Autologous and Allogeneic Stem-Cell Transplantation for Transformed Follicular Lymphoma: A Report of the Canadian Blood and Marrow Transplant Group

Villa, Diego; Crump, Michael; Panzarella, Tony; Savage, Kerry J.; Toze, Cynthia L.; Stewart, Douglas A.; MacDonald, David; Buckstein, Rena; Lee, Christina; Alzahrani, Mohsen; Rubinger, Morel; Foley, Ronan; Xenocostas, Anargyros; Sabloff, Mitchell; Muccilli, Alexandra; Chua, Neil; Couture, Félix; Larouche, Jean-François; Cohen, Sandra; Connors, Joseph M.; Ambler, Kimberley; Al-Tourah, Abdulwahab J.; Ramadan, Khaled M. A.; Kuruvilla, John

doi:10.1200/jco.2012.44.0693

Cited by 96 publications

(95 citation statements)

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“…on May 10, 2018. by guest www.bloodjournal.org From DLBCL, 64 and has also been the traditional approach in patients with follicular lymphoma who experience histologic transformation to a more aggressive lymphoma. [65][66][67] Based in large part on extrapolation of this data, CHOP (and more recently R-CHOP) has been the initial treatment approach for CLL patients who experience RS. The efficacy of R-CHOP in CLL patients with RS was first prospectively evaluated in the CLL2G trial of the German CLL study group that enrolled 15 patients with RS.…”

Section: What Are the Treatment Options For Patients With Rs?mentioning

confidence: 99%

“…These studies suggest that SCT is feasible in patients with RS and may be associated with improved outcomes. 65,67 Although all of these studies are subject to potential selection bias and are limited by the fact that the clonal relationship of the CLL and DLBCL was not determined, collectively they suggest that "fit" RS patients with limited comorbidities who have a donor available and demonstrate chemosensitive disease benefit from postremission SCT.…”

Section: Role Of Stem Cell Transplantationmentioning

confidence: 99%

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How we treat Richter syndrome

Parikh

Kay

Shanafelt

2014

Blood

158

146

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Richter syndrome (RS) is defined as the transformation of chronic lymphocytic leukemia (CLL) into an aggressive lymphoma, most commonly diffuse large B-cell lymphoma (DLBCL). RS occurs in approximately 2% to 10% of CLL patients during the course of their disease, with a transformation rate of 0.5% to 1% per year. A combination of germline genetic characteristics, clinical features (eg, advanced Rai stage), biologic (ζ-associated protein-70+, CD38+, CD49d+) and somatic genetic (del17p13.1 or del11q23.1) characteristics of CLL B cells, and certain CLL therapies are associated with higher risk of RS. Recent studies have also identified the crucial role of CDKN2A loss, TP53 disruption, C-MYC activation, and NOTCH1 mutations in the transformation from CLL to RS. An excisional lymph node biopsy is considered the gold standard for diagnosis of RS; a 18F-fluorodeoxyglucose positron emission tomography scan can help inform the optimal site for biopsy. Approximately 80% of DLBCL cases in patients with CLL are clonally related to the underlying CLL, and the median survival for these patients is approximately 1 year. In contrast, the remaining 20% of patients have a clonally unrelated DLBCL and have a prognosis similar to that of de novo DLBCL. For patients with clonally related DLBCL, induction therapy with either an anthracycline- or platinum-based regimen is the standard approach. Postremission stem cell transplantation should be considered for appropriate patients. This article summarizes our approach to the clinical management of CLL patients who develop RS.

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Section: What Are the Treatment Options For Patients With Rs?mentioning

confidence: 99%

Section: Role Of Stem Cell Transplantationmentioning

confidence: 99%

How we treat Richter syndrome

Parikh

Kay

Shanafelt

2014

Blood

158

146

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“…28 Aggressive histology transformation of an indolent lymphoma often involves SCT as part of the management strategy, but there may be a rationale for favoring ASCT in this group of patients on the basis of the available data. 29,30 The grade of FL and type of transplant remain controversial. The National Comprehensive Cancer Network (NCCN) guidelines suggest treating grade 3 FL (FL3) as an aggressive NHL without a distinction between FL3 subtypes.…”

Section: Sct In the Relapsed Or Refractory Settingmentioning

confidence: 99%

The role of autologous and allogeneic stem cell transplantation in the management of indolent B-cell lymphoma

Kuruvilla

2016

Blood

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Despite improvements over the past decade in the overall survival of patients with indolent non-Hodgkin lymphomas, these lymphomas remain largely incurable with standard therapies. Immunochemotherapy with rituximab-based regimens has become a well-established standard of care in the primary and relapsed disease settings. The role of hematopoietic stem cell transplantation in indolent lymphoma has been defined by the adoption of this therapy largely in the relapse setting because randomized trials in the first-line setting have not shown survival advantages. Allogeneic stem cell transplantation has the possibility for cure because of the potential for immunologic graft-versus-lymphoma effect, but there are significant concerns regarding nonrelapse mortality. Autologous stem cell transplantation offers a safe treatment platform, but relapse remains a significant issue. The role of transplantation in the current treatment landscape of immunochemotherapy has not been conclusively proven, and randomized trials are lacking. This review summarizes the current relevant data regarding transplantation in indolent non-Hodgkin lymphoma and highlights the issues relevant to clinicians in the field.

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“…Histologic transformation into an aggressive lymphoma occurs in 17%, 28%, and 37% of FL patients after 5, 10, and 15 y, respectively, with an apparent plateau at 15 y, after which transformation rarely seems to occur (1). There is increasing evidence that autologous consolidation of transformation of FL (TF) patients as first-line treatment may improve survival (2)(3)(4). Furthermore, retrospective analyses suggest that patients can be cured more often when transformation is diagnosed at an early stage (5,6).…”

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confidence: 99%

¹⁸F-FDG or 3′-Deoxy-3′-¹⁸F-Fluorothymidine to Detect Transformation of Follicular Lymphoma

et al. 2015

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Considering the different treatment strategy for transformed follicular lymphoma (TF) as opposed to follicular lymphoma (FL), diagnosing transformation early in the disease course is important. There is evidence that 18 F-FDG has utility as a biomarker of transformation. However, quantitative thresholds may require inclusion of homogeneous non-Hodgkin lymphoma subtypes to account for differences in tracer uptake per subtype. Moreover, because proliferation is a hallmark of transformation, 3′-deoxy-3′-18 F-fluorothymidine ( 18 F-FLT) might be superior to 18 F-FDG in this setting. To define the best tracer for detection of TF, we performed a prospective a headto-head comparison of 18 F-FDG and 18 F-FLT in patients with FL and TF. Methods: 18 F-FDG and 18 F-FLT PET scans were obtained in 17 patients with FL and 9 patients with TF. We measured the highest maximum standardized uptake value (SUV max ), defined as the lymph node with the highest uptake per patient, and SUV range , defined as the difference between the SUV max of the lymph node with the highest and lowest uptake per patient. To reduce partial-volume effects, only lymph nodes larger than 3 cm 3 (A50 isocontour) were analyzed. Scans were acquired 1 h after injection of 185 MBq of 18 F-FDG or 18 F-FLT. To determine the discriminative ability of SUV max and SUV range of both tracers for TF, receiver-operatingcharacteristic curve analysis was performed. Results: The highest SUV max was significantly higher for TF than FL for both 18 F-FDG and 18 F-FLT (P , 0.001). SUV range was significantly higher for TF than FL for 18 F-FDG (P 5 0.029) but not for 18 F-FLT (P 5 0.075). The ability of 18 F-FDG to discriminate between FL and TF was superior to that of 18 F-FLT for both the highest SUV max (P 5 0.039) and the SUV range (P 5 0.012). The cutoff value for the highest SUV max of 18 F-FDG aiming at 100% sensitivity with a maximum specificity was found to be 14.5 (corresponding specificity, 82%). For 18 F-FLT, these values were 5.1 and 18%, respectively. When the same method was applied to SUV range , the cutoff values were 5.8 for 18 F-FDG (specificity, 71%) and 1.5 for 18 F-FLT (specificity, 36%). Conclusion: Our data suggest that 18 F-FDG PET is a better biomarker for TF than 18 F-FLT PET. The proposed thresholds of highest SUV max and SUV range should be prospectively validated.

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Autologous and Allogeneic Stem-Cell Transplantation for Transformed Follicular Lymphoma: A Report of the Canadian Blood and Marrow Transplant Group

Abstract: Patients undergoing autoSCT had better outcomes than those treated with rituximab-containing chemotherapy alone. AlloSCT did not improve outcome compared with rituximab-containing chemotherapy and was associated with clinically significant toxicity.

Cited by 96 publications

References 34 publications

How we treat Richter syndrome

How we treat Richter syndrome

The role of autologous and allogeneic stem cell transplantation in the management of indolent B-cell lymphoma

¹⁸F-FDG or 3′-Deoxy-3′-¹⁸F-Fluorothymidine to Detect Transformation of Follicular Lymphoma

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Autologous and Allogeneic Stem-Cell Transplantation for Transformed Follicular Lymphoma: A Report of the Canadian Blood and Marrow Transplant Group

Abstract: Patients undergoing autoSCT had better outcomes than those treated with rituximab-containing chemotherapy alone. AlloSCT did not improve outcome compared with rituximab-containing chemotherapy and was associated with clinically significant toxicity.

Cited by 96 publications

References 34 publications

How we treat Richter syndrome

How we treat Richter syndrome

The role of autologous and allogeneic stem cell transplantation in the management of indolent B-cell lymphoma

18F-FDG or 3′-Deoxy-3′-18F-Fluorothymidine to Detect Transformation of Follicular Lymphoma

Contact Info

Product

Resources

About

¹⁸F-FDG or 3′-Deoxy-3′-¹⁸F-Fluorothymidine to Detect Transformation of Follicular Lymphoma