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Treatment progress of relapsed/refractory Hodgkin lymphoma

Journal of Leukemia & Lymphoma.2018;27(12):705-707,711. doi:10.3760/cma.j.issn.1009-9921.2018.12.001

Hodgkin lymphoma (HL) is a curable malignancy for most patients, while the treatment of relapsed and refractory (R/R) HL is still facing severe challenges. In the 60th American Society of Hematology (ASH) Annual Meeting, many researches reported the latest development of the treatment of R/R HL. For chemosensitive patients, autologous stem cell transplantation after high-dose of salvage chemotherapy still remains the standard treatment method. The emerging of antibody drug conjugate, inhibitors of programmed death-1, chimeric antigen receptor T-cell immunotherapy and the combinations of multiple drugs have brought an increasing options for R/R HL treatment. This paper reviews the progress of R/R HL therapy.

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Treatment progress of mantle cell lymphoma

Jing TANG ; Wei XU

Journal of Leukemia & Lymphoma.2018;27(12):708-711. doi:10.3760/cma.j.issn.1009-9921.2018.12.002

In recent years, the incidence of non-Hodgkin lymphoma (NHL) is on the rise. Among the newly diagnosed NHL patients, 3 %-10 % are mantle cell lymphoma (MCL), which is common in middle-aged and elderly men, and the incidence of extranodal aggression is more in stage Ⅲ or Ⅳ. MCL has clinical and pathological features of the invasiveness in invasive lymphoma and the incurability in indolent lymphoma. Although the application of new drugs has made more progress in the treatment of MCL, the overall survival rate is not good; the majority of patients relapse after treatment, and there are no standard treatment regimens. The progresses in MCL will be summarized in this paper based on the reports in the 60th American Society of Hematology (ASH) Annual Meeting.

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Treatment progress of peripheral T-cell lymphoma

Rong HUANG ; Lei FAN

Journal of Leukemia & Lymphoma.2018;27(12):712-715. doi:10.3760/cma.j.issn.1009-9921.2018.12.003

Peripheral T-cell lymphoma (PTCL), also known as mature T-cell lymphoma, is a group of malignant proliferative diseases derived from mature T cells. Because natural killer (NK) cells are similar in immunophenotype and function to T cells, NK-cell lymphoma and mature T-cell lymphoma are often classified as one class. The 60th American Society of Hematology (ASH) Annual Meeting has covered various fields about PTCL, especially in terms of treatment. Brentuximab vedotin combined with CHP regimen, histone deacetylase inhibitor combined with HMA regimen, and classic CHOP regimen together with lenalidomide or alemtuzumab provide new options for the treatment of PTCL patients; novel drugs represented by JAK inhibitors, daratumumab, and TP53 inhibitors have also initially demonstrated clinical utility, but large-scale clinical trials are still needed for validation.

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Treatment progress of relapsed/refractory diffuse large B-cell lymphoma

Jiaqi QIN ; Wei XU

Journal of Leukemia & Lymphoma.2018;27(12):716-720,724. doi:10.3760/cma.j.issn.1009-9921.2018.12.004

Patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) after two or more lines of therapy and who are not candidates for stem cell transplantation have limited effective treatment options, resulting in a poor prognosis, thus, treatments with novel mechanisms of action are urgently needed. In the 60th American Society of Hematology (ASH) Annual Meeting, detailed reports focused on the research progresses of single agent, drug combination and chimeric antigen receptor T cell (CAR-T) therapy, providing more treatment options for R/R DLBCL patients.

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Progress of chemotherapy-free regimens in follicular lymphoma

Jin MAO ; Wei XU

Journal of Leukemia & Lymphoma.2018;27(12):721-724. doi:10.3760/cma.j.issn.1009-9921.2018.12.005

Follicular lymphoma (FL) is a kind of indolent non-Hodgkin lymphoma (HL) originating from the follicular germinal center. Chemotherapy could cause a variety of adverse reactions, such as infection, secondary malignancies and myelosuppression. The new "chemotherapy-free" treatment can significantly improve the tolerance of FL patients. The emergence of chemotherapy-free regimens such as venetoclax combined with rituximab and new non-chemotherapy drugs such as anti-CD20 and anti-CD3 bispecific IgG4 antibody REGN1979 provide new therapeutic regimens and ideas for primary and relapsed/refractory FL patients.

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Clinical significance of bone marrow immunopathologic detection: analyses of 266 newly diagnosed lymphoma cases

Mingsuo LIU ; Shunan WANG ; Yingmin LIU ; Wei GUO ; Xin WAN ; Mohan WANG ; Ou BAI

Journal of Leukemia & Lymphoma.2018;27(12):725-730. doi:10.3760/cma.j.issn.1009-9921.2018.12.006

Objective To investigate the clinical significance of bone marrow immunopathogenesis in the diagnosis and staging of lymphoma. Methods Clinical data of 266 patients with newly diagnosed lymphoma admitted to Department of Hematology in the First Hospital of Jilin University from August 2015 to December 2017 were retrospectively analyzed. The results of lymphoma diagnosis and staging in different bone marrow detection methods were compared, SPSS 22.0 software was used to make statistical analysis and χ2 test was used to compare the positive rates of lymphoma bone marrow infiltration in different methods. Results In the 266 patients, 64 cases (24.1 %) were diagnosed with lymphoma by using bone marrow detection on the condition that no lymph node pathology was available and all the immunophenotypes of 64 cases were identified by bone marrow immunopathology. Bone marrow infiltration was identified in 121 patients (45.5 %), among which the rate of bone marrow infiltration was 0 (0/12) in Hodgkin lymphoma (HL) and 47.6 % (121/254) in non-Hodgkin lymphoma (NHL). The rate of bone marrow infiltration was 50.0 % (105/210) and 36.4 % (16/44) in B type and T type NHL respectively. The positive rate of bone marrow infiltration detected by bone marrow smear, bone marrow biopsy, bone marrow flow cytometry and bone marrow immunopathology were 78.5 % (95/121), 87.6 % (106/121), 89.3 % (108/121), 96.7 % (117/121) respectively. Bone marrow immunopathology was more advantageous than any other methods, and there was a statistical difference (χ2＝18.38, 9.09, 3.76; all P < 0.05). Among 121 patients who were identified with bone marrow infiltration by bone marrow detection, the staging of 42 patients (34.7 %) were amended, including the staging of 39 amended patients (32.2 %) through bone marrow immunopathologic detection. Conclusion Bone marrow immunopathology can be used for the diagnosis and classification of lymphoma, which has an obvious advantage in detecting bone marrow infiltration of lymphoma compared with bone marrow smear, bone marrow biopsy, bone marrow flow cytometry, and it can be used to amend the clinical staging.

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Analysis of clinical features in pulmonary lymphoma

Lu LIU ; Hui LI ; Na XU ; Zhongkun LI ; Hong XIA ; Hongtao REN ; Hao YU ; Na LI ; Huizheng BAO

Journal of Leukemia & Lymphoma.2018;27(12):731-734,739. doi:10.3760/cma.j.issn.1009-9921.2018.12.007

Objective To investigate the clinical features of pulmonary lymphoma and to get a better understanding of this disease. Methods Clinical data of 253 lymphoma patients in the Department of Lymphoma and Hematology in Jilin Cancer Hospital from October 2014 to March 2017 were retrospectively analyzed. The patients were divided into 30 cases of pulmonary lymphoma (lung lymphoma group) and 223 cases of non-pulmonary lymphoma (the control group). Rate assay and latex turbidimetry was used to detect lactic dehydrogenase (LDH) and β2macroglobulin (β2-MG) respectively. The expressions of programmed death 1 (PD-1), programmed death ligand 1 (PD-L1) and cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) in peripheral blood CD4 +CD8 +T lymphocytes were detected by using flow cytometry. The count and measurement data of both groups were compared by using χ 2test and t test respectively. Results The patients in pulmonary lymphoma group showed secondary lesions. The proportion of smoking people in pulmonary lymphoma group was higher than that in the control group [43.3 % (13/30) vs. 24.2 % (54/223), χ 2＝ 4.964, P＝ 0.026]. The proportion of the patients in Ⅲ-Ⅳ stage in pulmonary lymphoma group was higher than that in the control group [93.3 % (28/30) vs. 57.0 % (127/223), χ2＝ 14.750, P < 0.001]. The proportion of the patients with higher international prognostic index (IPI) score in pulmonary lymphoma group was higher than that in the control group (χ2＝ 21.888, P < 0.001). The proportion of the patients with increased expression of β2-MG in pulmonary lymphoma group was higher compared with the control group [66.7 % (20/30) vs. 50.2 % (112/223), χ2＝6.682, P ＝0.091]. The proportion of the patients with the increased LDH was higher compared with the control group [63.3 % (19/30) vs. 41.5 % (86/223)], and the difference was statistically significant (χ2＝ 6.682, P ＝ 0.010). Diffuse large B-cell lymphoma (DLBCL) was the common pathological type in pulmonary lymphoma group (15 cases), followed by Hodgkin lymphoma (7 cases); imaging showed single mass or nodular type, multiple masses or nodular type, bilateral pulmonary infiltration, pleural effusion were 36.7 % (11/30), 30.0 % (9/30), 63.3 % (19/30) and 36.7 % (11/30), respectively. There were no statistical differences in the protein expression of immune check points such as PD-1, PD-L1 and CTLA-4 in both groups (all P ＞ 0.05). Conclusions Pulmonary DLBCL should be considered a secondary disease, but not a primary lesion. Smoking history is a risk factor for lymphoma patients with pulmonary involvement. Pulmonary lymphoma is similar to other extra-nodal lymphoma with high IPI scores, advanced stage and elevated LDH.

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Primary systemic anaplastic lymphoma kinase negative anaplastic large cell lymphoma: clinical analyses of 32 cases

Xiaoli WANG ; Lingling DUAN ; Mingzhi ZHANG ; Jingjing WU

Journal of Leukemia & Lymphoma.2018;27(12):735-739. doi:10.3760/cma.j.issn.1009-9921.2018.12.008

Objective To investigate the clinical manifestations, treatment outcomes and prognosis factors of the patients with primary systemic anaplastic lymphoma kinase negative anaplastic large cell lymphoma (ALK-ALCL). Methods The clinical data of 32 patients histologically confirmed with ALK-ALCL from January 2011 to December 2017 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. Kaplan-Meier method, Log-rank test and Cox proportional hazards model were used for the survival analysis. Results There were 19 males and 13 females in 32 patients, and the median age of onset was 50 years old (14-78 years old). The proportion of the patients with B symptom, extranodal involved, stageⅢ-Ⅳ, International Prognostic Index (IPI) sore 2-3 were 34.4 % (11 cases), 53.1 % (17 cases), 59.4 % (19 cases) and 50.0 % (16 cases) respectively. Chemotherapy alone and chemotherapy plus radiotherapy were the main methods, and a few patients received surgery alone, surgery plus chemotherapy, chemotherapy plus autologous stem cell transplantation or palliative care. The efficacy of 28 cases could be evaluated. The objective effective rate was 85.7 % (24/28), the complete remission (CR) rate was 42.9 % (12/28), and the partial remission (PR) rate was 42.9 % (12/28). The median progression-free survival (PFS) time was 28 months (95 % CI 13-42 months) and the median overall survival (OS) time was 43 months (95 % CI 24-61 months). The anticipated 5-year OS rate was 36.6 % . Single factor analysis results revealed that patients who was female (χ2＝7.654, P＝0.006), with normal serum lactic dehydrogenase (LDH) level (χ2＝7.575, P＝0.006), normal serum β2microglobulin level (χ2＝4.770, P＝0.029) and without B symptom (χ2＝9.418, P＝0.002), IPI score 0-1 (χ2＝4.119, P＝0.042) had a better prognosis. Multivariate survival analysis indicated that symptoms B ( HR＝ 12.460, 95 % CI 2.645-58.708, P＝ 0.001) and IPI score ( HR＝7.521, 95 % CI 1.624-34.841, P＝0.010) were the independent factors for prognosis. Conclusion The prognosis of the patients with primary systemic ALK-ALCL is poor, especially for the worse prognosis of the patients with symptoms B and IPI sore 2-3.

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Expression of miRNA-21 in mucosa-associated lymphoid tissue lymphomas and its relationship with CHOP regimen

Li LI ; Yifei YANG ; Junchao YANG ; Liyun ZHOU

Journal of Leukemia & Lymphoma.2018;27(12):740-743. doi:10.3760/cma.j.issn.1009-9921.2018.12.009

Objective To investigate the expression of miRNA (miR-21) in mucosa-associated lymphoid tissue(MALT) lymphomas and its relationship with the effects in CHOP regimen. Methods Lymph gland tissues and preoperative peripheral blood of 52 patients pathologically diagnosed with MALT lymphoma in Department of Hematology of Affiliated Hospital of Hebei University of Engineering from January 2015 to December 2017 were collected; meanwhile, 10 tissues from patients with lymphadenitis and 20 peripheral serum from healthy examination patients were also collected. Quantitative real-time polymerase chain reaction (qPCR) was used to compare the lymph gland tissues in MALT lymphoma patients and lymphadenitis patients, and the expression of miR-21 in peripheral serum of MALT lymphoma and healthy people. The selected 20 cases of MALT lymphoma were given CHOP regimen treatment for 6 cycles, and then the efficiency and inefficiency were compared; at the same time, the expression of miR-21 in peripheral serum of the patients in the effective group was detected. Results The relative expression of miR-21 of lymph node tissues in lymphadenitis patients and MALT lymphoma patients was 1.03±0.12 and 4.53±0.73 respectively, and the relative expression of miR-21 in preoperative peripheral serum of healthy people and MALT lymphoma patients was 0.83±0.04 and 3 . 87 ± 0 . 21 respectively , and the differences were statistically significant (P ＝ 0.047, P ＝ 0.044). After 6 cycles of CHOP regimen, the total effect rate of MALT lymphoma was 70 % (14/20), and the relative expression of miR-21 in preoperative and postoperative peripheral serum for the patients who obtained the effective results after CHOP regimen was 3.95 ±0.08 and 1.62 ±0.41, and the differences were statistically significant (P＝ 0.035). Conclusions The expression of miR-21 has a certain correlation with the occurrence and development of MALT lymphoma. Furthermore, the serum miR-21 expression may be related to the effect of CHOP regimen chemotherapy in MALT lymphoma.

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Myeloid neoplasms with eosinophilia and abnormal PDGFRA/B: report of three cases and review of literature

Roujia WANG ; Xiaoxia HU ; Mengqiao GUO ; Shenglan GONG ; Xiong NI ; Shuqing LYU ; Jianmin WANG

Journal of Leukemia & Lymphoma.2018;27(12):744-749. doi:10.3760/cma.j.issn.1009-9921.2018.12.010

Objective To investigate clinical and hematological features of myeloid neoplasms with eosinophilia and abnormal PDGFRA/B and the effect of imatinib. Methods The data of three eosinophilia patients with abnormal PDGFRA/B fusion gene in Changhai Hospital, the Second Military Medical University and 22 Chinese cases reported in Chinese medical journals were analyzed. Thirty-one cases of idiopathic hypereosinophilic syndrome from Changhai Hospital, the Second Military Medical University were used as the controls. Results Compared with idiopathic hypereosinophilic syndrome, no differences were found in age, percentage of bone marrow eosinophils and counts of platelets in peripheral blood in myeloid neoplasms with eosinophilia and abnormal PDGFRA/B (all P ＞0.05), but statistical differences were found in gender (χ2＝5.080, P ＝ 0.016), peripheral blood white blood cell count (t ＝ 4.908, P ＝ 0.001), eosinophilic granulocyte absolute value (χ2＝ 17.230, P ＝ 0.001) and hemoglobin concentration (t ＝ 2.770, P ＝ 0.013). The median follow-up time was 17 months (3-108 months) in 24 myeloid neoplasms patients with eosinophilia and abnormal PDGFRA/B from Chinese report. Complete hematopoietic remission (CHR) rate was 91.7 % (22/24) after the treatment of imatinib. The total complete molecular remission (CMR) rate was 75.0 % (18/24). The median time of remission was 3 months (1-8 months). CMR in patients with PDGFRA and with PDGFRB was 76.5 % (13/17) and 85.7 % (6/7), respectively. Only one patient (4.2 %) died of disease relapse. Conclusion Imatinib has a favorable effect on myeloid neoplasms with eosinophilia and abnormal PDGFRA/B featured by distinct hematologic and clinical manifestations.

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