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Hijiya N.,Oncology and Stem Cell Transplantation | Hijiya N.,Northwestern University | Millot F.,University of Poitiers | Suttorp M.,University Hospital Carl Gustav Carus
Pediatric Clinics of North America | Year: 2015

Chronic myelogenous leukemia (CML) is a rare disease in children. There is little evidence of biological differences between CML in children and adults, although host factors are different. Children develop distinct morbidities related to the off-target effects of tyrosine kinase inhibitors. The goal of treatment in children should be cure rather than suppression of disease, which can be the treatment goal for many older adults. This article reviews data from the literature on the treatment of CML, discusses the issues that are unique to CML in children, and recommends management that takes these issues into consideration. © 2015 Elsevier Inc.

Murawski N.,Universitatsklinikum des Saarlandes | Pfreundschuh M.,Universitatsklinikum des Saarlandes | Zeynalova S.,University of Leipzig | Poeschel V.,Universitatsklinikum des Saarlandes | And 10 more authors.
Annals of Oncology | Year: 2014

Background: To improve outcome of elderly patients with diffuse large B-cell lymphoma, dose-dense rituximab was evaluated in the prospective DENSE-R-CHOP-14 trial. Patients and methods: Rituximab (375 mg/m2) was given on days 0, 1, 4, 8, 15, 22, 29, 43, 57, 71, 85, and 99 together with six CHOP-14 cycles. Results were to be compared with patients who had received the same chemotherapy in combination with eight 2-week applications of rituximab in RICOVER-60. Results: One hundred twenty-four patients are assessable. Dose-dense rituximab resulted in considerably higher serum levels during the first 50 days of treatment, but rituximab exposure time was not prolonged. Grade 3 and 4 infections were exceptionally high in the first 20 patients without anti-infective prophylaxis, but decreased after introduction of prophylaxis with aciclovir and cotrimoxazole in the remaining 104 patients (from 13% to 6% per cycle and from 35% to 18% per patient; P = 0.007 and P = 0.125, respectively). Patients with international prognostic index = 3-5 had higher complete response/complete response unconfirmed rates (82% versus 68%; P = 0.033) than in the respective RICOVER-60 population, but this did not translate into better long-term outcome, even though male hazard was decreased (event-free survival: from 1.5 to 1.1; progression-free survival: from 1.7 to 1.1; overall survival: from 1.4 to 1.0). Conclusions: Dose-dense rituximab achieved higher rituximab serum levels, but was not more effective than eight 2-week applications in the historical control population, even though minor improvements in poor-prognosis and male patients cannot be excluded. The increased, though manageable toxicity, precludes its use in routine practice. Our results strongly support anti-infective prophylaxis with aciclovir and cotrimoxazole for all patients receiving R-CHOP. © The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

El-Mallawany N.K.,Oncology and Stem Cell Transplantation | Cairo M.S.,Children and Adolescent Cancer and Blood Diseases Center
Clinical Advances in Hematology and Oncology | Year: 2015

Burkitt lymphoma and diffuse large B-cell lymphoma represent the majority of mature B-cell non-Hodgkin lymphomas in children, adolescents, and young adults. Although they are characterized by specific clinical and biological nuances, the 2 diseases share significant clinicopathologic overlap and are treated with the same chemotherapy regimens in pediatrics. Modernday chemotherapy protocols achieve overall event-free survival rates of nearly 90%. The addition of the anti-CD20 monoclonal antibody rituximab to backbone chemotherapy holds great promise for improving long-term curative outcomes while diminishing acute and long-term toxicities. However, in the contemporary era, the long-term survival for patients with relapsed or refractory disease is meager. The role of hematopoietic stem cell transplantation in children, adolescents, and young adults with relapsed/ refractory disease is currently being defined. Meanwhile, novel humoral and cellular immunotherapies, as well as agents targeting specific molecular pathways that drive lymphomagenesis, are exciting developments that are being evaluated in clinical trials. © 2015, Millennium Medical Publishing, Inc. All rights reserved.

Pfefferle S.,Oncology and Stem Cell Transplantation | Frickmann H.,Bernhard Nocht Institute for Tropical Medicine | Gabriel M.,Bernhard Nocht Institute for Tropical Medicine | Schmitz N.,Oncology and Stem Cell Transplantation | And 2 more authors.
Infection | Year: 2012

An acute infection with hepatitis E virus (HEV) genotype 3 subtype c was diagnosed in a patient with chronic lymphatic B-cell leukemia 6 weeks after the infusion of donor lymphocytes. Despite intensive care the patient died 39 days after admission due to pericardial effusion that was related to acute liver failure. We suggest that diagnostic procedures for detection of HEV infection should be seriously considered for the immunocompro-mised patient with elevated liver enzymes in the absence of a travel history to HEV endemic countries. © Springer-Verlag 2011.

Schmitz N.,Oncology and Stem Cell Transplantation | Trumper L.,University of Gottingen | Ziepert M.,University of Leipzig | Nickelsen M.,Oncology and Stem Cell Transplantation | And 6 more authors.
Blood | Year: 2010

To evaluate outcome and prognosis of patients with T-cell lymphoma we analyzed 343 patients treated within trials of the German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL). Two hundred eighty-nine patients belonged to 1 of the 4 major T-cell lymphoma subtypes: anaplastic large cell lymphoma (ALCL), anaplastic large cell lymphoma kinase (ALK)-positive (n = 78); ALCL, ALK-negative (n = 113); peripheral T-cell lymphoma, unspecified (PTCLU; n = 70); and angioimmunoblastic T-cell lymphoma (AITL; n = 28). Treatment consisted of 6-8 courses of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone/prednisolone) or etoposide plus (CHOEP). Three-year event-free survival (EFS) and overall survival were 75.8% and 89.8% (ALK-positive ALCL), 50.0% and 67.5% (AITL), 45.7% and 62.1% (ALK-negative ALCL), and 41.1% and 53.9% (PTCLU), respectively. The International Prognostic Index (IPI) was effective in defining risk groups with significantly different outcomes. For patients, ≤ 60 years with lactate dehydrogenase ≤ upper normal value (UNV), etoposide improved improved 3-year EFS: 75.4% versus 51.0%, P = .003. In patients > 60 years 6 courses of CHOP administered every 3 weeks remains the standard therapy. Patients with ALK-negative ALCL, PTCLU, or AITL presenting with IPI > 1 have a poor prognosis and should be considered candidates for novel treatment strategies. © 2010 by The American Society of Hematology.

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