Aiming at a Curative Strategy for Follicular Lymphoma

Bendandi, Maurizio

doi:10.3322/ca.2008.0011

Cited by 34 publications

(25 citation statements)

References 139 publications

(169 reference statements)

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“…All included studies, regardless of whether they are published or not, were assessed for internal advanced stage disease (Ann Arbor stage III or IV) and cannot be cured with conventional therapy. The prognosis was good for patients with follicular lymphoma, for whom the median survival is 8-10 years [5]. However, many patients with mantle cell lymphoma (60-70%) have more aggressive disease, and for them, the progression-free survival is very short and the median overall survival is 3-4 years [6].…”

Section: Study Selection Quality Assessment and Data Extractionmentioning

confidence: 99%

A systematic review and meta-analysis of immunochemotherapy with rituximab for B-cell non-Hodgkin's lymphoma

et al. 2010

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Oncology, Huashan Hospital, Fudan University, Shanghai, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China Abstract Background. Although some randomized controlled trials had compared the anti-CD20 monoclonal antibody rituximab plus chemotherapy (R-chemo) to chemotherapy alone for B-cell non-Hodgkin's lymphoma, the curative effects of R-chemo were still controversial. A systematic review and meta-analysis was performed to examine the effi cacy of using R-chemo compared with the identical chemotherapy alone in the patients with B-cell non-Hodgkin's lymphoma. Material and methods. Medical databases and conference proceedings were searched for randomized controlled trials which compared R-chemo with chemotherapy alone in patients with newly diagnosed or relapsed B-cell non-Hodgkin's lymphoma. Endpoints were overall survival, overall response, disease control, and adverse events. Results. Twelve eligible trials were identifi ed, reporting outcomes of 4 996 patients. Fixed-effects analysis showed overall survival to be superior for R-chemo-treated patients (relative risks [RR], 1.09; 95%confi dence interval [CI], 1.06-1.12, p Ͻ0.00001). Superiority was also observed for the patients receiving R-chemo with respect to overall response (RR, 1.17; 95%CI, 1.10-1.25, p Ͻ0.00001), complete response (RR, 1.52; 95%CI, 1.27-1.82, p Ͻ0.00001), and disease control (RR, 1.36; 95%CI, 1.26-1.46, p Ͻ0.00001). R-chemo improved overall survival, overall response and disease control in patients with diffuse large B-cell lymphoma (RR, 1.11, 95%CI: 1.06-1.16, p Ͻ0.0001; RR, 1.09, 95%CI: 1.01-1.19, pϭ0.03 and RR, 2.00, 95%CI: 1.59-2.53, pϽ 0.00001, respectively) and follicular lymphoma (RR, 1.08, 95%CI: 1.04-1.12, p Ͻ0.0001; RR, 1.19, 95%CI: 1.07-1.33, p ϭ0.001 and RR, 2.58, 95%CI: 1.61-4.12, p Ͻ0.0001, respectively). Meanwhile, R-chemo improved overall response in patients with mantle cell lymphoma (RR, 1.22, 95%CI: 1.07-1.40, p ϭ0.004). Conclusion. R-chemo is superior to chemotherapy alone in patients with B-cell non-Hodgkin's lymphoma, especially for diffuse large B-cell lymphoma and follicular lymphoma.Non-Hodgkin's lymphoma is the most common hematologic cancer in adults, with the incidence of more than 66 000 cases anticipated in the United states in 2008 [1]. Approximately 85% of nonHodgkin's lymphomas in adults are of B-cell origin. Some B-cell non-Hodgkin's lymphomas are indolent, or slow growing, yet incurable. In contrast, others are aggressive or highly aggressive, and may be rapidly fatal, yet are often curable [2]. Diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL) and mantle cell lymphoma (MCL) are the main subtypes of B-cell lymphoma. Diffuse large B-cell lymphoma, with shorter overall survival and progression-free survival, is the most common subtype of aggressive B-cell lymphoma. Although patients with diffuse large B-cell lymphoma are potentially curable when treated with standard regimen: cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) and t...

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Section: Study Selection Quality Assessment and Data Extractionmentioning

confidence: 99%

A systematic review and meta-analysis of immunochemotherapy with rituximab for B-cell non-Hodgkin's lymphoma

et al. 2010

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“…For this reason, the association of rituximab and polychemotherapy, whether or not preceded by splenectomy, can be considered as the most appropriate treatment for this setting of patients. 61 The issue of treating MCL has been thoroughly discussed in a recent article of this "How I Treat" series. 62 In the splenic forms of MCL, the neoplastic clone commonly shows an overt leukemic dissemination and BM involvement and harbors a mutated Ig repertoire with a higher frequency than nodal MCLs do.…”

Section: Treatment Strategies In Slsmentioning

confidence: 99%

How I diagnose and treat splenic lymphomas

Iannitto

Tripodo

2011

Blood

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The incidental finding of an isolated splenomegaly during clinical assessment of patients evaluated for unrelated causes has become increasingly frequent because of the widespread use of imaging. Therefore, the challenging approach to the differential diagnosis of spleen disorders has emerged as a rather common issue of clinical practice. A true diagnostic dilemma hides in distinguishing pathologic conditions primarily involving the spleen from those in which splenomegaly presents as an epiphenomenon of hepatic or systemic diseases. Among the causes of isolated splenomegaly, lymphoid malignancies account for a relevant, yet probably underestimated, number of cases. Splenic lymphomas constitute a wide and heterogeneous array of diseases, whose clinical behavior spans from indolent to highly aggressive. Such a clinical heterogeneity is paralleled by the high degree of biologic variation in the lymphoid populations from which they originate. Nevertheless, the presenting clinical, laboratory, and pathologic features of these diseases often display significant overlaps. In this manuscript, we present our approach to the diagnosis and treatment of these rare lymphomas, whose complexity has been so far determined by the lack of prospectively validated prognostic systems, treatment strategies, and response criteria. (Blood. 2011;117(9):2585-2595)

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“…Tiene una mayor incidencia en pacientes de edad media avanzada (60 años). Es una enfermedad de progresión lenta y curso indolente, por lo que se suele diagnosticar ya en estadios avanzados, siendo común la afectación de áreas extralinfáticas 1 . Esta enfermedad suele responder bien a los tratamientos convencionales de quimioterapia, consiguiéndose en la mayoría de los casos respuestas clínicas completas (RC).…”

Section: Características Clínicasunclassified

Vacuna idiotípica en el tratamiento del linfoma folicular: situación actual y perspectivas futuras

Zabalegui¹,

Cerio²,

Inogés³

et al. 2009

Anales Sis San Navarra

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RESUMENEl linfoma folicular (LF) está considerado como el segundo tipo de linfoma no-Hodgkin más común, representando más del 20% del total de los linfomas. Es una enfermedad de progresión lenta y curso indolente en la que, a pesar de la buena respuesta al tratamiento, las recaídas son muy frecuentes y cada vez es más difí-cil conseguir respuestas completas. Por ello, se puede considerar que hasta el momento, el LF es incurable. La búsqueda continua de nuevas estrategias terapéu-ticas en enfermedades neoplásicas, junto con un mejor conocimiento del sistema inmunitario, ha llevado a la aparición de una nueva disciplina, conocida con el nombre de inmunoterapia, que aprovecha la capacidad del sistema inmunitario de atacar lo extraño sin dañar lo propio. El LF es un tumor muy apropiado para este tipo de tratamiento por presentar un antígeno específi-co de tumor: el idiotipo de la inmunoglobulina monoclonal expresada en la membrana de todas las células tumorales. Se han realizado diversos estudios en los que se ha probado la inmunoterapia como tratamiento complementario al tratamiento convencional. Recientemente, nuestro grupo ha publicado un estudio en el que se observa claramente que los resultados que se obtienen tras la vacunación idiotípica, cuando se consigue la inmunización adecuada del paciente, son mejores que los obtenidos con quimioterapia sola. En este sentido, es necesario seguir investigando para aclarar si la vacunación idiotípica pudiera no sólo mantener remisiones completas duraderas en los pacientes vacunados, sino incluso conseguir la curación de los mismos. Por ello, resulta interesante abordar un mejor planteamiento de los ensayos clínicos, la mejora de la producción de la vacuna y el estudio de mecanismos de la célula tumoral capaces de modificar la inmunoglobulina específica del tumor.Palabras clave. Linfoma folicular. Inmunoterapia. Vacuna idiotípica. Glicosilación. Splicing alternativo. ABSTRACTFollicular lymphoma is the second most prevalent non-Hodgkin lymphoma, representing 20% of all lymphomas. Follicular lymphoma is an indolent disease with a slow progression in which, although exhibiting a good response to treatment, relapse is very frequent and complete remission is not easy to maintain. Therefore, the disease is regarded as incurable. The search for new therapeutic strategies, together with a better understanding of the immune system, has led to the emergence of a new treatment named immunotherapy. Follicular lymphoma is a malignancy suitable for this kind of treatment given the fact that it is characterized by presenting a unique tumour-specific antigen: the idiotype of the monoclonal immunoglobulin displayed on the membrane of tumour cells. Several studies have been conducted to test immunotherapy as complementary to conventional treatment. In a previous study by our group, a clear benefit was evident is obtained after idiotypic vaccination, when an adequate immunization of the patient is obtained, in comparison to chemotherapy alone. In this sense, analysis is needed of whether idi...

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Aiming at a Curative Strategy for Follicular Lymphoma

Cited by 34 publications

References 139 publications

A systematic review and meta-analysis of immunochemotherapy with rituximab for B-cell non-Hodgkin's lymphoma

A systematic review and meta-analysis of immunochemotherapy with rituximab for B-cell non-Hodgkin's lymphoma

How I diagnose and treat splenic lymphomas

Vacuna idiotípica en el tratamiento del linfoma folicular: situación actual y perspectivas futuras

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