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PURPOSE: Rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone administered every 3 weeks (R-CHOP-21) is the standard care for diffuse large B-cell lymphoma (DLBCL). It is unknown whether the dose-dense R-CHOP (R-CHOP-14) could improve the outcome of the disease in Asian population. MATERIALS AND METHODS: Newly diagnosed DLBCL patients were centrally, randomly assigned (1:1) to receive R-CHOP-14 or R-CHOP-21. R-CHOP-14 was administered every 2 weeks, and R-CHOP-21 was administered every 3 weeks. Primary end point was disease-free survival (DFS). Secondary end points included overall survival (OS), progression-free survival (PFS), response rate and toxicities. RESULTS: Seven hundred and two patients were randomly assigned to receive R-CHOP-14 (n=349) or R-CHOP-21 (n=353). With a median follow-up of 45.6 months, the two groups did not differ significantly in 3-year DFS (79.6% for R-CHOP-14 vs. 83.2% for R-CHOP-21, p=0.311), 3-year OS (77.5% for R-CHOP-14 vs. 77.6% for R-CHOP-21, p=0.903), or 3-year PFS (63.2% for R-CHOP-14 vs. 66.1% for R-CHOP-21, p=0.447). Patients with an International Prognostic Index (IPI) score ≥ 2 had a poorer prognosis compared to those with an IPI score < 2. Grade 3/4 hematologic and non-hematologic toxicities were manageable and similar between R-CHOP-14 and R-CHOP-21. CONCLUSION: R-CHOP-14 did not improve the outcome of DLBCL compared to R-CHOP-21 in Asian population. With manageable and similar toxicities, both of the two regimens were suitable for Asian DLBCL patients. For high-risk patients with IPI ≥ 2, new combination regimens based on R-CHOP deserve further investigation to improve efficacy.
Subject(s)
Humans , Asian People , B-Lymphocytes , Cyclophosphamide , Disease-Free Survival , Doxorubicin , Follow-Up Studies , Lymphoma, B-Cell , Prednisone , Prognosis , Rituximab , VincristineABSTRACT
Objective To evaluate the safety of cetuximab combined with intensity-modulated radiotherapy (IMRT) plus concurrent cisplatin chemotherapy in locoregionally advanced nasopharyngeal carcinoma (NPC) in a Chinese multicenter clinical study.MethodsFrom July 2008 to April 2009,100Patients with primary stage Ⅲ- Ⅳb non-keratinizing NPC were enrolled.The planned dose of IMRT to gross tumor volume and positive cervical lymph nodes was 66.0-75.9 Gy and 60-70 Gy in 30-33 fractions.Cisplatin (80 mg/m2,q3 week (w)) and cetuximab (400 mg/m2 one w before radiation,and then 250mg/m2 per w) were given concurrently.The adverse events (AEs) were graded according to common terminology criteria for adverse events v3.0.ResultsThe compliance of the entire group of patient was satisfactory.Actual median dose to gross tumor volume was 69.96 Gy,and the median dose to positive cervical lymph nodes was 68 Gy.Median dose of cisplatin was 133 mg,median first-dose of cetuximab was 690 mg,and median weekly dose was 410 mg.AEs were well tolerated and manageable,mainly consisting of acneiform skin eruptions,dermatitis and mucositis.Grade 4 mucositis was observed in 2％ of the patients and no other grade 4 AEs were observed.ConclusionsThe combined treatment modality of IMRT +concurrent chemotherapy + cetuximab in loco-regionally advanced NPC is well tolerated.
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Objective To investigate the role of radiotherapy (RT) and prognostic factors in the combined modality treatment (CMT) of patients with stage ⅠE-ⅡE extranodal nasal type NK/T-cell lym-phoma. Methods From Dec. 1990 to Dec. 2006,177 patients who were diagnosed and treated in our hos-pital were retrospectively analyzed,induding 37 received chemotherapy (CT) alone ( median 4 cycles), 128 received CT (median 3 cycles) followed by RT (median 52 Gy) ,6 received RT alone (median 58 Gy) and 6 received RT ( median 54 Gy) followed by CT ( median 5 cycles). Results The overall response ( CR + PR) rate after initial CT was 60.8% compared with 83.8% after RT ( x2 = 28.63, P < 0.01 ). The 5-year overall survival (OS) and progress-free survival (PFS) rates were 46.2% and 36.8% ,respectively. The lo-cal control rates were 80.9% for RT ( alone or with CMT) and 50.0% for CT alone (x2 = 14.39, P < 0.01 ), and corresponding 5-year OS and PFS were 53.4% vs. 18.3 % ( x2 = 23.38, P < 0.01 ) and 45.0% vs. 10.9% (x2 =23.46,P <0.01 ),respectively. Compared with CT alone,the following definitive RT for patients who achieved response or not after initial CT significantly improved the local control [83.5%, 76.2% vs. 50.0% (x2 = 14.13,P <0.01;x2 =5.78,P <0.01)] and 5-year OS[56.2%,48.6% vs. 18.3%(x2 =28.87,P <0. 05;x2 =4.80,P <0.05)]. Concinsions Compared with CT alone, RT a-chieves better tumor response, local control and survival of patients not only with tumor response but also with local progression after CT. Definitive RT should be the reasonable choice of treatment for early stage extran-odal nasal type NK/T-cell lymphoma.
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AIM: To investigate the effect of 5 - fluorouracil ( 5 - FU ) on the expression of the stem cell marker CD133 on colon cancer stem cells. METHODS:CD133 expression on several colon cancer cell lines was detected by flow cytometry. The CD133 positive cells from DLD1 cells were separated by the method of magnetic activated cell separation. Colony assay was used to measure self - renew ability and MTS assay was used to detect the sensitivity to 5 - FU after separation. After 5 - FU treatment, the change of CD133 mRNA level was measured by qPCR. RESULTS: CD133 expression on the surface of colon cacner cell lines DLD1, HT29, SW480, HCT116, Lovo, RKO was 30.20% , 82.00% , 0.34% , 91.80% , 85.30% , 0.28% respectively. DLD1 cells had two obvious populations according to CD133 expression. CD133 positive cells were separated from DLD1 cells, the positive purity was 87.21% ±5.33% and the negative purity was 84.30% ±4.65%. CD133 positive cells formed more colonies with limited dilution colony assay (46.33% ±4.44% vs 31.00% ±2.00% , P <0.05). CD133 positive cells were less sensitive to 5 - FU compared to CD133 negative cells(20% less, P <0.01). 5 - FU at concentration of 1 mg/L upregulated CD133 mRNA expression in both DLD1 and HT29 cells, the relative quantity was increased from 1 to 1.684 ±0.012(P <0.01 )and 30.702 ±0.280 to 49.379 ±0.460(P <0.01) in HT29 and DLD1, respectively. CONCLUSION: Compared to CD133 negative cells, CD133 positive cells show more ability to form colonies in vitro, and are less sensitive to 5 - FU. 5 - FU upregulats the mRNA expression of CD133, resulting in the CD133 colon cancer stem cells enrichment during 5 - FU treatment.
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Background and purpose:Majority of patients with B cell lymphoma often achieve complete clinical remission after systemic treatment, but half of the patients ultimately relapse. The residual neoplastic cells, commonly called ‘minimal residual disease’ (MRD), are thought to be the source of relapse. But not all of the patients whose results of IgH rearrangement were positive had relapse or distant involvement. It was thought that the patients whose IgH rearrangement was positive relapsed or not may be associated with the quantity of IgH rearrangement. The study tried to investigate the feasibility and clinical significance of detecting immunoglobulin heavy chain gene in DLBCL by SYBR Green RT-FQ-PCR. Methods:Fifty-seven bone marrow specimens from 44 patients diagnosed with DLBCL were used to detect IgH-R. Namalwa cell line and U-937 cell line were used for positive and negative control respectively. The ?-actin gene was chosen as inter control. DNA was isolated by phenol-chloroform-isoamyl alcohol and then was amplified by SYBR Green RT-FQ-PCR targeting the IgH-R CDR Ⅲ.Results:Melting curve analysis could confirm the specificity of IgH-R. The positive rate detected by RT-FQ-PCR was 63.2%. The positive results of IgH/?-actin were between 0.01 and 4131.69, and the median was 0.42. There was a significant difference between stage Ⅰ/Ⅱ and stage Ⅲ/Ⅳ in IgH-R quantity (P=0.018). Nonparametric test showed that there was a significant difference between patients with normal LDH and patients with elevated LDH (P=0.046).Conclusions:SYBR Green RT-FQ-PCR is a valuable, feasible and sensitive tool to detect IgH rearrangement in DLBCL. Detecting IgH-R using RT-FQ-PCR can help staging more accurately.