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Br J Haematol ; 2022 Aug 09.
Article in English | MEDLINE | ID: covidwho-1978426


To optimise management of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection identifying high-risk patients and maintaining treatment dose intensity is an important issue in patients with aggressive lymphomas. In the present study, we report on the presentation, management, and outcome of an international series of 91 patients with primary central nervous system lymphoma and SARS-CoV-2 infection. SARS-CoV-2 was diagnosed before/during first-line treatment in 64 patients, during follow-up in 21, and during salvage therapy in six. Among the 64 patients infected before/during first-line chemotherapy, 38 (59%) developed pneumonia and 26 (41%) did not clear the virus. Prolonged exposure to steroids before viral infection and/or treatment with high-dose cytarabine favoured pneumonia development and virus persistence and were associated with poorer survival; 81% of patients who did not clear virus died early from coronavirus disease 2019 (COVID-19). Vaccination was associated with lower pneumonia incidence and in-hospital mortality. Chemotherapy was initiated/resumed in 43 (67%) patients, more commonly among patients who did not develop pneumonia, cleared the virus, or did not receive steroids during infection. Chemotherapy resumption in patients with viral persistence should be indicated cautiously as it was associated with a poorer survival (6-month, 70% and 87%, p = 0.07). None of the 21 patients infected during follow-up died from COVID-19, requiring similar measures as infected subjects in the general population.

Blood Adv ; 2022 May 17.
Article in English | MEDLINE | ID: covidwho-1846780


Patients with aggressive B-cell lymphoma and MYC rearrangement at FISH exhibit poor outcome after R-CHOP. In the last decade, 68 patients with Burkitt lymphoma (BL; n=46) or high-grade B-cell lymphoma (single, double or triple hit; HGBCL; n=22) were treated with a dose-dense, short-term therapy termed "CARMEN regimen", at five Italian Centers. Forty-six (68%) patients were HIV-positive. CARMEN included a 36-day induction with sequsingle weekly doses of cyclophosphamide, vincristine, rituximab, methotrexate, etoposide, and doxorubicin plus intrathecal chemotherapy, followed by high-dose-cytarabine-based consolidation. Patients who did not achieve complete remission (CR) after induction received BEAM-conditioned ASCT after consolidation. Sixty-one (90%) patients completed induction and 59 (87%) completed consolidation. Seventeen patients received ASCT. Grade-4 hematological toxicity was common but did not cause treatment discontinuation; grade-4 non-hematological toxicity was recorded in 11 (16%) patients, with grade-4 infections in 6 (9%). Six (9%) patients died of toxicity (sepsis in four, COVID-19, ARDS). CR rate after the whole treatment was 73% (95%CI=55-91%) for HGBCL patients and 78% (95%CI=66-90%) for BL patients. At a median follow-up of 65 (IQR 40-109) months, 48 patients remain event-free, with a 5-year PFS of 63% (95%CI=58-68%) for HGBCL and 72% (95%CI=71-73%) for BL, with a 5-year OS of 63% (95%CI=58-68%) and 76% (95%CI=75-77%), respectively. HIV seropositivity had not a detrimental effect on outcome. This retrospective study shows that CARMEN is a safe and active regimen both in HIV-negative and -positive patients with MYC-rearranged lymphomas. Encouraging survival figures, attained with a single dose of doxorubicin and cyclophosphamide, deserve further investigation in HGBCL and other aggressive lymphomas.

Blood Adv ; 6(1): 327-338, 2022 01 11.
Article in English | MEDLINE | ID: covidwho-1622201


Lymphoma represents a heterogeneous hematological malignancy (HM), which is characterized by severe immunosuppression. Patients diagnosed of coronavirus disease 2019 (COVID-19) during the course of HM have been described to have poor outcome, with only few reports specifically addressing lymphoma patients. Here, we investigated the clinical behavior and clinical parameters of a large multicenter cohort of adult patients with different lymphoma subtypes, with the aim of identifying predictors of death. The study included 856 patients, of whom 619 were enrolled prospectively in a 1-year frame and were followed-up for a median of 66 days (range 1-395). Patients were managed as outpatient (not-admitted cohort, n = 388) or required hospitalization (n = 468), and median age was 63 years (range 19-94). Overall, the 30- and 100-days mortality was 13% (95% confidence interval (CI), 11% to 15%) and 23% (95% CI, 20% to 27%), respectively. Antilymphoma treatment, including anti-CD20 containing regimens, did not impact survival. Patients with Hodgkin's lymphoma had the more favorable survival, but this was partly related to significantly younger age. The time interval between lymphoma diagnosis and COVID-19 was inversely related to mortality. Multivariable analysis recognized 4 easy-to-use factors (age, gender, lymphocyte, and platelet count) that were associated with risk of death, both in the admitted and in the not-admitted cohort (HR 3.79 and 8.85 for the intermediate- and high-risk group, respectively). Overall, our study shows that patients should not be deprived of the best available treatment of their underlying disease and indicates which patients are at higher risk of death. This study was registered with, NCT04352556.

COVID-19 , Lymphoma , Adult , Aged , Aged, 80 and over , Cohort Studies , Humans , Lymphoma/diagnosis , Lymphoma/therapy , Middle Aged , Prognosis , SARS-CoV-2 , Young Adult