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Non-Hodgkin lymphoma in HIV-positive patients treated with antiretroviral therapy and chemotherapy: A single institution retrospective study
abstracts 1068PD
Non-Hodgkin lymphoma in HIV-positive patients treated with antiretroviral therapy and chemotherapy: A single institution retrospective study
D. Dalu1, C. Fasola1, D. De Francesco2, G. Bombonati1, L. Ammoni1, N.M. La Verde1 Oncology, ASST Fatebenefratelli Sacco, Milan, Italy, 2Institute for Global Health, UCL, London, UK
1
1069PD
Obstetric and maternal outcome of 134 patients with Hodgkin lymphoma diagnosed during pregnancy: Results from the INCIP registry
F. Amant1, C. Maggen2, D. Dierickx3, E. Lugtenburg4, A. Laenen5, E. Cardonick6, R.G. Shmakov7, M. Bellido Casado8, A.C. Garcia9, M. Gziri10, M. Halaska11, P. Ottevanger12, K. Van Calsteren13, A. L’Hauglin6, E. Polushkina7, L. Van Dam4, P. Vandenberghe3, S.H. Woei-A-Jin14 1 Department of Gynecologic Oncology, Antoni Van Leeuwenhoek Hospital – The Netherlands Cancer Institute, Amsterdam, Netherlands, 2Obstetrics and Gynecology, University Hospitals Leuven and Department of Oncology, KU Leuven, Leuven, Belgium, 3 Department of Hematology, University Hospitals Leuven and Department of Oncology, KU Leuven, Leuven, Belgium, 4Hematology, Erasmus University Medical Center, Rotterdam, Netherlands, 5Biostatistics and Statistical Bioinformatics Center, KU Leuven, Leuven, Belgium, 6Obstetrics and Gynecology, Cooper University Hospital, Philadelphia, PA, USA, 7Academician V.I.Kulakov of the Ministry of Healthcare of Russian Federation, National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russian Federation, 8Department of Hematology, University Medical Center Groningen, Groningen, Netherlands, 9Oncology, Hospital Regional de Alta Especialidad de Ixtapaluca (HRAEI), Mexico City, Mexico, 10Obstetrics, Cliniques Universitaires St Luc, Brussels, Belgium, 11Obstetrics and Gynecology, 3rd Medical Faculty Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic, 12Internal Medicine, Radboud UMC Nijmegen, Nijmegen, Netherlands, 13 Obstetrics and Gynecology, University Hospitals Leuven and Department of Development and Regeneration, KU Leuven, Leuven, Belgium, 14Medical Oncology, University Hospitals Leuven and Department of Oncology, KU Leuven, Leuven, Belgium Background: The purpose of this study was to assess obstetric and maternal outcome of pregnant patients with diagnosis of Hodgkin lymphoma (HL) registered by the International Network on Cancer, Infertility and Pregnancy (INCIP) to guide physicians in clinical management. Methods: Clinical data of pregnant patients diagnosed with HL between 1969 and 2018 were collected from the INCIP registry. For survival analysis of classical HL treated with an ABVD-based regimen, non-pregnant controls were selected based on stage and prognostic score at diagnosis. Results: The median gestational age at diagnosis of 134 eligible patients was 20 weeks (range: 3 – 37). Antenatal chemotherapy was initiated in 53.7% of patients. Ten (7.5%) early pregnancies were terminated. One foetus deceased in the third trimester after three cycles of chemotherapy. In total, 120 (89.6%) pregnancies ended in a live birth.
v436 | Haematological Malignancies
Preterm delivery was observed in 47 (40.1%) singleton pregnancies. Birth weight percentiles were lower in children prenatally exposed to oncological treatment and 17.9% were small for gestational age at birth. Four children (3.5%) had major congenital malformations. Five-year progression-free survival (PFS) for HL during pregnancy was 82.5% and 90.9% for early (n ¼ 62) and advanced stage (n ¼ 15). Five-year overall survival (OS) was 97.3% and 100%, respectively. Although not significant, patients with early stage HL appeared to have inferior PFS compared with matched non-pregnant controls (n ¼ 62), more clearly seen in the subgroup that initiated chemotherapy during pregnancy (n ¼ 45). OS was comparable between both groups, supporting the effectiveness of salvage therapy. For advanced stage HL survival was similar to controls, albeit small numbers. Conclusions: Although further prospective research on the efficacy of chemotherapy during pregnancy is necessary, survival of patients diagnosed with early stage HL during pregnancy appears not to be statistically different from matched non-pregnant controls, Awareness of complications as preterm delivery and low birth weight is important in this population. Clinical trial identification: NTC00330447. Legal entity responsible for the study: The authors. Funding: European Union’s Horizon 2020 Research and Innovation Program under grant agreement No 647047 Research Foundation-Flanders (FWO., grant no G070514N) and ESGO (European Society of Gynaecological Oncology) Charles University Research Project Progres Q28 and Q34 and by grant MH CZ - DRO ("Kralovske Vinohrady University Hospital - FNKV, 00064173"). Disclosure: All authors have declared no conflicts of interest.
1070PD
Treatment outcomes and pattern of failure in primary gastric diffuse large B cell lymphoma with complete remission following RCHOP chemotherapy
H.J. Kang1, B-O. Choi1, S-E. Jung2, K-S. Park3, J-H. O4, H.H. Lee5, Y-W. Jeon6, S-G. Cho6 Radiation Oncology, Catholic University Lymphoma Group, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 2 Radiology, Catholic University Lymphoma Group, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 3Pathology, Catholic University Lymphoma Group, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 4Nuclear Medicine, Catholic University Lymphoma Group, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 5Gastroenterology, Catholic University Lymphoma Group, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 6Hematology, Catholic University Lymphoma Group, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
1
Background: The optimal treatment for primary gastric diffuse large B cell lymphoma (DLBCL) is unclear. The treatment for primary gastric DLBCL is in accordance with the principle of treatment for general DLBCL. We aimed to evaluate the treatment outcomes and pattern of failure in primary gastric DLBCL. Methods: Between April 2001 and November 2018, 120 patients with stage I–IV primary gastric DLBCL were retrospectively reviewed in this study. All patients had been in complete remission after receiving rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Ninety patients (75%) were treated with R-CHOP alone, and the other 30 patients (25%) underwent R-CHOP with local treatment for gastric lesions. Twelve patients (10%) underwent gastrectomy, and 18 patients (15%) received consolidation radiotherapy (RT). Results: The median follow-up time was 49 (range, 5 to 197) months. The 5-year locoregional failure-free survival (LRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) rates were 85.6%, 86.5%, 83.4%, and 90.3%, respectively. During the follow-up, 17 patients (14.2%) experienced disease recurrence. Only 3 patients developed distant metastasis without locoregional failure (LRF). All except two cases of LRF included gastric failure. There was no LRF in patients who received R-CHOP with local treatment. On multivariate analysis, poor performance status was an independent prognostic factor for LRFS, and multiple gastric lesions influenced LRFS, DMFS, DFS, and OS. Conclusions: The main pattern of initial failure is LRF, especially in the stomach in patients with primary gastric DLBCL. Gastric local treatment such as consolidation RT can effectively prevent gastric failure. Therefore, gastric local treatment should be considered for patients at high risk of LRF, such as multiple gastric lesions. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Volume 30 | Supplement 5 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz251.003/5577789 by guest on 25 October 2019
Background: HIVþ pts have a 25-fold higher risk of developing NHL. Two independent prognostic factors influence incidence and prognosis: highly active antiretroviral therapy (HAART) and CD4þ lymphocyte count. Diagnosis of NHL can occur simultaneously (naive pts), or after diagnosis of HIV infection (experience-pts). Methods: Single institution retrospective cohort study conducted in ASST FBF-Sacco Polo Luigi Sacco (Milan, Italy). Pts aged > ¼18 years, diagnosis of HIV infection and NHL, on HAART treated with first line R-CHOP-like chtp from Jan 2007 to Jan 2017. Chi-square, Fisher’s exact or Wilcoxon Rank-sum test, log-rank test or Cox regression model for OS, PFS and RR were used. Results: We enrolled 46 HIVþ pts: 11 naive-pts, 35 experience-pts (exp-pts). No difference in median age at diagnosis (49vs48ys p ¼ 0.40), sex (male 72.7vs85.7% p ¼ 0.37), histological types: DLBCL (2vs24), BL (3vs3), PEL (1vs0), PCNSL (1vs0), PBL (2vs2) low-grade NHL (2vs4) T-cell NHL(0 vs 2) (p ¼ 0.13). Naı¨ve-pts higher stage (stage IV 90.9vs41.2% p ¼ 0.05). No difference in frequency of B symptoms (40vs41% p ¼ 0.99), bulky masses (18.2vs20.6% p ¼ 0.99), 2 extranodal sites (45.5vs40% p ¼ 0.61), CNS involvement (44.4vs38.2% p ¼ 0.99), AIDS-definig diseases (44.4vs28.6% p ¼ 0.43) HCV/HBV infection (p ¼ 0.08/0.99). Naive-pts aaIPI intermediate-high risk (90.0vs58.1% p ¼ 0.11). CD4þ count at NHL diagnosis(102vs222/mcl p ¼ 0.05). During R-CHOP-like chtp naı¨ve-pts more infectious toxicity (50% vs 10.7% p ¼ 0.02). During a median (IQR 2-44) follow-up of 12 mts no difference in RR (CR 60% vs 62.5% p ¼ 0.85), median OS (67 mts vs 69.4 mts p ¼ 0.3) and PFS (p ¼ 0.8). Conclusions: The compromised immune status in naı¨ve-pts may explain their worst NHL conditions at diagnosis and toxicity during chtp. The immediate start of HAART in combination with chemotherapy probably reduce the impact of these factors in term of response to treatment and survival (RR, PFS and OS). CD4þ count together with HAART remain the independent prognostic factor with the greatest influence on OS [exp vs naı¨ve-pts: OS HR 0.83 (95% CI); OS/CD4þ HR 1.80 (95% CI)]. Naive-pts should be treated with standard chtp regimens, without modification of dose or schedule. Legal entity responsible for the study: ASST-FBF-SACCO. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Annals of Oncology
Non-Hodgkin lymphoma in HIV-positive patients treated with antiretroviral therapy and chemotherapy: A single institution retrospective study
D. Dalu1, C. Fasola1, D. De Francesco2, G. Bombonati1, L. Ammoni1, N.M. La Verde1 Oncology, ASST Fatebenefratelli Sacco, Milan, Italy, 2Institute for Global Health, UCL, London, UK
1
1069PD
Obstetric and maternal outcome of 134 patients with Hodgkin lymphoma diagnosed during pregnancy: Results from the INCIP registry
F. Amant1, C. Maggen2, D. Dierickx3, E. Lugtenburg4, A. Laenen5, E. Cardonick6, R.G. Shmakov7, M. Bellido Casado8, A.C. Garcia9, M. Gziri10, M. Halaska11, P. Ottevanger12, K. Van Calsteren13, A. L’Hauglin6, E. Polushkina7, L. Van Dam4, P. Vandenberghe3, S.H. Woei-A-Jin14 1 Department of Gynecologic Oncology, Antoni Van Leeuwenhoek Hospital – The Netherlands Cancer Institute, Amsterdam, Netherlands, 2Obstetrics and Gynecology, University Hospitals Leuven and Department of Oncology, KU Leuven, Leuven, Belgium, 3 Department of Hematology, University Hospitals Leuven and Department of Oncology, KU Leuven, Leuven, Belgium, 4Hematology, Erasmus University Medical Center, Rotterdam, Netherlands, 5Biostatistics and Statistical Bioinformatics Center, KU Leuven, Leuven, Belgium, 6Obstetrics and Gynecology, Cooper University Hospital, Philadelphia, PA, USA, 7Academician V.I.Kulakov of the Ministry of Healthcare of Russian Federation, National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russian Federation, 8Department of Hematology, University Medical Center Groningen, Groningen, Netherlands, 9Oncology, Hospital Regional de Alta Especialidad de Ixtapaluca (HRAEI), Mexico City, Mexico, 10Obstetrics, Cliniques Universitaires St Luc, Brussels, Belgium, 11Obstetrics and Gynecology, 3rd Medical Faculty Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic, 12Internal Medicine, Radboud UMC Nijmegen, Nijmegen, Netherlands, 13 Obstetrics and Gynecology, University Hospitals Leuven and Department of Development and Regeneration, KU Leuven, Leuven, Belgium, 14Medical Oncology, University Hospitals Leuven and Department of Oncology, KU Leuven, Leuven, Belgium Background: The purpose of this study was to assess obstetric and maternal outcome of pregnant patients with diagnosis of Hodgkin lymphoma (HL) registered by the International Network on Cancer, Infertility and Pregnancy (INCIP) to guide physicians in clinical management. Methods: Clinical data of pregnant patients diagnosed with HL between 1969 and 2018 were collected from the INCIP registry. For survival analysis of classical HL treated with an ABVD-based regimen, non-pregnant controls were selected based on stage and prognostic score at diagnosis. Results: The median gestational age at diagnosis of 134 eligible patients was 20 weeks (range: 3 – 37). Antenatal chemotherapy was initiated in 53.7% of patients. Ten (7.5%) early pregnancies were terminated. One foetus deceased in the third trimester after three cycles of chemotherapy. In total, 120 (89.6%) pregnancies ended in a live birth.
v436 | Haematological Malignancies
Preterm delivery was observed in 47 (40.1%) singleton pregnancies. Birth weight percentiles were lower in children prenatally exposed to oncological treatment and 17.9% were small for gestational age at birth. Four children (3.5%) had major congenital malformations. Five-year progression-free survival (PFS) for HL during pregnancy was 82.5% and 90.9% for early (n ¼ 62) and advanced stage (n ¼ 15). Five-year overall survival (OS) was 97.3% and 100%, respectively. Although not significant, patients with early stage HL appeared to have inferior PFS compared with matched non-pregnant controls (n ¼ 62), more clearly seen in the subgroup that initiated chemotherapy during pregnancy (n ¼ 45). OS was comparable between both groups, supporting the effectiveness of salvage therapy. For advanced stage HL survival was similar to controls, albeit small numbers. Conclusions: Although further prospective research on the efficacy of chemotherapy during pregnancy is necessary, survival of patients diagnosed with early stage HL during pregnancy appears not to be statistically different from matched non-pregnant controls, Awareness of complications as preterm delivery and low birth weight is important in this population. Clinical trial identification: NTC00330447. Legal entity responsible for the study: The authors. Funding: European Union’s Horizon 2020 Research and Innovation Program under grant agreement No 647047 Research Foundation-Flanders (FWO., grant no G070514N) and ESGO (European Society of Gynaecological Oncology) Charles University Research Project Progres Q28 and Q34 and by grant MH CZ - DRO ("Kralovske Vinohrady University Hospital - FNKV, 00064173"). Disclosure: All authors have declared no conflicts of interest.
1070PD
Treatment outcomes and pattern of failure in primary gastric diffuse large B cell lymphoma with complete remission following RCHOP chemotherapy
H.J. Kang1, B-O. Choi1, S-E. Jung2, K-S. Park3, J-H. O4, H.H. Lee5, Y-W. Jeon6, S-G. Cho6 Radiation Oncology, Catholic University Lymphoma Group, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 2 Radiology, Catholic University Lymphoma Group, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 3Pathology, Catholic University Lymphoma Group, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 4Nuclear Medicine, Catholic University Lymphoma Group, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 5Gastroenterology, Catholic University Lymphoma Group, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 6Hematology, Catholic University Lymphoma Group, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
1
Background: The optimal treatment for primary gastric diffuse large B cell lymphoma (DLBCL) is unclear. The treatment for primary gastric DLBCL is in accordance with the principle of treatment for general DLBCL. We aimed to evaluate the treatment outcomes and pattern of failure in primary gastric DLBCL. Methods: Between April 2001 and November 2018, 120 patients with stage I–IV primary gastric DLBCL were retrospectively reviewed in this study. All patients had been in complete remission after receiving rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Ninety patients (75%) were treated with R-CHOP alone, and the other 30 patients (25%) underwent R-CHOP with local treatment for gastric lesions. Twelve patients (10%) underwent gastrectomy, and 18 patients (15%) received consolidation radiotherapy (RT). Results: The median follow-up time was 49 (range, 5 to 197) months. The 5-year locoregional failure-free survival (LRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) rates were 85.6%, 86.5%, 83.4%, and 90.3%, respectively. During the follow-up, 17 patients (14.2%) experienced disease recurrence. Only 3 patients developed distant metastasis without locoregional failure (LRF). All except two cases of LRF included gastric failure. There was no LRF in patients who received R-CHOP with local treatment. On multivariate analysis, poor performance status was an independent prognostic factor for LRFS, and multiple gastric lesions influenced LRFS, DMFS, DFS, and OS. Conclusions: The main pattern of initial failure is LRF, especially in the stomach in patients with primary gastric DLBCL. Gastric local treatment such as consolidation RT can effectively prevent gastric failure. Therefore, gastric local treatment should be considered for patients at high risk of LRF, such as multiple gastric lesions. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Volume 30 | Supplement 5 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz251.003/5577789 by guest on 25 October 2019
Background: HIVþ pts have a 25-fold higher risk of developing NHL. Two independent prognostic factors influence incidence and prognosis: highly active antiretroviral therapy (HAART) and CD4þ lymphocyte count. Diagnosis of NHL can occur simultaneously (naive pts), or after diagnosis of HIV infection (experience-pts). Methods: Single institution retrospective cohort study conducted in ASST FBF-Sacco Polo Luigi Sacco (Milan, Italy). Pts aged > ¼18 years, diagnosis of HIV infection and NHL, on HAART treated with first line R-CHOP-like chtp from Jan 2007 to Jan 2017. Chi-square, Fisher’s exact or Wilcoxon Rank-sum test, log-rank test or Cox regression model for OS, PFS and RR were used. Results: We enrolled 46 HIVþ pts: 11 naive-pts, 35 experience-pts (exp-pts). No difference in median age at diagnosis (49vs48ys p ¼ 0.40), sex (male 72.7vs85.7% p ¼ 0.37), histological types: DLBCL (2vs24), BL (3vs3), PEL (1vs0), PCNSL (1vs0), PBL (2vs2) low-grade NHL (2vs4) T-cell NHL(0 vs 2) (p ¼ 0.13). Naı¨ve-pts higher stage (stage IV 90.9vs41.2% p ¼ 0.05). No difference in frequency of B symptoms (40vs41% p ¼ 0.99), bulky masses (18.2vs20.6% p ¼ 0.99), 2 extranodal sites (45.5vs40% p ¼ 0.61), CNS involvement (44.4vs38.2% p ¼ 0.99), AIDS-definig diseases (44.4vs28.6% p ¼ 0.43) HCV/HBV infection (p ¼ 0.08/0.99). Naive-pts aaIPI intermediate-high risk (90.0vs58.1% p ¼ 0.11). CD4þ count at NHL diagnosis(102vs222/mcl p ¼ 0.05). During R-CHOP-like chtp naı¨ve-pts more infectious toxicity (50% vs 10.7% p ¼ 0.02). During a median (IQR 2-44) follow-up of 12 mts no difference in RR (CR 60% vs 62.5% p ¼ 0.85), median OS (67 mts vs 69.4 mts p ¼ 0.3) and PFS (p ¼ 0.8). Conclusions: The compromised immune status in naı¨ve-pts may explain their worst NHL conditions at diagnosis and toxicity during chtp. The immediate start of HAART in combination with chemotherapy probably reduce the impact of these factors in term of response to treatment and survival (RR, PFS and OS). CD4þ count together with HAART remain the independent prognostic factor with the greatest influence on OS [exp vs naı¨ve-pts: OS HR 0.83 (95% CI); OS/CD4þ HR 1.80 (95% CI)]. Naive-pts should be treated with standard chtp regimens, without modification of dose or schedule. Legal entity responsible for the study: ASST-FBF-SACCO. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Annals of Oncology