Haematological Malignancy Diagnostic Service

Leeds, United Kingdom

Haematological Malignancy Diagnostic Service

Leeds, United Kingdom
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Crouch S.,University of York | Simpson J.,University of York | Ansell P.,University of York | Kane E.,University of York | And 5 more authors.
Cancer Epidemiology | Year: 2011

Background: Increased understanding of the relationship between lymphomas and co-morbidities is likely to provide valuable insights into the natural history of these disorders. Methods: 761 cases with lymphoma (310 diffuse large B-cell [DLBCL]; 226 follicular [FL]; and 225 Hodgkin [HL]) and 761 unaffected age and sex matched controls were recruited and their histories of infection and non-infection diagnoses in primary care records were compared using negative binomial regression. Results: No differences were observed between the infectious illness patterns of DLBCL and FL cases and their matched controls over the 15 years preceding lymphoma diagnosis. A marked excess of infectious illness episodes was recorded for HL cases compared to their controls; evident at least a decade prior to HL diagnosis. For non-infectious consultations an excess of case over control visits emerged 4-6 years before DLBCL and FL diagnosis; no specific co-morbidity associations were found. No case-control differences for non-infectious conditions were apparent for HL. Conclusion: There are substantial variations in patterns of illness prior to diagnosis of the three lymphoma subtypes examined. The excess of infectious diagnoses prior to HL may point to underlying immune abnormality, but there was no suggestion of this for DLBCL and FL where a generalized excess of non-infectious conditions was evident. © 2010 Elsevier Ltd.


PubMed | Haematological Malignancy Diagnostic Service
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

6566 Background: Alemtuzumab can produce remissions with very low or even undetectable levels of CLL. MRD flow cytometry for CLL can detect as few as one malignant cell in 100,000 blood or bone marrow cells.91 patients with previously treated or refractory CLL received alemtuzumab between 1996 and 2003. All patients had regular bone marrow assessments by MRD flow cytometry during therapy with the aim of achieving the best possible response including to MRD negativity.There were 74 men and 17 women with a median age of 58 (range 32 to 75). Patients received a median of 12 weeks of intravenous alemtuzumab therapy. There were 19 mild (grade 1 or 2) and 33 severe (grade 3 or 4) infectious episodes. Responses according to NCI criteria were: 33 (36%) patients achieved a complete response (CR), 17 (19%) a partial response (PR), and 41 (45%) no response. CLL was eradicated from the marrow below the level of detection by MRD Flow in 18 (20%) patients. There was no significant difference in response or survival between purine analogue refractory and purine analogue sensitive patients. Median survival was significantly longer in MRD negative patients compared to MRD positive CR, a PR, or no response (median not reached for MRD negative CR, 41 months for MRD positive CR, 30 months for PR and 15 months for NR, p=0.0004). Those patients that achieved an MRD negative CR had a significantly longer treatment free survival than patients with MRD positive CR, PR or non-responders (not reached for MRD negative CRs, 20 months for MRD positive CRs, 13 months for PRs, 6 months for NR, p<0.0001). The overall survival for the 18 patients with MRD negative remissions was 84% at 60 months. Eight (47%) of the MRD negative patients have converted to an MRD positive status at a median time of 28 months.MRD negative remissions are an achievable goal with alemtuzumab. Attaining this response leads to an improved overall and treatment free survival. [Table: see text].


PubMed | Haematological Malignancy Diagnostic Service
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

6522 Background: Approximately half of CLL patients do not respond to alemtuzumab and others progress after responding to alemtuzumab. We report here factors predictive for lack of response and approaches to achieve the best outcome for these patients.91 patients with relapsed or refractory CLL received alemtuzumab aiming for minimal residual disease (MRD) negativity. Factors correlated with response were reviewed and strategies for overcoming resistance or relapse are reported.The chance of response was associated with lymph node size (p <0.0001): [Figure: see text] High dose methyl prednisolone (HDMP; 1g/mGross lymphadenopathy predicts for poor response to alemtuzumab but therapy with HDMP or CHOP followed by alemtuzumab can be effective in achieving MRD negative CR. The majority of alemtuzumab refractory patients (8/11) respond to the addition of fludarabine. Retreatment with alemtuzumab was effective for 3 of 7 relapsing patients. [Table: see text].

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