was
191×10 6 /L (range, 44-640), and the plasma HIV RNA load, available in 7
cases, ranged from undetectable to 351,516 copies/mL (median, 8,813
copies/mL). One patient had a salivary gland lymphoma, and 7 had a gastric
lymphoma, concomitant in one case with a pulmonary involvement.
Disease stage was IE in 4 cases, IIE in 2 cases, and IV in the 2 others. Histological
analyses of tumour samples displayed typical features of MALT
lymphoma in all cases, with focal transformation into diffuse large B-cell
lymphoma (DLBCL) in 2 cases. Concomitant Helicobacter pylori (Hp)
infection of the stomach was found in 6 cases, including 5 patients with
a gastric lymphoma. Immunohistochemistry showed a nuclear expression
of BCL10 in the 5 studied cases. Three cases were found to be EBERnegative,
whereas less than 1% EBER + cells were detected in 4 cases. A
monoclonal rearrangement of IGH gene was detected in 4 cases out of
6 analyzed. RT-PCR and/or FISH analysis performed in 7 cases, displayed
the presence of t(11;18) translocation in one case. Treatment for lymphoma
consisted of Hp eradication therapy in the 5 patients with a Hpassociated
gastric MALT lymphoma. Four of them achieved a complete
remission (CR) whereas the disease remained stable in one patient, due
to Hp resistance to 4 lines of antibiotic treatment. Partial gastrectomy followed
by CHOP-derived chemotherapy was performed in one case with
focal DLBCL. Surgical resection of a pulmonary lobe was performed in
one case. One patient was treated with rituximab alone. All the patients
received HAART from 0 to 30 months after lymphoma diagnosis. Five
patients achieved a CR after the first-line treatment. Subsequent transformation
into DLBCL occured in the lung of one patient. To date, 7
patients are alive, from 12 to 111 months after diagnosis, including 5
patients in CR and 2 with stable disease. One patient in CR died at 66
months, with cerebrovascular accident. Conclusions. In HIV-infected
patients, MALT lymphoma seems to have an indolent clinical course
similar to MALT lymphomas occuring in immunocompetent patients.
Table 1.
12 th Congress of the European Hematology Association
haematologica/the hematology journal | 2007; 92(s1) | 269