A phase II study for the evaluation of quinine as a modulator of multidrug resistance in non-Hodgkin's lymphoma.
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Adult↗
Biomedical subjects
Pierre Soubeyran
Publications and source records attributed to Pierre Soubeyran.
Aggressive non-Hodgkin's lymphoma: concomitant evaluation of interleukin-2, soluble interleukin-2 receptor, interleukin-4, interleukin-6, interleukin-10 and correlation with outcome.
The purpose of this study was to assess the prognostic value of a large panel of cytokines in aggressive non-Hodgkin's lymphoma (NHL) and to confront it to parameters of the International Prognostic Index (IPI). It investigated the concomitant determination of interleukin-2 (IL-2), soluble interleukin-2 receptor (sIL-2R), interleukin-4 (IL-4), interleukin-6 (IL-6) and interleukin-10 (IL-10) on a uniform population of 116 previously untreated patients. Commercially available enzyme-linked immunoassay kits were used for cytokines measurements. Results were correlated with complete remission (CR), overall survival (OS) and failure free survival (FFS). In univariate analysis, sIL-2R and IL-6 demonstrated prognostic significance for CR (p = 0.016 and p = 0.048), OS (p = 0.0011 and p = 0.0387) and FFS (p = 0.0001 and p = 0.0363), but multi-variate analysis failed to demonstrate an independent prognostic significance. In the intermediate group risk defined by IPI, patients presenting high level of sIL-2R or IL-6 demonstrated lower CR rate and survival than those with low level. In conclusion, sIL-2R and IL-6 serum levels are elevated in high grade NHL and are correlated to CR, OS and FFS, but this study did not support their independent prognostic value. However, sIL-2R and IL-6 measurements may improve risk assignment by IPI and allow a better prognostic evaluation of patients with intermediate prognosis NHL.
Adult↗
Fludarabine phosphate-CVP in patients over 60 years of age with advanced, low-grade and follicular lymphoma: a dose-finding study.
The aim of this study was to establish a safe and effective regimen of fludarabine phosphate, cyclophosphamide, vincristine and prednisone (F-CVP) as first-line treatment for elderly patients with advanced, low-grade non-Hodgkin's lymphoma. Twenty-three patients >60 years were assigned successively to eight treatment cycles (Dose level 1: low F, low CV [n=4]; 2A: high F, low CV [n=8]; 2B: low F, high CV [n=4]; 3: high F, high CV [n=7]). High and low levels were: F, 25 and 20mg/m(2), respectively (Days 1-5); C, 750 and 500 mg/m(2), respectively (Day 1); and V, 1.4 and 1mg/m(2), respectively (Day 1). Patients received P at 40 mg/m(2) on Days 1-5. Response was assessed after Cycles 2, 4, 6 and 8. At level 3, dose-limiting toxicity (opportunistic infections and neutropenia) became evident, particularly after Cycle 6. Further patients were recruited at Dose level 2A. All regimens proved effective, with an OR rate of 78% (65% CR), and 3-year survival of 65% (+/-10%). Among 18 responders, 51% were still in response at 3 and 5 years. The study shows that this combination therapy is highly effective. The addition of F to CVP at Dose level 2A was feasible and increased the CR rate, with good tolerability in elderly patients.
Administration, Oral↗
Variability of quantitative polymerase chain reaction detection of the bcl-2-IgH translocation in an international multicenter study.
The t(14;18)(q32;q21) chromosomal translocation is closely associated with follicular lymphoma. Polymerase chain reaction (PCR) analysis has high sensitivity and is used to assess responses to therapy. Quantification of translocation-bearing cells is a possible advantage of real-time PCR over conventional PCR. A collaborative study comparing results from 12 international laboratories is reported.
Biomarkers, Tumor↗
Follicular lymphoma international prognostic index.
The prognosis of follicular lymphomas (FL) is heterogeneous and numerous treatments may be proposed. A validated prognostic index (PI) would help in evaluating and choosing these treatments. Characteristics at diagnosis were collected from 4167 patients with FL diagnosed between 1985 and 1992. Univariate and multivariate analyses were used to propose a PI. This index was then tested on 919 patients. Five adverse prognostic factors were selected: age (> 60 years vs < or = 60 years), Ann Arbor stage (III-IV vs I-II), hemoglobin level (< 120 g/L vs > or = 120 g/L), number of nodal areas (> 4 vs < or = 4), and serum LDH level (above normal vs normal or below). Three risk groups were defined: low risk (0-1 adverse factor, 36% of patients), intermediate risk (2 factors, 37% of patients, hazard ratio [HR] of 2.3), and poor risk (> or = 3 adverse factors, 27% of patients, HR = 4.3). This Follicular Lymphoma International Prognostic Index (FLIPI) appeared more discriminant than the International Prognostic Index proposed for aggressive non-Hodgkin lymphomas. Results were very similar in the confirmation group. The FLIPI may be used for improving treatment choices, comparing clinical trials, and designing studies to evaluate new treatments.
Adult↗
High-dose methotrexate-based chemotherapy followed by consolidating radiotherapy in non-AIDS-related primary central nervous system lymphoma: European Organization for Research and Treatment of Cancer Lymphoma Group Phase II Trial 20962.
PURPOSE: To confirm the feasibility and estimate the efficacy of methotrexate (MTX), teniposide, carmustine, and methylprednisolone (MBVP) chemotherapy combined with radiotherapy (RT) for patients with non-AIDS-related primary CNS lymphoma (PCNSL) treated in a multicenter setting. PATIENTS AND METHODS: Treatment consisted of two cycles of MBVP (MTX 3 g/m2 days 1 and 15, teniposide 100 mg/m2 days 2 and 3, carmustine 100 mg/m2 day 4, methylprednisolone 60 mg/m2 days 1 to 5, and two intrathecal injections of MTX 15 mg, cytarabine 40 mg, and hydrocortisone 25 mg) followed by 40 Gy of RT. Primary end points were response and safety of this regimen. RESULTS: Twelve centers included 52 patients who were all analyzed on an intent-to-treat basis. Median follow-up of all patients was 27 months. One patient progressed and died before treatment, and five patients died during treatment. Four patients received RT after one cycle of chemotherapy, and 42 patients completed the entire treatment. Hematologic grade 3 and 4 toxicity was seen in 78% of patients for leukocytes and 24% of patients for platelets. The overall response rate of all 52 patients was 81%. Two patients who did not fulfill the criteria of objective response survived more than 1 year; one of them is still alive without disease. Eighteen patients died; 11 deaths were a result of tumor, five were probably treatment-related, one was caused by late leukoencephalopathy, and one was a result of intercurrent disease. Median estimated overall survival was 46 months. CONCLUSION: MBVP followed by RT for PCNSL has a high response rate. However, the 10% toxic death rate during treatment in a multicenter setting underlines the need for highly specialized care.
Adolescent↗
[Lymphomas in the elderly].
About 50% of lymphomas occur in patients older than 60 and this proportion will probably increase in the future because of increasing lymphoma incidence and population ageing in developed countries. Most of the characteristics of lymphomas occurring in the elderly do not differ from that of their younger counterpart and standard treatment should be applied whenever possible. However, a significant proportion of these patients, which remains difficult to detect, is exposed to a high risk of toxicity. Further studies should lead to better designate this population. Among possible tools, comprehensive geriatric assessment can be valuable although it remains necessary to adapt it to the oncohematology context.
Age Factors↗
Quality of life in patients with aggressive non-Hodgkin's lymphoma. Validation of the medical outcomes study short form 20 and the Rotterdam symptom checklist in older patients.
In the elderly population, cancer treatment aims to cure and/or maintain Quality of Life (QoL). However, there is little QoL data to provide evidence for QoL benefits for some of the cancer treatments. This pilot study developed valid QoL questionnaires in French, for patients over 65 years with a diagnosis of large cell lymphoma, part of the Lymâge phase II study. They were asked to complete two questionnaires, the Medical Outcomes Study Short Form 20 (MOS SF20; generic) and the Rotterdam symptom checklist (RSCL; cancer-specific). Between June 1995 and April 1997, questionnaires were returned by 63 of 89 patients. This article reports the process undertaken to adapt the English version to a French setting, and provides the results of factor analysis, convergent and discriminant validity and reliability. Our data suggest that QoL questionnaires can be used in elderly patients. These two questionnaires are validated in French and would help us to analyse the QoL of elderly patients with the development of new treatments as done in the Lymâge study.
Aged↗
[Update on lymphomas].
Important progress have been recently achieved in the management of Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). Prognostic factors are now better defined in HD thanks to new biologic and radiologic information which complete old and relevant clinical factors. These parameters are expected to improve decision making in patient's management. However, treatment strategy is under new discussion and controversies about the role of radiotherapy and its doses. There are now enough arguments to consider radiotherapy unnecessary in advanced stages when a complete remission is achieved by chemotherapy. There is also important concern about late effects of treatment and not only secondary cancers. Non-Hodgkin's lymphomas are heterogeneous and different entities are now better defined and described, thanks to a common and similar language for immunological clinical data and treatment outcome. New strategies are under investigation using monoclonal antibodies with or without radioisotopes, in association with chemotherapy or radiotherapy. Undoubtedly, these new approaches are going to improve the overall prognosis of NHL.
Hematopoietic Stem Cell Transplantation↗