| 1. |
- Glimelius, Ingrid, 1975-, et al.
(författare)
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Stable use of radiotherapy in lymphoma patients over time : A comprehensive national overview of radiotherapy use in Sweden with focus on older patients
- 2024
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Ingår i: Clinical and Translational Radiation Oncology. - : Elsevier. - 2405-6308. ; 46
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Tidskriftsartikel (refereegranskat)abstract
- Background and purposeThe role of radiotherapy (RT) in lymphoma is constantly refined with the advent of novel treatments. However, RT is still an effective treatment and tolerability is high. Therefore, we aimed to describe the use of RT in primary treatment of lymphoma over calendar time, with a specific focus on older patients (age ≥ 70 years) with non-Hodgkin lymphoma (NHL) subtypes.Materials & MethodsAll adult patients diagnosed with lymphoma from 2007 to 2018 in Sweden were included and followed for survival until end of 2020. Patient characteristics and relative survival (RS) were described for patients with NHL by subtype and RT use.ResultsIn the cohort of lymphoma patients aged ≥ 70 years (n = 12,698) 11 % received RT as part of primary treatment. No decline in use of RT over calendar period was seen. Use of RT as monotherapy was associated with stage I-II disease and older age among patients with stage III-IV disease. Patients with indolent lymphomas aged ≥ 70 years who were selected for treatment with RT as monotherapy with a dose of ≥ 20 Gy had 2-year RS rate of 100 % which remained similar at five years. For patients with DLBCL, RT as monotherapy with a dose of ≥ 20 Gy was mostly administered to patients aged ≥ 85 years with a 2-year RS rate of 68 %.ConclusionThe use of RT in first-line lymphoma treatment was stable over calendar time. RT monotherapy is associated with encouraging outcomes among patients with NHL aged ≥ 70 years who were selected to receive this.
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| 2. |
- Jakobsen, Lasse H., et al.
(författare)
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Minimal relapse risk and early normalization of survival for patients with Burkitt lymphoma treated with intensive immunochemotherapy : an international study of 264 real-world patients
- 2020
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Ingår i: British Journal of Haematology. - : Wiley. - 0007-1048 .- 1365-2141. ; 189:4, s. 661-671
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Tidskriftsartikel (refereegranskat)abstract
- Non-endemic Burkitt lymphoma (BL) is a rare germinal centre B-cell-derived malignancy with the genetic hallmark of MYC gene translocation and with rapid tumour growth as a distinct clinical feature. To investigate treatment outcomes, loss of lifetime and relapse risk in adult BL patients treated with intensive immunochemotherapy, retrospective clinic-based and population-based lymphoma registries from six countries were used to identify 264 real-world patients. The median age was 47 years and the majority had advanced-stage disease and elevated LDH. Treatment protocols were R-CODOX-M/IVAC (47%), R-hyper-CVAD (16%), DA-EPOCH-R (11%), R-BFM/GMALL (25%) and other (2%) leading to an overall response rate of 89%. The two-year overall survival and event-free survival were 84% and 80% respectively. For patients in complete remission/unconfirmed, the two-year relapse risk was 6% but diminished to 0·6% for patients reaching 12 months of post-remission event-free survival (pEFS12). The loss of lifetime for pEFS12 patients was 0·4 (95% CI: −0·7 to 2) months. In conclusion, real-world outcomes of adult BL are excellent following intensive immunochemotherapy. For pEFS12 patients, the relapse risk was low and life expectancy similar to that of a general population, which is important information for developing meaningful follow-up strategies with increased focus on survivorship and less focus on routine disease surveillance.
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| 3. |
- Wästerlid, Tove, et al.
(författare)
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Application of precision medicine in clinical routine in haematology-Challenges and opportunities
- 2022
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Ingår i: Journal of Internal Medicine. - : John Wiley & Sons. - 0954-6820 .- 1365-2796. ; 292:2, s. 243-261
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Forskningsöversikt (refereegranskat)abstract
- Precision medicine is revolutionising patient care in cancer. As more knowledge is gained about the impact of specific genetic lesions on diagnosis, prognosis and treatment response, diagnostic precision and the possibility for optimal individual treatment choice have improved. Identification of hallmark genetic aberrations such as the BCR::ABL1 gene fusion in chronic myeloid leukaemia (CML) led to the rapid development of efficient targeted therapy and molecular follow-up, vastly improving survival for patients with CML during recent decades. The assessment of translocations, copy number changes and point mutations are crucial for the diagnosis and risk stratification of acute myeloid leukaemia and myelodysplastic syndromes. Still, the often heterogeneous and complex genetic landscape of haematological malignancies presents several challenges for the implementation of precision medicine to guide diagnosis, prognosis and treatment choice. This review provides an introduction and overview of the important molecular characteristics and methods currently applied in clinical practice to guide clinical decision making in haematological malignancies of myeloid and lymphoid origin. Further, experimental ways to guide the choice of targeted therapy for refractory patients are reviewed, such as functional precision medicine using drug profiling. An example of the use of pipeline studies where the treatment is chosen according to the molecular characteristics in rare solid malignancies is also provided. Finally, the future opportunities and remaining challenges of precision medicine in the real world are discussed.
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| 4. |
- Wästerlid, Tove
(författare)
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Burkitt lymphoma and diffuse large B-cell lymphoma – therapeutic strategies and pathogenetic mechanisms
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Burkitt lymphoma (BL) is a rare, aggressive disorder constituting 1% of all non-Hodgkin lymphoma. Diffuse large B-cell lymphoma (DLBCL) is more common, accounting for 30% of malignant lymphoma. Standard treatment for adult BL and for certain subgroups of patients with DLBCL remains to be defined due to paucity of randomised trials performed. The focus in this thesis lies on the effect of prognostic factors and treatment on outcome for patients with these two aggressive lymphomas, using unselected, population based patient cohorts.In the first and second study, prognostic factors and efficacy of treatment regimens used for adult BL patients were investigated using data from the Swedish lymphoma registry (SLR) and Danish lymphoma registry (study two). Age was determined the most important predictor of adverse prognosis, and improvement in outcome during the study period was restricted to patients aged ≤65. Also, the superiority of high-intensive chemotherapy regimens compared to low-intensive treatment was confirmed, whereas the role of the monoclonal antibody rituximab remained undefined.In the third study, the impact of dose-dense chemotherapy administration and addition of etoposide were evaluated for adult DLBCL patients, using data from a six-year period, collected from the SLR. Among all patients, there was no evidence of a difference in outcome between examined regimens. However, when restricted to patients ≤65, the addition of etoposide to the R-CHOP-14 regimen was associated with superior outcome. In study number four, the frequency and potential clinical implications of expression of the transcription factor SOX11 in adult BL was investigated. SOX11 is aberrantly expressed in various hematopoietic and solid malignancies and appears to affect clinicopathological characteristics. Fourteen of 45 examined adult BL samples expressed SOX11 and its presence did not impact overall survival, in our material. In contrast, SOX11 knockdown in a BL cell line resulted in increased cellular proliferation, suggesting a potential growth regulatory role for SOX11 in BL.Collectively, the studies included in this thesis provide real-world data regarding the effect on outcome of patient characteristics and treatment in adult BL and DLBCL. Although optimal treatment needs to be established in a randomised setting, this work emphasises the importance of high-intensive treatment and provides unselected, population based information on clinicopathological factors that affect outcome. Novel therapeutic strategies are warranted particularly for elderly patients, but will hopefully contribute to improve survival and decrease toxicity for all adult BL and DLBCL patients. Additionally, results presented in this thesis may possibly serve as comparative data for future population based studies.
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| 5. |
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| 6. |
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| 7. |
- Wästerlid, Tove, et al.
(författare)
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Impact of chemotherapy regimen and rituximab in adult Burkitt lymphoma : a retrospective population-based study from the Nordic Lymphoma Group
- 2013
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Ingår i: Annals of Oncology. - : Elsevier BV. - 0923-7534 .- 1569-8041. ; 24:7, s. 1879-1886
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Tidskriftsartikel (refereegranskat)abstract
- Background: Standard treatment of adult Burkitt lymphoma is not defined due to the lack of randomised trials. In this situation, population-based data may represent a useful contribution in order to identify an optimal treatment strategy. Patients and methods: The aims of this study were to investigate the outcome for adult HIV-negative BL with different chemotherapy regimens, and to assess possible improvement within the time frame of the study. The study population was identified through the Swedish and Danish lymphoma registries 2000-2009. Results: A total of 258 patients were identified. Since 2000, overall survival (OS) improved significantly only for younger patients (<65 years). Intensive regimens such as the Berlin-Frankfurt-Munster, hyper-fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) and cyclophosphamide, vincristine, doxorubicin, methotrexate, ifosfamide, etoposide, and cytarabine (CODOX-M/IVAC) were associated with a favourable 2-year OS of 82%, 83%, and 69%, respectively. The low-intensive CHOP/CHOEP regimens achieved a 2-year OS of 38.8%, confirming their inadequacy for the treatment of BL. In a multivariate analysis, rituximab was not significantly associated with improved OS. Conclusions: In this population-based retrospective series of adult BL, intensive chemotherapy regimens were associated with favourable outcome. The impact of the addition of rituximab remains uncertain and warrants further investigation.
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| 8. |
- Wästerlid, Tove, et al.
(författare)
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Impact on survival of addition of etoposide to primary chemotherapy in diffuse large B-cell lymphoma: a Swedish Lymphoma Registry study.
- 2015
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Ingår i: Hematological Oncology. - : Wiley. - 0278-0232.
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Tidskriftsartikel (refereegranskat)abstract
- No randomised study in the rituximab era has been performed specifically to evaluate addition of etoposide to treatment of diffuse large B-cell lymphoma (DLBCL). The aim of this study was to compare the outcome with three chemotherapy regimens (R-CHOP-21, R-CHOP-14 and R-CHOEP-14) in a population-based cohort in terms of overall survival, adjusted for clinical prognostic factors. Through the Swedish Lymphoma Registry, 3443 patients with DLBCL were identified 2007-2012. Among all patients, there was no evidence of a difference between the regimens, after adjustment for prognostic factors. However, when restricted to patients aged up to 65, R-CHOEP-14 was associated with superior outcome compared to both R-CHOP-21 (hazard ratio: 0.49, 95% confidence interval: 0.3-0.9, p = 0.028) and R-CHOP-14 (hazard ratio: 0.64, 95% confidence interval: 0.4-1.0, p = 0.06), when adjusted for prognostic factors. Results were consistent in an additional stratified analysis with patients grouped according to age and IPI-score. In conclusion, we could show that R-CHOEP-14 was associated with superior overall survival in patients with DLBCL aged up to 65 years, indicating that this may be a valid treatment option for this patient population. To further investigate which patient groups that may benefit the most from treatment intensification, R-CHOEP-14 should be compared to R-CHOP-21 in a randomised setting. Copyright © 2015 John Wiley & Sons, Ltd.
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| 9. |
- Wästerlid, Tove, et al.
(författare)
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Outcome and determinants of failure to complete primary R-CHOP treatment for reasons other than non-response among patients with diffuse large B-cell lymphoma
- 2020
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Ingår i: American Journal of Hematology. - : Wiley. - 0361-8609 .- 1096-8652. ; 95:7, s. 740-748
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Tidskriftsartikel (refereegranskat)abstract
- Patients with diffuse large B-cell lymphoma (DLBCL) who fail to complete planned treatment with R-CHOP due to toxicity are sparsely described. We investigated the extent of failure to complete treatment (six cycles or more, or three cycles + RT for patients with stage I disease) with R-CHOP for reasons unrelated to non-response, the determinants of such failure and the outcome among these patients. Three thousand one hundred and forty nine adult DLBCL patients who started primary treatment with R-CHOP were identified through the Swedish lymphoma register 2007-2014. Of these, 147 (5%) stopped prematurely after 1-3 cycles of R-CHOP for reasons unrelated to non-response, 168 (5%) after 4-5 cycles and 2639 patients (84%) completed planned treatment. Additionally, 195 (6%) patients did not complete treatment due to non-response or death before treatment end. In a multivariable logistic regression model, age > 75 years, poor performance status, extranodal disease and Charlson Comorbidity Index >= 1 were significantly associated with failure to complete planned R-CHOP treatment for other reasons than non-response. Non-completion of treatment strongly correlated with survival. Five-year overall survival for patients who received 1-3 cycles was 26% (95% CI: 19%-33%), 49% (95% CI: 41%-57%) for 4-5 cycles and 76% (74%-77%) for patients who completed treatment. Failure to complete planned R-CHOP treatment is an important clinical issue associated with inferior survival. Old age and poor performance status most strongly predict such failure. These results indicate a need for improved treatment tailoring for patients with certain baseline demographics to improve tolerability and chance for treatment completion.
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| 10. |
- Wästerlid, Tove, et al.
(författare)
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Population based study of prognostic factors and treatment in adult Burkitt lymphoma : a Swedish Lymphoma Registry study
- 2011
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Ingår i: Leukemia and Lymphoma. - : Informa UK Limited. - 1042-8194 .- 1029-2403. ; 52:11, s. 2090-2096
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Tidskriftsartikel (refereegranskat)abstract
- Burkitt lymphoma (BL) is a rare neoplasm constituting 1-2% of adult lymphomas. Our aims in this study were to establish prognostic factors for overall survival in adult BL and evaluate the efficacy of different chemotherapy regimens in a population based setting. The study population was collected from the Swedish Lymphoma Registry 2000-2010. During this period, 156 adult patients with BL were identified. In multivariate analysis, age and performance status (PS) were significant adverse prognostic factors for overall survival. A modified prognostic index, based on: age >40 years, PS >1, and lactate dehydrogenase > upper limit of normal (ULN) was proposed. Patients with a score of 0-1, 2, and 3 were found to have a 2-year survival of 91.2%, 58.4%, and 27.5%, respectively. High-intensity regimens were associated with more favorable overall survival. Rituximab addition was not significantly associated with improvement in survival. A modified prognostic index may be valuable for adult BL, as proposed.
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